CONSTIPATION - Full extract 

Old magazines used to abound with advertisements for laxatives. Constipation was blamed for everything from bad breath to pimples and poor humour. Then for a while the significance of constipation was often understated. But in recent years, our understanding of the condition has improved and there is now more emphasis on a healthy diet and regular bowel habit.

There is no such thing as the correct bowel pattern. Most people have a bowel action every day or two; some go more frequently, others less. In general terms, constipation just means difficulty in having bowel actions. For some, this means going to the toilet less often than they would like. For others, it is the discomfort of wanting to have a bowel action but not being able to, perhaps passing hard stools with difficulty. Constipation can affect people of any age and can cause great discomfort.

Until the past few decades, every effort was made to produce foods like fluffy breads and highly processed cereals. Then it was noted that races who ate raw food and plenty of roughage seemed to have none of the bowel conditions that affect Western societies - problems such as constipation, diverticular disease, haemorrhoids and even bowel cancer. The experts believe this has something to do with the frequency and ease of defecation, the greater volume of stools and their shorter transit time in the large bowel. Although high-fibre foods do not suit everyone, in recent years there has been a growing trend towards natural unprocessed foods.

Infants tend to become constipated when their diet changes from, say, breast milk to a formula. There is a great variety of bowel habits in infants; some open their bowels two or three times a day, others twice a week. This is of no concern unless the infant is distressed or unwell. Sometimes a small fissure or tear occurs in the anus and an infant will hold back for fear of causing further pain. This only compounds the situation and medical advice is essential. The doctor is likely to recommend a course of laxatives and an anaesthetic cream for the bottom.

A change of routine, such as going away on holidays, can cause constipation in both adults and children. It is often due to a combination of factors such as having to use a strange toilet and a change of diet. Extra fruit and fluids is the best approach, but sometimes a laxative is necessary.

Prolonged periods of bed rest and lack of exercise can also cause constipation, especially in older people. Ignoring the urge to defecate can cause problems as well; after a while the sensation simply goes away, which can result in constipation. Medications such as analgesics, sedatives, antidepressants and some blood pressure tablets can also be responsible. When an elderly person becomes vaguely unwell, constipation is one of several causes that should be considered.

The presence of other symptoms like abdominal pain and vomiting requires special assessment, in case there is an associated bowel obstruction. Other medical conditions such as underactive thyroid gland can also cause constipation.

If constipation persists or if there is a change in bowel habit, the possibility of an underlying bowel cancer has to be considered, especially in older patients and those with a family history of the condition. A bowel X-ray or an internal inspection of the bowel, called a colonoscopy, may be recommended. The presence of blood in bowel motions always requires prompt and thorough investigation.

After ruling out specific causes of constipation, careful attention to diet is the next step, with the emphasis on fruit, vegetables, plenty of fluids and grain foods like muesli and unprocessed bran. Those who feel bloated with extra fibre might prefer a bulk forming agent such as Metamucil. A variety of laxatives is also available for short term use. These include granules and tablets that stimulate bowel movement, and others that have a softening effect on stools. There are also mixtures that draw water into the bowel to produce loose motions.

If emptying the lower rectum is the problem, special suppositories and small enemas may be recommended. A particular laxative is available for most constipation problems.

Health Tip:
* Although constipation is a distressing symptom, in most cases it can be readily managed.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001