Chronic constipation: treatment in adults and children, eating habits

Traditionally, doctors define chronic constipation as having three or fewer defecations a week. However, patients themselves often mean by this name the presence of a hard stool, a feeling of incomplete emptying of the intestine, the need for tension during defecation.

Whatever it was, constipation is one of the most common complaints of people on the digestive tract when referring to doctors. They often introduce negative changes in daily activities. Changing lifestyle and proper nutrition with chronic constipation in many cases help to get rid of this problem in both adults and children.

Causes of chronic constipation

Chronic constipation often has many causes that can be divided into two groups - external and internal. External causes of chronic constipation:

• Insufficient fiber intake.
• Insufficient water consumption.
• Reduced mobility.
• Disorders of electrolyte balance( hypercalcemia, hypokalemia, hypermagnesemia).
• Endocrinological diseases - diabetes, hypothyroidism, hyperparathyroidism.
• Neurological diseases - multiple sclerosis, dementia, neuropathies, Parkinson's disease, spinal cord injury.
• Renal failure.
• Psychological disorders - depression, drug abuse.
• Drug administration - for example, anticholinergics, diuretics, beta-blockers, opiates, calcium channel blockers, antidepressants, non-steroidal anti-inflammatory drugs, iron preparations.

A normal act of defecation occurs as a result of a series of sequential actions, starting with relaxation of the pubic-rectum muscles, lowering the pelvic floor, suppressing segmental peristalsis of the large intestine, contraction of the abdominal wall muscles, and ending with relaxation of the anal sphincter with the exit of the stool.

Internal causes that lead to chronic constipation can be divided into two categories:

1. Pelvic floor dysfunction.
2. Deceleration of stool transit through the colon.

Pelvic floor dysfunction includes weakness of his muscles, a violation of the sensitivity of the rectum, a decrease in pressure in the anal canal, anatomical disorders( eg, prolapse of the rectum), and damage to the perineum.

The slowing of stool transit through the colon is a poorly understood problem that is considered the cause of chronic constipation in children and young women. At the same time there is a decrease in contractile activity of the large intestine, which leads to a slowdown in the movement of stool, swelling, discomfort in the abdomen, constipation.

Risk factors for chronic constipation :

• Elderly.
• Pregnancy.
• Dehydration. Foods that are poor in fiber.
• Insufficient physical activity.
• Depression.

Classification

Chronic constipation can be divided into two categories - primary( or functional) and secondary.

Functional constipation is divided into three types:

1. Constipation with normal transit of fecal matter along the large intestine. This kind of chronic constipation is associated with psychological stress, it responds well to treatment.
2. Constipation with slow transit( advance) of stools along the large intestine. This type of chronic constipation is characterized by a decrease in the frequency of defecations, stress during the emptying of the intestine. Pelvic floor dysfunction.
3. . This is the discoordination of the pelvic floor muscles during a defecation attempt.

Secondary chronic constipation is caused by diseases, drugs, lifestyle and eating patterns.

Symptoms of

It is believed that a person can have chronic constipation if he has had some of the following symptoms for 3 months and longer over the past year:

• Three or fewer defecations a week.
• Difficulties during bowel evacuation.
• Need for tension during defecation.
• Hard chair.
• Discomfort and bloating in the abdomen.
• Sensation of incomplete emptying of the intestine.
• Feeling that something blocks the intestine.
• Need for manual stimulation when emptying the intestine.

Diagnosis

Doctors diagnose chronic constipation based on patient complaints and examination. The finger examination of the rectum is mandatory.

In addition, the doctor, trying to detect a possible cause of constipation, may appoint:

• Blood tests. A specialist who treats a patient with chronic constipation may suspect that he has a systemic illness, such as hypothyroidism, in which the diagnosis is established based on a decrease in thyroid hormone levels.
• Recto-manoscopy. In this examination, the doctor examines the rectum with a metal tool with illumination at the end.
• Colonoscopy. This examination examines the entire large intestine with a flexible instrument - a colonoscope.
• Anal sphincter manometry - allows you to evaluate the coordination of muscles involved in defecation.
• Study of transit of fecal matter along the colon.
• Irrigoscopy is an x-ray method of examination of the large intestine with contrasting.

Treatment of

Many people are interested in what and how to treat chronic constipation. The first measures aimed at getting rid of this problem are to change the way of life and nutrition.

But how to cure chronic constipation if none of this helps? In this case, doctors try to find out its causes and, if possible, eliminate them.

To alleviate the symptoms of constipation, most often recommend:

• Dietary supplements with fiber. Fiber is a part of plants and passes through the human digestive tract, not being digested. It also absorbs a large amount of water. Due to this, the chair softens, its volume increases. Fiber can help reduce the passage of food through the colon. When the stool has a softer consistency and a larger volume, it easily passes through the intestine. Of course, it is better to eat a sufficient amount of fiber with food, but sometimes it may be necessary and its use in the form of a dietary supplement.
• Laxatives. There are many types of laxatives, each of which has different mechanisms of action. But the result of their application is one - ease of defecation. More about laxatives →
• Surgical treatment. Operations are performed in cases where chronic constipation is caused by intestinal blockage, prolapse of the rectum, anal fissure. Patients who have a slow transit of stool in the colon, in spite of medical treatment, sometimes carry out removal of part of the large intestine.

Laxatives are one of the most commonly prescribed remedies for chronic constipation.

These belong to:

• Laxatives, increasing the volume of feces. Their action is similar to how fiber works - they absorb water and soften the stool, making it easier to empty the intestines. To these means from a constipation belong psillium( seeds of a plantain), a methylcellulose and a sterulium. During the intake of these drugs you need to drink plenty of water. When taking laxatives, increasing the volume of feces, a person may develop bloating and flatulence, but eventually they pass.
• Stimulating laxatives. These drugs stimulate the nerve fibers of the large intestine, which causes more severe muscle contractions in its wall. Their action develops, usually in 8-12 hours, so they are best taken at night. Suppositories with stimulant laxatives are quicker( within 20-60 minutes).These drugs include bisacodyl, docusate, glycerin, senna and sodium picosulfate. Possible side effects from stimulant laxatives include abdominal cramps, addiction( after prolonged use of these drugs, the intestine may become less active).
• Osmotic laxatives. These drugs keep fluid in the large intestine with the help of osmosis, thanks to which less water is absorbed from the lumen into the bloodstream. These include lactulose and macrogol. The effect of taking lactulose can occur after 2 days, so it is not suitable for rapid relief of constipation. Possible side effects from its use include bloating and abdominal pain. Macrogol is faster. Stronger osmotic laxatives( for example, magnesium salts) are used to rapidly empty the intestine.
• Laxatives, softening the stools. The most commonly used drug in this group is sodium docusate, which also has a weak stimulating effect. To soften solid feces in the rectum, oily enemas are often used.

The choice of a suitable remedy for chronic constipation depends on the symptoms, possible side effects, the presence of other diseases.

Basic rules:

• Treatment of chronic constipation in adults begins with the appointment of laxatives, increasing the amount of feces.
• If the stool remains firm, despite the use of these remedies, you can try to take osmotic laxatives.
• If the stool has a soft consistency, but its exit from the intestine is still difficult, you can use a stimulant laxative.
• To treat stool, osmotic laxatives( macrogol) are used. During this time, the patient should be monitored.

A person with constipation should take laxatives for a short time. After relief of symptoms, treatment with these drugs should be discontinued, as long-term use may lead to addiction.

Some patients with chronic constipation are treated with prebiotics and probiotics. But the effectiveness of their use is different, the form of the drug should be selected individually.

Many people with chronic constipation helps training the pelvic floor muscles.

Diet

Food is one of the main curative and preventive methods for chronic constipation. Its essence lies in the use of foods rich in fiber. It is not digested in the human digestive tract, increasing the volume of the stool and softening it.

Foods rich in fiber:

• Whole grain bread.
• Fruits and vegetables. Diet for chronic constipation in adults means consuming at least five servings of fruits and vegetables every day.
• Whole grain cereals.
• Brown rice.

The result of such nutrition may come in a few days, but some people are relieved only a month later. Sometimes at first the person develops bloating and flatulence, so the amount of fiber in the diet should be increased gradually.

It is very important for chronic constipation not to forget to drink enough water - up to 2 liters per day. This will soften the stool and facilitate the emptying of the intestine. It should be remembered that alcoholic drinks and coffee enhance dehydration of the body, so it is better to abandon their use.

Prevention

Patients are often interested in what to do to prevent chronic constipation.

For this you need to listen to the following tips:

• Increase the amount of fiber in the diet to 25-35 grams per day.
• Drink plenty of fluids.
• Do not ignore the desire to visit the toilet, as this can cause constipation.
• Ensure comfortable conditions in the toilet( sufficient amount of time, privacy).
• Maintain an adequate level of physical activity( at least 150 minutes per week).

Consequences of chronic constipation

Complications of chronic constipation include:

• Increase in the size of venous vessels in the anus. Stress during defecation can cause hemorrhoids.
• Rupture of the skin in the anal area( anal fissure).
• Stool. Chronic constipation can cause the accumulation of very hard stools, which get stuck in the intestine.
• Stress during defecation can cause a part of the rectum to fall out.

Chronic constipation is an infrequent or difficult bowel movement that occurs for several months or longer. Most people are familiar with conventional constipation, but chronic form of this problem disrupts daily activities and worsens the quality of life. Treatment of chronic constipation includes changing lifestyle and nutrition, the use of laxatives and the elimination of the cause of its development.

Author: Olga Khanova, doctor,
specially for Moizhivot.ru

Useful video on how to get rid of chronic constipation