Constipation

Constipation is a frequent complains among people of all ages and races. It can be described as a difficult or infrequent passage of faeces, hardness of stool or a feeling of incomplete evacuation.
Symptoms: faecal impaction which may occur from a state of constipation is found to be particularly common among he bedridden elderly or after a barium meal or enema has been given. The patient experiences recurrent rectal pain and tenesmus and makes repeated but futile attempts to defecate. Rectal examination discloses a firm, sometimes rocklike but often rubbery putty like mass. Acute constipation occurs when a change in bowel habits produces infrequent stool. A sudden change may suggest an organic cause mechanical bowel obstruction should be considered in patients complaining of constipation for a few hours or days. A detailed drug history in case of bedridden medicate patients should also be taken as a number of drugs may cause constipation. When a change of bowel habit persists for weeks or occurs intermittently with increasing frequency or severity, colonic tumours and other causes if partial obstruction should be suspected. Reduced stool size suggests an obstructive lesion on the distal colon. The common functional causes of chronic constipation hamper normal bowel movements because the storage transport and evacuation mechanism of the colon are drained. The cause is found to be some sort of systemic disorder lie debilitating infections, hyperthyroidism, hypercalcemia, porphyria and most commonly a neurogenic disorder like irritable bowel syndrome, colonic inertia and megacolon. Certain neurologic disorders like; Parkinsonism, cerebral thrombosis, and spinal cord injury are important extra intestinal causes. Chronic constipation is extremely prevalent among the elderly because of age related decrease in intrinsic colonic reflexes, low fibre diets, lack of exercise, and chronic use of medication. Many people wrongly believe that daily defecation is necessary and consider them constipated if stool frequency is reduced. Overzealous treatment with laxatives leads to cathartic colon. Constipation is also frequently blamed for symptoms such as nausea, abdominal pain and fatigue, but one should remember that these are probably the result of an underlying problem and not connected to bowel movements.
Diagnosis; before counselling and reassurance from the part of the physician he must firstly make sure that the symptoms are not a result of an underlying more serious condition. After all other possibilities have been exhausted by use all manner of tests ranging from colonoscopy to a battery of blood tests to rule out anaemia and thyroid problems, the patient can be prescribed a mild laxative for a short duration. If this resolves the situation, a neurogenic cause is likely.
Treatment; treatment is generally a mixture of medication and a balanced diet. Ones diet should contain enough fibre to provide bulk to stool. Fruits and vegetables are recommended as is miller’s bran. Laxatives should be used carefully, as they might also interfere with the absorption of other drugs. An acute abdomen of an unknown etiology is a total contraindication for laxative use. Bulking agents such as bran, psyllium and calcium polycarbophill may also be used. Faecal impaction maybe treated with an enema of warm olive oil and if these fail manual fragmentation and disimpaction of the mass is required.