Constipation in adults is a decrease in the frequency of stools in adulthood, which is accompanied by a change in the consistency of feces, difficulty and pain during defecation. The symptom is caused by alimentary and psychogenic factors, functional intestinal disorders, inflammatory and tumor processes. To verify the cause of constipation, irrigoscopy, colonoscopy, coprogram and blood tests are performed. To normalize bowel movements, prescribe a special diet, enemas, laxatives.
Unbalanced nutrition is the most common etiological factor in the reduction of bowel movements. Constipation is caused by a lack of fibrous food and vegetable fiber in the diet, which contribute to the formation of feces of normal consistency and facilitate their movement through the intestines. The basis of the diet of most people are easily digestible carbohydrates (white bread, premium cereals, sweets), animal proteins and fats.
These reasons contribute to a decrease in intestinal motility, as a result of which feces stagnate in the colon. Adults complain of chronic constipation, stools are observed every 2-3 days. In this case, painful sensations are characteristic, when emptying, one has to strain strongly. Often there is a feeling of incomplete emptying of the intestine and discomfort in the rectal region.
According to medical statistics, constipation in adults, caused by psychological discomfort, ranges from 13% to 23% of all cases of violations of the act of defecation. The chair is delayed by various reasons - from the usual quarrel with a loved one or colleague to severe stress and depression. Short-term (1-2 days) lack of bowel movements is possible after a change of scenery, on a business trip or during a vacation trip.
The process of defecation is a partially arbitrary reflex act, if desired, a person can suppress the urge to visit the toilet. The most physiological is the stool in the morning, but adults who live in a constant rush often do not have time to empty their intestines. Gradually, to form the urge to defecate, more feces are required in the rectum, so the frequency of bowel movements decreases.
Chronic constipation is typical for adults leading a sedentary lifestyle. Their pelvic floor muscles weaken, and intestinal motility becomes sluggish, as a result, defecation is difficult. Due to a long stay in the rectal cavity, the feces lose water, become dry and lumpy, and going to the toilet is accompanied by painful sensations. Absence of stool associated with intestinal atony occurs in patients who comply with bed rest.
The main causes of constipation in pregnant women are the mechanical pressure of the enlarged uterus on the intestines and the action of the hormone progesterone. The symptom worries a woman from the second half of pregnancy, and reaches its greatest severity at a period of 35-37 weeks, when the uterus drops a little and strongly compresses the large intestine. Pregnant women are afraid to strain strongly during bowel movements, so as not to increase the tone of the uterus, so the stool sometimes lingers for 3-4 days.
This functional disorder affects an average of 10-15% of the adult population, and the most pronounced manifestations begin after 3 years. A person notices periodic stool disorders like constipation, accompanied by pain in the abdomen. Symptoms are more often observed in the morning: 30-4 minutes after waking up, severe abdominal cramps and the urge to defecate develop, but emptying does not occur. Sometimes constipation is replaced by loose stools.
IBS is characterized by a chronic course, the duration of the main symptoms is more than 6 months. Patients complain of pain in the anus during bowel movements, difficulty in emptying the bowels, and the need for manual assistance to remove feces from the rectum. The frequency of bowel movements without taking laxatives is less than 3 times a week. In the presence of such signs, a doctor's consultation is required to exclude more severe somatic causes of constipation.
With hemorrhoids, anal fissures, patients experience severe pain during the discharge of feces, so they try to consciously suppress the urge to remove feces and reduce the amount of food eaten. Permanent constipation is also due to reflex rectal spasm in response to the inflammatory process, which is why feces accumulate for a long time, acquiring a stony density.
As a rule, independent defecation is impossible, constipation lasts up to 7 days. In the feces that appear after taking laxatives or setting an enema, inclusions of pus and blood are visible. Stool retention worsens the course of proctological diseases, provokes further damage to the mucosa. In the initial stages of hemorrhoids, independent defecation persists, bright red blood is visible on the surface of the feces.
Prolonged constipation in adults is observed with obstruction of the intestinal lumen and the inability to move feces through the intestines. With intestinal obstruction, defecation is completely absent, against which a sharp diffuse pain in the abdomen develops, flatulence, in which gases do not leave. May be disturbed by painful ineffectual urge to remove feces. The most common causes of mechanical intestinal obstruction are:
Prolonged constipation occurs with various intestinal lesions with predominant involvement in the process of the colon - colitis, enterocolitis. First, an adult develops abdominal pain, rumbling and flatulence, later the stool begins to linger. In this case, tenesmus is possible, after which a small amount of mucus or pus is released from the anus.
Missing stool is one of the signs of non-specific ulcerative colitis. With UC, constipation in adults is accompanied by dyspeptic symptoms, pain and spasms, which are more pronounced in the lower abdomen. The disease is chronic, the change of periods of exacerbation and prolonged constipation is provoked by the following reasons: diet errors, emotional upheavals, antibiotics or hormonal drugs.
In women, bowel retention is often due to pathological processes in the uterus and appendages. In acute oophoritis, salpingitis, there are sharp pains in the lower abdomen, causing spasm of the anal sphincters. Defecation is usually absent. Constipation lasts for several days, sometimes self-emptying of the intestines is possible, but more often it is necessary to resort to enemas. Stool disorders persist throughout the period of acute inflammation of the reproductive organs.
The symptom occurs in diseases of the spinal cord, in which the distal sacral segments are damaged - transverse myelitis, poliomyelitis, trauma. There is a delay in stool without the urge to defecate. The accumulation of feces and the absorption of decay products into the bloodstream causes a state of intoxication. Constipation in adults appears with Hirschsprung's disease, which occurs with damage to a small area of the colon.
With hypothyroidism in adults, prolonged constipation occurs for no apparent reason, which occurs without severe pain or other dyspeptic disorders. A rare discharge of feces is associated with a decrease in intestinal motility, when trying to empty a person, you need to strain hard, help yourself with your hands. Persistent constipation is noted in diabetic neuropathy, especially in type 2 diabetes.
Prolonged absence of stool is provoked by poisoning with salts of heavy metals. Constipation is most typical for occupational lead intoxication. Lack of bowel movements is accompanied by severe pain in the abdomen, fever. Constipation also worries with uremia, liver failure - conditions that are characterized by endogenous intoxication.
Most often, constipation develops against the background of prolonged abuse of laxatives. Over time, there is a suppression of the natural reflex act responsible for normal defecation, there is no urge to stool. There are other medicinal causes of prolonged constipation in adults:
Adults with complaints of constipation are sent for examination to a gastroenterologist. The doctor collects an anamnesis, provides a physical examination. The complex of mandatory diagnostic measures for defecation disorders includes modern instrumental methods for examining the gastrointestinal tract, which refine laboratory methods. The most informative are:
The main method of eliminating constipation in adults, which can be used at home, is to change the diet. It is important to increase the amount of vegetable fiber, which helps to increase the volume of feces and stimulates the urge to defecate. Fiber is recommended to be taken in the form of wheat bran (3-4 tablespoons per day), whole grain bread, fresh fruits and vegetables should be added to the diet.
It is necessary to increase fluid intake to 2.5 liters per day, which helps soften the stool. To stimulate intestinal motility, you should add regular physical activity, try to empty the intestines at the same time, in the morning after breakfast. When constipation is combined with severe pain in the abdomen, fever, blood in the stool, you should consult a doctor.
Medications that are prescribed for the treatment of constipation in adults are selected taking into account the clinic and the cause of defecation disorders. To quickly completely empty the intestines and prevent intoxication, cleansing or siphon enemas with hypertonic solutions are placed. To reduce pain in rectal pathology, therapeutic enemas with oils and anesthetics are administered. For the treatment of constipation use:
With hernias, an opening of the hernial sac is shown, followed by hernioplasty. Treatment of constipation in adults associated with intestinal obstruction includes laparotomy with a thorough exploration of the intestine. If a non-viable part of the intestine is detected, a segmental resection is provided, followed by the formation of an anastomosis. For colon cancer, a hemicolectomy or total colectomy is performed.