What is Constipation?

Everyone would have had constipation at some point of time or the other in their life. When this happens, it is difficult to pass stools, and the bowel movement is less than normal or tough. This can be really painful at times and may even need medical intervention.  

Certain people are used to passing stools a couple of times a day, while for a few others, it is once a day, and for a few others, it could also be a few times a week and so on. However for a few people, constipation is a part and parcel of their life. This is mostly dependent on the body constitution and as per the habits formed. In medical terms, anything longer than three days without bowel movements is what can be termed constipation. 

Constipation could be a one-off thing caused by some medications; but if it is consistent then it is an issue with the waste disposal system of our body, called as functional or primary constipation. There are three kinds of functional constipation namely: Normal Transit Constipation, Slow Transit Constipation and Defecation Disorders. 

• Normal Transit Constipation: This kind of constipation is the most common of all, usually found in young kids and adults. The muscles in the colon squeeze and relax as they should, neither too fast and nor too slow. The waste also moves at the right speed; and yet, the stool feels hard and difficult to pass. This may also be accompanied by belly pain or bloating. 

• Slow Transit Constipation: In this condition, the colon isn’t moving the waste with the required speed. As yet, even doctors have no idea why it happens. There is a possibility that the nerves are not signaling the colon muscles to move as they ideally should. This situation is found commonly in young women. 

• Defecation Disorders: In this case, you have the urge to go, but are unable to pass the stools and it may be hard and painful. Usually it takes a coordinated effort of the pelvic muscles for us to be able to pass stools naturally. People having this issue may also have anal fissures and hemorrhoids, and may need treatment. They end up spending a lot of time in the toilet, trying to pass the stools, or may have to use a finger or enema to pass them fully. 

Snippet Highlight: Constipation need to be diagnosed and identified properly, so that it can be treated correctly. The treatments of constipation may differ based on the category as mentioned above. 

The worldwide constipation estimate is said to be 16%, whereas it does vary upto 80%. An interesting statistic to be mentioned is that 33.5% suffering from this fall between age of 60 to 110 years.  

In India, in a nationwide survey conducted by the healthcare company Abbot, 22% of India’s adult population was found to be suffering from constipation. In fact, 13% of these complained of having severe constipation. 

In any case, we encounter people everyday who are constipated but may not really be talking about it willingly. We don’t need statistics to tell us that this is a widely prevalent problem. Perhaps, this is also why a movie like “Piku”, based on the protagonist’s fixation with his problem of constipation, became a runaway success. While the movie was hilarious in parts, it also brought to light a common problem which people face but do not discuss in public. 

There are multiple causes leading to constipation. Most of the causes are as listed below: 

• Changes in eating habits, or diet, and eating disorders
• Changes in activities or being less active
• Not drinking enough water
• Having less fiber
• Having more dairy products
• Magnesium deficiency
• Sleeplessness
• Holding on and not passing stools when you feel like it
• Chronic stress
• Excessive laxative use
• Certain medications ( Narcotics, antidepressants, and iron pills)
• Antacids with calcium or aluminum
• Irritable bowel syndrome
• Pregnancy
• Nerve or muscle problems in the gut
• Colon cancer
• Neurological conditions such as Parkinson's disease or multiple sclerosis
• Hypothyroidism 

The typical symptoms that can be categorised as that of constipation are:  

• Troubled, lesser or no bowel movements
• Hard stools
• Bloating of the stomach
• Uneasiness and discomfort even after passing stools
• Not feeling an urge to pass stools
• Having to use finger or enema to pass stools
• Spending more time to try and pass stools
• Having to constantly use laxatives 

The doctor will conduct a few tests to decide why a person is suffering from constipation  They are: 

1. Blood test: This is especially important since hypothyroidism is also a cause.
2. Sigmoidoscopy: This is an examination of the rectum and lower, or sigmoid (a terminal part of the large intestine connecting the descending colon to the rectum), colon. Trained professionals will insert a lighted, flexible tube into the anus to examine the rectum and the lower portion of the colon, as part of this procedure.
3. Colonoscopy: In this procedure, the entire colon in inspected using a flexible, camera-equipped tube.
4. Anorectal manometry: A narrow, flexible tube is inserted into the anus and rectum in this procedure, and a small balloon at the tip of the tube is then inflated. Then this is pulled back through the sphincter muscle and helps to measure the muscle coordination that happens to move the stools.
5. Balloon expulsion test: This test is usually done along with anorectal manometry. It  measures the time taken to push out a balloon that is filled with water and placed in the rectum.
6. Colonic transit study: This is done to determine how the food moves through your colon. The person may be asked to swallow a capsule containing either a radiopaque marker or a wireless recording device. This helps track the progress of the capsule through the colon over several days and will also be visible on the X-rays. This is meant to understand intestinal muscle dysfunction.
7. Defecography: This is nothing but taking an X-ray of the rectum during defecation. A soft paste made of barium is inserted into the rectum, and this is then passed just like stool. The inserted barium is captured on the X-rays to reveal any problems with the muscle function or coordination.
8. MRI defecography: In this, a contrast gel is inserted into the rectum just like above and this is then passed like stool. The MRI scan can then visualize and evaluate the function of the defecation muscles. This test helps diagnose the problems causing constipation like rectocele or rectal prolapse as well. 

Not all constipation may need medical intervention; at times, the use of over-the-counter laxatives for a few days, can help relieve the issue. Only if basic treatment does not help and the doctor suspects some underlying cause, few tests may be prescribed. 

However, if you are asked to undergo tests, then the doctor may be able to determine the exact cause and will put you under the required medication. There is also a remote possibility based on the test results that some surgery may also be advised. 

In most other cases, you may follow below steps and continue a normal healthy life:

• Unless instructed by a doctor otherwise, drink 8 to 10 glasses of water in a day and keep yourself hydrated.
• It may be a good idea to drink a glass of warm liquid in the morning.
• Include fresh fruits and vegetables into the diet.
• Prunes and bran cereal also may be included in the diet.
• Exercising daily helps the muscles of the intestines as well.
• Never ignore the urge to pass stools. 

Conventional Treatments 

• Over-the-counter laxatives
• Changes in diet
• Prescribed medications
• Fibre supplements
• Surgery (only in certain extreme cases of impaction) 

Alternative Treatments 

In India, people do not resort to just conventional treatments for conditions like constipation. Mostly, home remedies and changes to diet can help cure constipation to a great extent. 

Ayurveda  

Ayurveda takes a holistic approach to treating constipation, and identifies whether it is a Vata dosha, Pitta dosha or Kapha dosha or a combination of these before treating the person. Most remedies are diet based and they suggest eating fresh and properly cooked food, and eating by chewing thoroughly. 

It is suggested to include digestive spices like cumin seeds, coriander, turmeric powder, fennel and asafetida, and leafy vegetables and salad in the diet. A glass of warm milk at bedtime, and in cases of severe constipation, mixed with two teaspoonful of castor oil or even ghee is suggested. Ayurvedic physicians may also prescribe Triphala Churna/ Triphala tablets commonly, whereas there are many other such remedies as well. 

Homeopathy 

A case study research conducted at the University of Johannesburg Homeopathy Health Training Centre on the efficacy of individualised homeopathic treatment on chronic constipation in adults concluded that there were positive improvements in stool frequency and stool form in all the participants. 

An overall physical and emotional wellbeing was also reported by the people. The different remedies prescribed as part of this study were Bryonia alba, Calcarea carbonica, Mercurius solubilis, Natrium muriaticum, Nux vomica, Pulsatilla and Sepia. 

Acupuncture Treatment 

The literature published for the above mentioned study also quotes a systematic review by Zhang et al. (2013) to mention that Acupuncture too can offer a safe and alternate remedy for constipation. Improved weekly spontaneous bowel movement and an overall improved quality of life was observed. 

Nutrition 

Nutrition and a healthy, balanced diet can play a big role in managing and curing constipation. 

Here is what you can try: 

Foods to eat:

High-fibre foods like raw fruits and veggies, nuts, and seeds

Green leafy veggies

Prunes and figs

Supplements:

Probiotics

Flaxseed oil

Cod Liver Oil

Liquids:

Warm fluids

Lots of water

Avoid:

Processed/Ultra-processed foods

Fried Foods

Alcohol

Caffeine

Dairy based foods 

Movement 

There is no reason why constipation should restrict anyone from leading a normal life or travelling as desired. If one can change the diet habits, bowel habits, and bring in some lifestyle changes, it is quite possible to carry on normally. Alongside, a little holistic approach with some Yoga and meditation can also help improve the situation as a whole. 

Mindset 

As in the case of most other issues, if you allow constipation to play on your mind, it could be your undoing. You may find the process of diagnosis embarrassing but you need to undergo the right treatment at the right time, be willing to make lifestyle changes, and consciously work at it to see the results. Relying on laxatives to tide by may not be the best approach as in the long run, that itself causes constipation! 

Diet is a big part of constipation prevention and above inputs on the same need to be followed. Most medical practitioners would also suggest the same. You may also look at the below factors. 

• Stress Reduction: Stress is also a major factor resulting in constipation; so adopt good mind and body practices to reduce stress. Meditation, Yoga, Reading, Walking, Warm Baths, etc. can be tried.
• Regular exercise: Daily exercise or practice of Yoga improves intestinal muscle activity, aiding in better bowel movement

*Medical Disclaimer - The following information is for educational purposes only. No information provided on this website, including text, graphic, and images, are intended as substitutes for professional medical advice. Please consult with your doctor about specific medical advice pertaining to your condition(s)