Constipation in adults is a decrease in the frequency of stool in adulthood, which is accompanied by a change in the consistency of feces, difficulties and soreness 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.
Causes of constipation in adults
Eating habits
Unbalanced nutrition is the most frequent etiological factor in reducing bowel movements. Constipation is caused by a lack of fibrous food and vegetable fiber in the diet, which contribute to the formation of fecal masses of normal consistency and facilitate their progress 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 causes 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 once every 2-3 days. At the same time, painful sensations are characteristic, when emptying, you have to strain hard. Often there is a feeling of incomplete bowel emptying and discomfort in the rectal area.
Psychogenic factors
According to medical statistics, constipation in adults due to psychological discomfort accounts for 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 depressive states. Short-term (1-2 days) absence of bowel movements is possible after a change of situation, on a business trip or during a vacation trip.
Lifestyle
The process of defecation is partly an arbitrary reflex act, if desired, a person can suppress the urge to visit the toilet. The most physiological is stools in the morning, but adults who live in a constant hurry often do not have time to empty their intestines. Gradually, a greater amount of feces in the rectum is required to form the urge to defecate, so the frequency of bowel movements decreases.
Chronic constipation is characteristic of adults who lead a sedentary lifestyle. Their pelvic floor muscles weaken, and intestinal peristalsis becomes sluggish, as a result, defecation becomes difficult. Due to prolonged stay in the rectal cavity, the stool loses water, becomes dry and lumpy, visiting the toilet is accompanied by painful sensations. The absence of stool associated with intestinal atony occurs in patients who observe bed rest.
Pregnancy
The main causes of constipation in pregnant women are the mechanical pressure of the enlarged uterus on the intestines and the effect of the hormone progesterone. The symptom has been bothering a woman since the second half of pregnancy, and reaches its greatest severity at the age of 35-37 weeks, when the uterus drops slightly and squeezes the large intestine strongly. Pregnant women are afraid to strain too much during defecation, so as not to increase the tone of the uterus, so the stool is sometimes delayed for 3-4 days.
Irritable bowel syndrome
This functional disorder affects an average of 10-15% of the adult population, and the most pronounced manifestations begin after the age of 30. A person notices periodic violations of the stool by the type of constipation, accompanied by abdominal pain. Symptoms are more often observed in the morning: 30-40 minutes after waking up, severe abdominal cramps and 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 defecation, difficulty emptying the intestines 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.
Damage to the rectum
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 volume of portions of food eaten. Constant constipation is also caused by 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, self-defecation is impossible, constipation lasts up to 7 days. In the fecal masses that appear after taking laxatives or enemas, 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 noticeable on the surface of the stool.
Intestinal obstruction
Prolonged constipation in adults is observed with obstruction of the intestinal lumen and the inability to move feces through the intestine. With intestinal obstruction, defecation is completely absent, against which a sharp diffuse abdominal pain develops, flatulence, in which gases do not escape. Painful fruitless urges to remove feces may bother. The most common causes of mechanical intestinal obstruction:
- Intestinal hernias. When the intestinal area enters the hernial sac, chronic constipation occurs in adults. Gradually, the intervals between bowel movements lengthen. The symptom is accompanied by dull pains and heaviness in the abdomen. Unpleasant sensations increase after physical exertion, lifting weights.
- Polyps. These benign formations, as they increase in size, clog the intestinal lumen and lead to stool retention in adults. At the beginning of the disease, an independent stool is possible, but with large polyps, defecation occurs only after an enema or medications.
- Cancer. Colonic tumors are characterized by fairly rapid growth, they delay the passage of feces and cause chronic constipation. There is also a constant pain in the lower abdomen with irradiation into the anal area. Dry lumpy or ribbon-like feces with blood inclusions are released.
Inflammatory diseases of the gastrointestinal tract
Prolonged constipation occurs with various intestinal lesions with predominant involvement in the process of the colon – colitis, enterocolitis. At first, an adult has abdominal pain, rumbling and flatulence, later the stool begins to linger. At the same time, 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 ulcerative colitis. Constipation in adults is accompanied by dyspeptic symptoms, pains and spasms, which are more pronounced in the lower abdomen. The disease proceeds chronically, the following causes provoke the change of periods of exacerbation and prolonged constipation: errors in diet, emotional shocks, taking antibiotics or hormonal drugs.
Defeat of the pelvic organs
In women, the delay in bowel movements is often caused by pathological processes in the uterus and appendages. With acute oophoritis, salpingitis, there are sharp pains in the lower abdomen, causing spasm of the anal sphincters. Defecation, as a rule, is absent. Constipation lasts for several days, sometimes self-emptying of the intestine 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.
Peripheral neuropathies
The symptom occurs in diseases of the spinal cord, in which distal sacral segments are damaged— – transverse myelitis, polio, injuries. There is a delay in stool without the urge to defecate. Accumulation of feces and absorption of putrefaction products into the bloodstream causes a state of intoxication. Constipation in adults occurs with Hirschsprung’s disease, which occurs with the defeat of a small area of the colon.
Endocrine pathology
With hypothyroidism, adults experience prolonged constipation for no apparent reason, which proceed without pronounced pain or other dyspeptic disorders. A rare discharge of fecal masses is associated with a decrease in intestinal motility, when trying to empty a person needs to strain hard, help himself with his hands. Persistent constipation is noted in diabetic neuropathy, especially in type 2 diabetes.
Intoxication
Prolonged absence of stool is provoked by poisoning with heavy metal salts. The most typical constipation for professional lead intoxication. The absence of defecation is accompanied by severe abdominal pain, an increase in body temperature. Constipation is also a concern for uremia, liver failure – conditions that are characterized by endogenous intoxication.
Complications of pharmacotherapy
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 are no urges to stool. There are other medicinal causes of prolonged constipation in adults:
- Analgesics: opioids, some nonsteroidal anti-inflammatory drugs.
- Psychotropic drugs: antidepressants, anticonvulsants and antiparkinsonian drugs.
- Trace elements: iron preparations, antacids with calcium and magnesium, aluminum salts of phosphoric acid (phosphalugel).
- Antihypertensive drugs: beta-blockers, diuretics, calcium channel blockers.
Rare reasons
- Diseases of the central nervous system: multiple sclerosis, brain tumors, Parkinson’s disease.
- Systemic connective tissue lesion: scleroderma, dermatomyositis, systemic lupus erythematosus.
- Metabolic disorders: porphyria, hypercalcemia, hypokalemia.
Diagnostics
Adults with complaints of constipation are sent for examination to a gastroenterologist. The doctor collects anamnesis, provides physical examination. The complex of mandatory diagnostic measures for defecation disorders includes modern instrumental methods of examination of the gastrointestinal tract, clarifying laboratory methods. The most informative are:
- Irrigoscopy. The double contrast method allows to evaluate the anatomical and functional features of the large intestine, reveals deformations of intestinal contours, volumetric formations and filling defects. For a detailed study of the digestive system, radiography of the barium passage is used.
- Colonoscopy. Endoscopic examination is intended for a thorough examination of the intestinal mucosa and the detection of diseases that manifest constipation. During the study, a biopsy of the intestine is performed to clarify the causes of the disease. In the obtained biopsies, the cellular composition and the number of intramural nerve ganglia are evaluated.
- Sonography. Ultrasound of the abdominal cavity is informative for the diagnosis of tumor neoplasms, adhesions. Ultrasound examination in the area of the umbilical ring, the outer ring of the inguinal canal is recommended to exclude hernial protrusions or infringement of intestinal loops. Women must have ultrasound of the pelvic organs.
- Сoprogram. Macroscopically determine the dry solid consistency of feces, “sheep” or “pencil” feces. Microscopic examination reveals an increased content of leukocytes, putrefaction products. The analysis of feces for helminth eggs, bacteriological seeding, and the Gregersen reaction to detect hidden blood are shown.
- Blood tests. An extended biochemical analysis is carried out with the measurement of glucose and electrolyte concentrations. It is necessary to establish the amount of free thyroxine, pituitary TSH. If glucose tolerance is impaired, an oral stress test is performed. To exclude chronic posthemorrhagic anemia, a clinical blood test is performed.
Treatment
Help before diagnosis
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 plant 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 contributes to the softening of feces. To stimulate intestinal motility, regular physical activity should be added, try to empty the intestines at the same time, in the morning after breakfast. If constipation is combined with severe abdominal pain, fever, and the presence of blood in the feces, you should consult a doctor.
Conservative therapy
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 hypertensive solutions are put. To reduce pain in rectal pathology, therapeutic enemas with oils and anesthetics are administered. For the treatment of constipation use:
- Laxatives. Osmotic medications and rectal candles of bisacodyl stimulating peristalsis are recommended. The frequency of administration and dosage of drugs are strictly controlled so as not to aggravate the patient’s condition. The course of treatment is no more than 2-3 months.
- Enterosorbents. The drugs reduce gas formation in the intestines, reduce the manifestations of flatulence and abdominal pain. To improve digestion and eliminate the cause of constipation, probiotics are taken that improve the colonic microflora.
- Antibiotics. In colitis and other inflammatory processes of bacterial etiology, drugs that act exclusively in the intestinal lumen are shown. Parasites are eliminated with the help of specific anthelmintic drugs.
- Antispasmodics. They are used to reduce pain and spasm of rectal sphincters, which makes it easier to defecate in adults. With unbearable pain, they are combined with non-narcotic analgesics, physiotherapy methods.
- Detoxification solutions. To eliminate poisoning as a cause of the absence of bowel movements, salt solutions are used, which are administered in large volumes, the method of forced diuresis. In case of intoxication with metals, complexons are prescribed.
Surgical treatment
In case of hernias, the opening of the hernial sac with subsequent hernioplasty is indicated. Treatment of constipation in adults associated with intestinal obstruction includes laparotomy with a thorough revision of the intestine. When a non-viable part of the intestine is detected, segmental resection is provided, followed by the formation of an anastomosis. With colon cancer, hemicolectomy or total colectomy is performed.