Chronic constipation: causes, treatments and prevention

Chronic constipation is a serious problem that worsens not only the quality of a person's life, but also his or her health.In addition, constipation can be a symptom of very dangerous diseases - for example, intestinal cancer.However, do not panic before the time: often this condition is caused by quite harmless functional reasons or a trivial violation of diet/drinking regime. In our article we will tell you in detail why chronic constipation occurs in adults and children, whether you can manage it yourself or it is better to consult a doctor and, most importantly - how to prevent stool problems.

Doctors define constipation as a condition in which defecation is difficult or infrequent. It is also characterized by dense stools and/or a feeling of incomplete emptying of the bowel after going to the toilet. If symptoms persist for more than 3 months, constipation is considered chronic.

Why does chronic constipation occur?

Patients diagnose themselves with chronic constipation much more often than doctors do. But even despite overdiagnosis, it remains one of the most common problems in gastroenterology. On average, women are thought to suffer from constipation 1.5-2 times more often than men. It is also more common in sedentary people. According to the results of various studies, the frequency of constipation increases sharply after the age of 65, which is associated with an age-related decrease in intestinal motility and a decrease in fiber intake.

The causes of chronic constipation can be functional or organic. Common functional causes are:

• irritable bowel syndrome;
• pelvic floor dysfunction;
• slow transit of feces through the bowel.

A common organic disease manifested by constipation is a malignant tumor (cancer) of the bowel. Always be aware if constipation occurs for no apparent reason, especially in the elderly.

Other causes of chronic constipation:

• Improper diet (lack of carbohydrates, fiber in the diet);
• abuse of laxatives;
• pregnancy;
• taking certain medications;
• metabolic disorders - diabetes mellitus, calcium deficiency or excess in the blood, hypothyroidism (decreased thyroid gland activity)
• diseases of the central and peripheral nervous system - multiple sclerosis, Parkinson's disease, stroke, neurofibromatosis, Hirschsprung's disease;
• systemic diseases - autoimmune myositis, systemic scleroderma;
• dyssynergic defecation (disorder of synchronized functioning of anorectal muscles).

Main symptoms of chronic constipation

In chronic constipation, patients usually complain of such bowel problems:

• infrequent defecation;
• difficult (prolonged or painful) emptying of the bowel;
• the need to constantly push (very often this leads to prolapse of the hemorrhoidal nodules or even of the pelvic organs, anal fissures)
• dense fecal masses, changes in their shape;
• feeling of incomplete emptying of the bowel.

However, in gastroenterology there are "red flags" - alarming symptoms in which it is necessary to consult a doctor as soon as possible and undergo examination, even if constipation itself does not bother the person very much. These include:

• Blood impurities in the stool;
• pronounced abdominal bloating;
• weight loss with prolonged constipation;
• vomiting (unrelated to intestinal infection or poisoning);
• constipation in the elderly that occurs for the first time or progresses rapidly.

These symptoms may indicate a malignant intestinal tumor and usually require a colonoscopy (examination of the bowel with an endoscope).

How to get rid of constipation?

First of all, it is necessary to consult a doctor - he or she will carry out the necessary examination, make a diagnosis and suggest how to treat chronic constipation in a given clinical situation.

Usually normalization of bowel function begins with a change in diet, drinking regime and lifestyle.

The diet for chronic constipation should definitely include:

• vegetables (the undisputed "anti-constipation" leader is red beets);
• fruits (kiwi, mango, apricots, plums, prunes - including prunes) are particularly useful. Note: in the study, kiwifruit was found to be the most "easily tolerated" and most effective laxative among fruits;
• cereals;
• dietary fiber (15-30 g/day).

Fiber intake, especially insoluble fiber (bran, whole grain products, fruit and vegetable peelings), should be increased gradually, otherwise intestinal bloating and abdominal pain may occur due to sudden stimulation of peristalsis.

Effective and tasty home remedies to normalize stools are salads:

• tomatoes + cucumbers + peppers + olive oil (or linseed oil in small quantity);
• vinaigrette;
• boiled red beetroot + sultanas + prunes + sunflower oil.

Many people prefer to eat yogurt with oat bran as a snack . Such foods will be particularly useful if the yogurts are prepared independently using a special bacterial starter.

In addition to eating properly with constipation, you need to reconsider your drinking regime. It is quite possible that dense stools are associated precisely with a lack of fluid. Gastroenterologists recommend drinking 2.5-3 liters a day - plain water, compotes, chunks or juices.

Don't underestimate physical activity. It has been proven that a sedentary lifestyle leads to hypodynamia of the intestine, while activity, on the contrary, stimulates its peristalsis.

Medical treatment of chronic constipation

Medical treatment of constipation in adults is not always a simple task. Some 'gut' medications can only be taken for a short course, others quickly develop addiction, others are not helpful for the body and so on.

To safe conditional laxatives (from chronic constipation) can be attributed to prebiotic lactose. This is not absorbed in the digestive tract, but is broken down by intestinal bacteria into low molecular weight organic acids. They change the acidity in the intestinal lumen and have an osmotic effect - they increase the volume of the intestinal contents, which normalizes the consistency of the faeces and stimulates intestinal peristalsis.

Because lactulose is not absorbed and has no serious (systemic) side effects, it is safe for children from birth, pregnant and breastfeeding women. It can be used for a long time, the main thing is to gradually increase the dose of the drug, as an overdose can cause severe flatulence, abdominal pain and diarrhea.

Safe means also include bulk laxatives - for example, methylcellulose, psyllium (plantain seed husk), calcium polycarbophilus. These are prescribed 3-4 times a day with enough fluid. These drugs increase stool bulk and soften it. As with lactulosis, the laxative dose should be increased gradually to reduce bloating.

Psyllium Bran Fibre 500 mg, 200 capsules, Solgar

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Other drug groups for chronic constipation:

• Stimulant, or secretory laxatives - bisacodyl, castor oil, senna preparations, sodium picosulfate. These are over-the-counter remedies that are widely used, but they are not without drawbacks - with prolonged and uncontrolled use, they can cause pseudomelanosis of the intestine, loss of electrolytes, increased constipation due to the development of intestinal atony;
• softening agents - docusate, mineral oil (usually Vaseline). They soften fecal masses and facilitate their evacuation, but weakly stimulate direct peristalsis;
• glycerine suppositories - are intended for occasional use or for regular use if it is necessary to form a proper bowel emptying habit. For regular defecation at the same time (usually 15-45 minutes after breakfast), glycerine suppositories will work best;
• enemas with water or hypertonic solution - for permanent treatment they are not used, but without enemas in cases of fecal impaction (very dense fecal masses blocking the lumen of the bowel, when independent defecation becomes impossible).

Castor oil, 200 ml, Solaris

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Regulax picosulfate oral solution 50 ml

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The Internet is often interested in how effective folk remedies are for constipation. If we are talking about fiber-rich foods, vegetables and fruits, vegetable oils, then they can be safely used in the preparation of delicious and healthy dishes. But the use of various herbal decoctions and infusions requires consultation with a doctor.

Treating constipation in children

Chronic constipation in a child or adolescent is in most cases a functional disease. When examining them, they rarely reveal any anatomical changes, but constipation itself is diagnosed by doctors quite often. Why does this happen?

Functional constipation in children is almost always caused by fear of defecation. This may be due to its painfulness (for example, with a dense stool) or to the child's own shyness (not everyone can visit the street or school toilets). Shy children are embarrassed to ask to go to the toilet from the guardian or teacher and also tolerate "every last one". The habit of withholding the urge to empty the bowels leads to a buildup of feces in the rectum and its compaction, which means that defecation will become even more painful and the child will delay going to the toilet again for as long as possible.

If this vicious circle is not broken, there will be encoprezis - faecal incontinence. Many parents confuse it with diarrhea, but encoprezis is actually a manifestation of chronic, long-lasting constipation. It occurs due to overcrowding of the bowel: dense masses in the lower part of the rectum cannot pass out on their own, but soft faeces circulate around this "bottleneck" and are excreted spontaneously in small portions, soiling the laundry.

But first of all, however, it is necessary to break the "vicious relationship" as soon as possible: pain - urges to the toilet - fear of defecation - restraint - encoprezis. And osmotic laxatives help. In children, preparations based on macrogol (e.g. Forlax) or prebiotic lactose are usually used. The dose the pediatrician selects individually, increasing it slightly if necessary.

Also, as part of complex therapy, doctors sometimes use psyllium (plant fiber) supplements, and in acute constipation, vaseline oil may be used briefly.

Non-medicinal methods:

• A diet dominated by fruits, vegetables, and fiber (bran, oatmeal, lentils, beans, whole grain products, kiwi, mango, plums);
• Normal drinking regimen (on average, doctors recommend 6-8 glasses of water/compote/ pumpkin juice per day, but the exact amount of fluid is calculated according to age - from 1 liter per year to 3.2 liters at 14-18 years). Important! If the fluid intake is insufficient, a high-fiber diet can, on the contrary, aggravate constipation, so the child should be constantly reminded to drink;
• sufficient physical activity, and it's good that this is not just walks in the park, but moving games or even sport;
• creating psychological comfort. The child should never be scolded for holding back and soiling the laundry, with young children you can introduce rewards for successful defecation (e.g. funny stickers). You should also make sure that the toilet bowl is suitable for their height and, if necessary, install special footrests.

Prevent chronic constipation

To avoid constipation, follow a few simple rules:

• eat properly, remembering the importance of fruits, vegetables, cereals and soluble and insoluble fiber (dietary fiber);
• Drink more and favor water or compotes over coffee and tea;
• keep active;
• try to eat and empty your bowels at the same time (regular stools are important!);
• before taking new medicines, study the instructions carefully, especially the 'Side effects' section.

If defecation becomes more infrequent with age, you can carefully introduce more fiber into your diet and rely on the "anti-stool" vegetables and fruits listed above. But if changing your diet and lifestyle doesn't help, you should not hope "it will pass" and consult a doctor immediately. It is much easier to normalize bowel function at an early stage, but it is just as difficult to cope with neglected constipation, both in a child and in an elderly person.

The Liki24 team wishes you to feel great and never experience constipation!