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Constipation, Why am I constipated? Causes of bowel straining & treatments
Constipation
is defined as unduly infrequent bowel movements or difficult evacuation of the bowels causing abnormal bowel movements. This results in bowel straining and can be uncomfortable. You may ask why am I constipated? There are numerous causes and these will be described here. One very common cause is though the deliberate suppression of the desire to defecate and this requires psychological management usually. There are lots of reasons for this including fear of experiencing pain e.g with hemorrhoids of anal fissures. Suppression for other reasons e.g social reluctance to open your bowels or other causes of fear for example a bad childhood experience. Diet is also an important factor as it is almost unheard of in people that take a high fiber diet as part of their normal diet. This is particularly so in the western world where diets are high in complex carbohydrate and low in fiber.
If the above are not the cause then you might ask why am I constipated? There are lots of other causes and these can be divided into primary or idiopathic (i.e of unknown cause e.g. IBS) or secondary causes where the precipitant is clear. I am going to concentrate on secondary causes here:
Obstructive causes
Colorectal cancer
Benign strictures e.g. diverticular strictures, Crohn’s strictures
Hormonal causes
Hypothyroidism (underactive thyroid)
Diabetes Mellitus
Disorders of metabolism
Hypercalcaemia (high Calcium levels
Hypokalaemia (Low Potassium levels)
Pregnancy
Neuropathic (Nerve related)
Neuropathy
Multiple Sclerosis
Motor Neuron disease
Parkinson’s disease
Amyloidosis
Myopathic conditions
Hirschsprung’s disease
Drugs
Analgesics e.g. opiates such as Morphine
Anti depressants e.g. Amitriptyline
Antiparkinson treatments
Blood pressure pills e.g. Amlodipine (calcium antagonist)
Plus many more
The list above gives you an idea of the complex nature of this disorder,although the majority are of idiopathic (unknown cause).
Investigation oof symptoms
Investigations are warranted particularly in people over the age of 55 years and also in sufferers with a strong family history of bowel cancer. The main investigations for these abnormal bowel movements are blood tests, stool samples and large bowel investigations such as flexible sigmoidoscopy, colonoscopy and barium enema. Sometimes transit studies are performed using markers that show up on xray when swallowed, to determine the time it takes for the bowel to pass them.
Treatment of constipation
Treatment depends on the underlying cause. The most important thing is to treat the underlying cause, but if this is not possible then the treatment should be targeted at alleviating symptoms. This may include:
Fluid intake
It is important to have a good fluid intake and I normally advise at least 2 to 2 ½ litres a day unless you have a medical condition such as heart failure which may worsen with this. Seek help from your doctor if unsure. I would try to avoid alcohol, tea and coffee as these can inadvertently dehydrate. Take fluid in the form of water and juices whenever possible.
Diet
Diet is very important to prevent bowel straining. The most important foods are those high in fiber. These include fruits with their skins on, potato jackets, granary bread, brown bread, cereals and grains as well as a balanced intake of protein with meat, fish and poultry. Try to avoid white bread, white rice and pasta.
Exercise
A largely forgotten way of improving constipation, exercise such as swimming, jogging and sports in general do help to improve bowel movements, possibly by increased gut motility as well as increasing intrabdominal pressure.
Laxatives
Laxatives for constipation should be avoided whenever possible, but are often inevitable too! Natural laxatives such as prunes, grape juice and senna can be tried. Senna is available in tablet and liquid formulations. Other laxatives such as
Fybogel
, Lactulose,
Methylcellulose
, Movicol and very strong laxatives such as Picolax and Fleet are sometimes used. These should be discussed with your doctor first.
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