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 bowel emptying, abdominal pain. Сauses the development of intestinal dysbiosis, chronic colitis, cause intoxication of the body. Strong and frequent straining during the act of defecation leads to the development of anal fissures, hemorrhoids, hernias. Frequent constipation negatively affects the condition of the skin and contributes to its aging.
The concept of “constipation” implies difficulty in emptying the intestine, the absence of defecation 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 people prone to difficulty defecating (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, independently or by taking laxatives, are successfully resolved. Such conditions are not considered a disease.
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 released. Often, after defecation, there is no feeling of complete emptying of the intestine. It is possible to talk about constipation 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, therefore this problem has a high degree of social significance. Due to its prevalence and pronounced deterioration in the quality of life of patients, chronic constipation is isolated into an independent syndrome, and currently the problem of constipation is actively studied by proctologists, gastroenterologists and other specialists.
Young children and elderly people (over 60 years old) suffer most often from constipation. The 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, the side walls of the anus, the vagina).
The constant state of insufficient emptying of the rectal ampoule often leads to the development of perineal prolapse syndrome. Chronic constipation is diagnosed in cases when the frequency of stool becomes less frequent 3 times a week, defecation is significantly difficult and requires pronounced efforts, the consistency of the stool is dense, lumpy, there is a feeling of incomplete release of the rectum from feces.
Causes of constipation
The cause of the development of chronic constipation can be the peculiarities of lifestyle, eating habits. Constipation is promoted by regular restraint of the urge to defecate, eventually depressing 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 bowel movements is perceived by the patient as insufficiently frequent), a diet poor in products containing vegetable fiber, lack of daily fluid intake are factors contributing to the development of chronic bowel movement difficulties.
In addition, constipation is one of the signs of irritable bowel syndrome. In this pathological condition, intestinal motility is impaired and instability of the stool may occur: constipation with the release of a hard meager stool (sometimes with mucus) may alternate with diarrhea. A stressful state in such cases only worsens the functional activity of the intestine.
Constipation can be a consequence 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, the obstruction may be complete or partial. The causes of obstruction of the intestinal lumen may be tumor processes, scarring, adhesions, diverticula of the large intestine, intestinal inversion, worm infestations.
Coprostasis is characterized by a prolonged absence of stool, a feeling of overflow in the intestines, 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 syndrome (anal fissure, acute hemorrhoids, paraproctitis).
Neurological disorders (stress, depression, nervous shocks) can also contribute to the development of chronic bowel movement disorders. In addition, many medications can cause as a side effect inhibition of intestinal peristalsis and contribute to constipation. Pathologies of 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 the mechanism of development:
- alimentary (related to the peculiarities of the diet)
- neurogenic (caused by disorders of the neuro-reflex activity)
- psychogenic (associated with psycho-emotional state)
- constipation in anorectal diseases (hemorrhoids, anal fissure, paraproctitis)
- toxic (in cases of poisoning by lead or mercury, some drugs, chronic intoxication)
- protogenia (associated with functional disorders of the muscles of the diaphragm and pelvic floor)
- constipation in mechanical obstacles (for tumors, strictures, scarring, polyps, congenital anomalies of the digestive tract)
- iatrogenic constipation (as a result of taking medications).
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. The individual rhythm of bowel movement may vary. Depending on the change in the usual frequency of defecation, emptying from once every 2-3 days or less can be considered constipation. Defecation with constipation is characterized by pronounced tension, requires considerable effort. The stool is dense, dry, can resemble dry balls in shape, has the shape of beans, a cord.
In some cases, there may be so-called constipated diarrhea, when, against the background of a prolonged absence of normal defecation and a feeling of overcrowding in the abdomen, diarrhea occurs with liquid stool 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 emptying the intestines, the release of intestinal gases. Flatulence also often accompanies difficulties in the movement of intestinal masses. Increased gas formation is a consequence of the activity of microorganisms inhabiting the large intestine.
Patients suffering from constipation may notice a decrease in appetite, bad breath, belching air. As a rule, long-term chronic constipation contributes to depressed mood, decreased performance, sleep disorders, and other neurasthenic disorders.
Prolonged 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 may be persistent intestinal obstruction, requiring emergency surgery. A long-term obstruction contributes to the development of ischemia of the intestinal walls and can lead to necrotization. In some cases, constipation may signal a tumor process taking place, 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 of passing intestinal contents allows carcinogens to have a prolonged irritating effect. Senile people and people suffering from 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 (complaints, anamnesis, physical examination data) and an X-ray picture are evaluated, which makes it possible to assess the condition of the large intestine: peristalsis, lumen width, tumor formations, strictures, wall distensions, congenital malformations, megacolon. During irrigoscopy, intestinal obstruction is clearly detected.
The second stage of diagnostic measures is colonoscopy (endoscopic examination of the large intestine), sampling of biopsies of mucous membranes and their histological and, if necessary, cytological examination. Then methods are assigned to study the functional state of the intestine, depending on preliminary assumptions. These may 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 techniques is based on complaints, identified features of the intestine, assumptions about possible concomitant diseases and for the choice of treatment tactics.
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 characteristics, 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 cure the condition that caused the development of constipation. Knowing the mechanism of the occurrence of chronic constipation in the 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 causes, 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).
Diet is an important link in the treatment of constipation. Foods rich in plant fiber (vegetables, fruits, cereals) and a large amount of liquid (at least two liters per day) are necessarily introduced into the diet of patients. In the event that gas formation increases against the background of a diet and flatulence develops, the drug Mukofalk is prescribed. In addition, all foods that contribute to the aggravation of constipation are excluded from the diet.
Meals should be carried out according to the regime, at least five times a day in small portions. In any case, do not allow long breaks between meals. It is also necessary to carefully monitor the regularity of bowel movements. It is advisable to feel and restore the individual rhythm of natural defecation, avoid restraining urges. In the case of taking medications that contribute to the difficulty of transit of intestinal masses (narcotic analgesics, ganglioblockers, iron preparations, diuretics, oral contraceptives), it is necessary to cancel them and, if possible, replace them with drugs that do not affect digestion.
An active lifestyle, walking, swimming, and aerobics classes are recommended as stimulation of the digestive tract and strengthening the tone of intestinal muscles. In addition, an active life position has a positive effect on the psycho-emotional status and contributes to the easy experience of stress.
Laxatives are prescribed only in the case of persistent constipation that cannot be adjusted by diet and regime. At the same time, the drug is prescribed taking into account the mechanism of constipation. When prescribing laxatives, it must be remembered that prolonged intake of irritants of the intestinal wall that enhance peristalsis is fraught with the development of the “lazy bowel” syndrome, when after the drug is discontinued, the intestinal peristaltic activity drops to a minimum.
Prevention 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, a sufficient amount of fluid consumed, as well as an active lifestyle and compliance with the regime of meals and bowel movements.