Constipation

Constipation refers to a situation where you pass small and hard stools fewer than three times a week. Occasional constipation is not uncommon but when this persists for several weeks, it has evolved into a situation of chronic constipation. 

People who experience chronic constipation tend to feel as if there is a blockage in your rectum that restricts or limits bowel movement and hence, you are unable to completely empty your rectum. You may resort to applying pressure to your abdomen while straining excessively to pass motion. This discomfort can interfere with their ability to go about their daily routine.

Constipation is one of the prevalent digestive issues worldwide. In Singapore, a local study in 2000 showed that the incidence rate of constipation in those ages 16 and above was at about 7.3%

Why does constipation happen?

Constipation can happen as a result of your lifestyle. For example, not consuming enough fibre or drinking enough water, lack of activity, overconsuming dairy products, and stress can all cause constipation. Sometimes, overuse of laxatives or some medications like antacids, antidepressants, and iron pills, can also result in constipation.

In other cases, constipation could be a symptom of an underlying condition.

Colon Cancer

The colon’s primary role is to absorb water from residual food as it passes through your digestive tract. Stool is created as a result of this process and it is eventually passed out through the rectum. If it remains in the colon for too long, it can become dry and hard to pass.

Tumours in the colon can make it hard for the colon to fulfil its job. These tumours often begin quietly and may not be noticeable until they have developed more aggressively. Besides constipation, colon cancer presents with other symptoms such as rectal bleeding or blood in stool, stomach pain, fatigue and unexplained weight loss.

Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) affects the normal functioning of the colon but does not lead to permanent damage. People with this condition are usually on either ends of the spectrum: passing too quickly and too frequently in the case of diarrhoea, or passing too slowly and infrequently in the case of constipation. 

Hypothyroidism

Located at the side of the neck, the thyroid is a gland in charge of producing hormones integral to growth, development, and more. Hypothyroidism occurs when the thyroid is underactive and does not produce enough hormones. Apart from constipation, other symptoms of hypothyroidism include changes in menstrual cycle, weight gain, fatigue, depression, paleness and puffiness, sensitivity to cold, fragile nails and hair, and a slowed heart rate.

Parkinson’s Disease

Constipation related to Parkinson’s disease can happen as early as years before other telling signs and diagnosis. 

While there is no clear relationship between constipation and Parkinson’s disease, some possible explanations include lack of dopamine that sends signals to help your muscle move and poor muscle coordination as Parkinson’s weakens the muscles. This makes bowel movement through the digestive tract a difficult one. Besides muscles involved in digestion, Parkinson’s also impacts the muscles involved in chewing and swallowing. This can discourage patients from consuming a balanced diet.

Medication used to treat Parkinson’s disease, too, can cause constipation.

Hypercalcemia

Calcium is not only an important mineral for bone growth and strength, but also for maintaining optimal hormone levels and functioning of nerves, muscles and the brain. Hypercalcemia, or too much calcium in the blood, can interfere with the digestive system, amongst others, and cause stomach pains, vomiting, nausea, and constipation. The condition is associated with over 25 diseases, certain medication, and even dehydration.

Anorexia Nervosa

Anorexia nervosa – an eating disorder characterised by an extreme fear of gaining weight – is also associated with constipation. People with this type of eating disorder are often on a diet or workout excessively, sometimes to the point of starvation. To further keep the weight off, they may purge by vomiting or misusing laxatives. You may hear patients with anorexia nervosa complain about stomach aches or constipation.

Pregnancy

Constipation is the most common health issue in a pregnancy. This could be due to a combination of factors involving hormone and bodily changes. For example, many women experience a diet change during pregnancy where certain foods, such as dairy products and red meats, can exacerbate constipation. 

When should I seek help?

Occasional constipation is normal but you should consult your healthcare provider if constipation happens suddenly with stomach pains or cramps, and you are not able to pass at all.

Other signs to look out for include persistent constipation lasting more than 2 weeks, blood in your stool, unintended weight loss, severe pain while passing, and the size, shape, and consistency of your stool has changed dramatically.

What are the investigations into constipation?

Chronic constipation can develop complications such as anal fissure, haemorrhoids, and faecal impaction. Besides a look into your medical and family history, a physical examination or tests may be ordered to determine the cause of constipation.

A colonoscopy may be ordered to identify any mechanical obstruction. Some form of screening like a CT colonoscopy or barium enema may be ordered to eliminate any worrisome conditions including cancer. Lab tests, such as blood test, stool test, and imaging scan test, may be performed to look out for signs of certain conditions and diseases behind your constipation.

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