A Family Doctor's Tale - CONSTIPATION

DOC I HAVE CONSTIPATION

Constipation ( A Simple Guide to Constipation)  by definition is a condition which is characterized by fewer than normal bowel movement than usual.
It is accompanied by straining, incomplete evacuation and passage of hard stools. 


Many people do not realise the discomfort and abdominal cramps a patient with constipated hard stool stuck in his rectum and anus. Because of the pressure of the hard stool, he is sometimes unable to pass urine. His tummy feels bloated and constant peristaltic wave causes constant abdominal cramps and cold sweats. 
There are even patients who are unable to stand straight because of the pain. 
In the severe cases I have to evacuate the hard stools manually. Once the hard stools comes out from his anus, the patient could relax and breathe again. Unfortunately the stink in the consultation room may need the family doctor evacuate his room and use another consultation room.
 
It is particularly common among the elderly and younger children because of:

1. Insufficient fiber (fruits,vegetables) to form bulk in the stools.

2. Insufficient fluid in the diet(at least 8 glasses of water).

3. Insufficient time to go to toilet when there is the urge to pass motion.

4. Insufficient exercise to help the intestine to move especially after meals, common in sedentary jobs and older people

5. Stress cause the constriction of the anal sphincter preventing the stools from passing.

6. Depression on the other hand depress the movement of the intestines.

7. Drugs like cough mixture containing codeine, antispasmodic, antacids may also reduce the motility of the intestine.

8. Pregnancy in the later stage cause the womb to press against the intestine.

9. People with low thyroid hormone slows down the movement of the intestines.

10.People with piles or pelvic space occupying swelling which may press against the intestine or rectum.

Avoidance of constipation include:

1. Increase in daily fiber intake to at least 15gm (eg. 1 bowl of bran cereal for breakfast), fruits and vegetables).
Fiber increases the bulk of the stool allowing easy passage of stools through the large intestine.

2. Drink at least 8 glasses of water a day (2 liters). Water reduces the hardness of stools.

3. Regular exercises at least 2-3 times a day especially after meals. Exercise will enhance intestinal movement.

4. Allow a distraction free period of 15 min a day for bowel movement. The strongest intestinal movement occurs after breakfast.

5. Do not ignore or suppress the urge to pass bowel movement. This may impair the sensation to detect initiation of bowel movement leading to constipation.

Treatment of  Constipation
1.Follow the advice above.

2.Consult your family doctor to exclude any abdominal swelling which may be blocking the passage of stools.
A colonoscopy may be needed to check the large intestines for tumors or early cancer.
Your piles may be removed during the colonoscopy if found to be obstructing passage of stools.

3.Try Yogurt or fermented milk with lactobacillus as a method to stimulate more production of bulk in stools.

4.Try not to take laxatives unless it is deemed necessary by your doctor.
Most doctors preferred not to use medicine in combating constipation because it may lead on dependancy on laxatives.

5. Learn to relax the anal sphincter by doing some pelvic exercises