Constipation is a violation of the defecation process, characterized by the absence of stool for more than 48 hours or insufficient bowel movement. Manifestations of constipation are a decrease in the usual frequency of defecation, small portions of stool, a feeling of incomplete emptying of the intestine, and abdominal pain. Constipation causes the development of intestinal dysbiosis, chronic colitis, and causes intoxication of the body. Strong and frequent straining during the act of defecation leads to the development of anal fissures, hemorrhoids, hernia. Frequent constipation adversely affects the condition of the skin and contributes to its aging.
The concept of " constipation " means difficulty in emptying the intestines, the absence of bowel movements for more than three days. It is necessary to distinguish chronic constipation from situational (episodic). Situational constipation occurs in various situations that provoke it in persons prone to difficulty defecation (pregnancy, travel - “tourist constipation”, the use of products that impede the transit of intestinal masses, insufficient fluid intake, psycho-emotional experiences, stress). In addition, constipation can be caused by taking medications. Situational constipation occurs for a short time and, as a rule, resolves successfully on its own or with the help of laxatives. These conditions are not considered diseases.
Chronic constipation is a regular delay in defecation for 48 hours or more. At the same time, a small amount of dense and dry feces is excreted. Often after a bowel movement there is no feeling of complete emptying of the intestine. You can talk about constipation taking place if the patient has one, several or all of these signs. An important diagnostic sign is a change in the usual frequency and nature of bowel movements.
Constipation is a very common digestive disorder among the population, a tendency to constipation can lead to the development of serious proctological diseases, so this problem has a high degree of social significance. Due to its prevalence and a pronounced deterioration in the quality of life of patients, chronic constipation has been identified as an independent syndrome, and at present the problem of constipation is being actively studied by proctologists, gastroenterologists and other specialists.
Most often, constipation affects young children and the elderly (over 60 years of age). Feeling of difficulty in emptying the intestines, the impossibility of relief, despite persistent straining, the need to apply additional actions that stimulate the release of the rectum from feces (pressure on the perineum, side walls of the anus, vagina).
The constant state of insufficient emptying of the rectal ampulla often leads to the development of the perineal prolapse syndrome. Chronic constipation is diagnosed in cases where the frequency of stool becomes less than 3 times a week, defecation is significantly difficult and requires pronounced effort, the consistency of the stool is dense, lumpy, there is a feeling of incomplete release of the rectum from feces.
The cause of the development of chronic constipation may be the features of lifestyle, eating habits. Constipation is facilitated by the regular containment of the urge to defecate, which eventually inhibits the reflex activity of the intestine (prolonged bed rest, busy work schedule, frequent travel). Frequent use of laxatives due to unreasonable expectation of stool (the normal rhythm of defecation is perceived by the patient as insufficiently frequent), a diet poor in foods containing vegetable fiber, lack of daily fluid intake are factors contributing to the development of chronic bowel obstruction.
In addition, constipation is one of the signs of irritable bowel syndrome. In this pathological condition, intestinal motility is disturbed and stool instability may occur: constipation with the release of hard, scanty stools (sometimes with mucus) may alternate with diarrhea. Stress in such cases only worsens the functional activity of the intestine.
Constipation can be the result of a serious condition that often requires surgical correction: mechanical intestinal obstruction, contributing to the development of coprostasis. Depending on the degree of narrowing of the intestinal lumen, obstruction may be complete or partial. The causes of obstruction of the intestinal lumen can be tumor processes, cicatricial changes, adhesions, diverticula of the large intestine, volvulus, helminthic invasions.
Coprostasis is characterized by a prolonged absence of stools, a feeling of fullness in the intestines, and bursting pains in the abdomen. Sometimes the liquid contents of the intestine can bypass the fecal plug and come out in the form of diarrhea. The cause of constipation may be a psychological fear of defecation, which develops as a result of diseases of the rectum, accompanied by severe pain (anal fissure, acute hemorrhoids, paraproctitis).
Neurological disorders (stress, depression, nervous shocks) can also contribute to the development of chronic bowel disorders. In addition, many drugs can cause, as a side effect, inhibition of intestinal motility and contribute to constipation. Pathologies of the innervation of the intestinal wall (Hirschsprung's disease, multiple sclerosis, injuries and diseases of the spinal cord) also cause chronic constipation.
Constipation is classified according to the etiological factor and development mechanism:
Constipation can be accompanied by a variety of symptoms, depending on the diseases that cause them. In some cases, constipation is the only complaint of the patient. Individual bowel movements may vary. Depending on the change in the usual frequency of defecation, constipation can be considered emptying from once every 2-3 days or less. Defecation with constipation is characterized by severe tension, requires considerable effort. The stool is dense, dry, may resemble dry balls in shape, has the shape of beans, a cord.
In some cases, there may be a so-called constipation diarrhea, when, against the background of a long absence of normal bowel movements and a feeling of fullness in the abdomen, there is diarrhea with loose stools with mucus. Liquid feces containing mucus can resolve long-term constipation as a result of irritation of the intestinal wall.
Constipation is often accompanied by pain and heaviness in the abdomen, relieved after bowel movements, the release of intestinal gases. Flatulence also often accompanies difficulty in the movement of intestinal masses. Increased gas formation is a consequence of the activity of microorganisms that inhabit the large intestine.
Patients suffering from constipation may notice a decrease in appetite, halitosis, and belching of air. As a rule, long-term chronic constipation contributes to depressed mood, decreased performance, sleep disturbance, and other neurasthenic disorders.
Long-term chronic constipation can contribute to the development of complications from the digestive tract. These can be inflammatory bowel diseases (colitis, proctosigmoiditis), rectoanal pathologies (hemorrhoids, anal fissure, paraproctitis), diverticular disease of the large intestine, enlargement (stretching in width and length) of the large intestine - megacolon.
One of the most serious consequences of long-term constipation can be persistent bowel obstruction requiring emergency surgery. Long-term obstruction contributes to the development of ischemia of the intestinal walls and can lead to necrosis. In some cases, constipation can signal an ongoing tumor process, as well as be a sign of a disease prone to malignancy.
Alimentary constipation associated with a lack of fiber in the diet contributes to the formation of carcinogens in the intestine, and the difficulty in the passage of intestinal contents allows carcinogens to have a prolonged irritating effect. Elderly people and people with mental disorders may develop fecal blockage as a result of forgetfulness and lack of control over the regularity of defecation.
Diagnosis of chronic constipation is carried out in stages. At the first stage, clinical symptoms are assessed (complaints, anamnesis, physical examination data) and an X-ray picture that allows assessing the condition of the large intestine: peristalsis, lumen width, tumor formations, strictures, wall extensions, congenital developmental anomalies, megacolon. Irrigoscopy clearly reveals intestinal obstruction.
The second stage of diagnostic measures is colonoscopy (endoscopic examination of the large intestine), sampling of biopsy specimens of the mucous membranes and their histological and, if necessary, cytological examination. Then, methods for studying the functional state of the intestine are assigned, depending on preliminary assumptions. These can be bacteriological tests, a coprogram, a study to detect hidden blood, methods of manometry of the muscular walls of the intestine (sphincterometry, anorectometry), laboratory tests to detect functional disorders of the secretory organs of the digestive tract, etc.
The appointment of certain diagnostic methods is made on the basis of complaints, the identified features of the bowel, assumptions about possible concomitant diseases and for the choice of treatment tactics.
Laxatives and enemas for constipation should only be used as directed by a physician.
Treatment of chronic constipation is not limited to the appointment of laxatives. Self-medication is unacceptable, since long-term persistent constipation can be a symptom of a serious illness or contribute to the development of dangerous complications. In addition, self-administration of laxatives without taking into account their features, mechanisms of action and possible side effects often leads to the formation of persistent problems with defecation as a result of a decrease in intestinal motor functions. At the same time, the dosages of laxatives increase and over time, these drugs become completely ineffective.
Treatment of chronic constipation, in addition to symptomatic therapy, includes measures to identify and treat the condition that caused the development of constipation. Knowing the mechanism of the occurrence of chronic constipation in a patient, the doctor prescribes treatment taking into account pathogenetic factors, which contributes to a more effective action of symptomatic agents and does not cause a vicious circle that aggravates intestinal motility disorders.
Functional constipation can be caused by various reasons, but their pathogenesis is always based on pathologies that interfere with the functional characteristics of the digestive tract (unlike constipation as a result of mechanical obstruction, when, as a rule, surgical treatment is optimal).
In the treatment of constipation, an important link is diet. In the diet of patients, foods rich in plant fiber (vegetables, fruits, cereals) and a large amount of liquid (at least two liters per day) must be introduced. In the event that gas formation increases and flatulence develops against the background of the diet, Mucofalk is prescribed. In addition, all foods that contribute to the aggravation of constipation are excluded from the diet.
Nutrition must be carried out according to the regimen, at least five times a day in small portions. Never allow long breaks between meals. You also need to carefully monitor the regularity of bowel movements. It is desirable to feel and restore the individual rhythm of natural defecation, to avoid holding back urges. In the case of taking drugs that make it difficult to transit intestinal masses (narcotic analgesics, ganglionic blockers, iron preparations, diuretics, oral contraceptives), it is necessary to cancel them and, if possible, replace them with drugs that do not affect digestion.
As a stimulation of the digestive tract and strengthening the tone of the intestinal muscles, an active lifestyle, walking, swimming, and aerobics are recommended. In addition, an active life position has a positive effect on the psycho-emotional status and contributes to an easy experience of stress.
Laxatives are prescribed only in case of persistent constipation that cannot be corrected by diet and regimen. In this case, the drug is prescribed taking into account the mechanism of development of constipation. When prescribing laxatives, it must be remembered that prolonged use of agents that irritate the intestinal wall that enhance peristalsis is fraught with the development of the "lazy bowel" syndrome, when after discontinuation of the drug, the peristaltic activity of the intestine drops to a minimum.
Prevention of constipation is the timely detection and treatment of pathologies of the digestive tract and other diseases that contribute to constipation, proper nutrition, a diet rich in organic fiber, sufficient fluid intake, as well as an active lifestyle and adherence to the diet and bowel movements.