WHAT IS CONSTIPATION?
Commonly, constipation refers to a condition of slowed intestinal transit, whether associated with a reduction in the volume and weight of feces or not. These conditions lead to a decrease in the frequency of bowel movements. The definition of constipation also includes a range of symptoms now grouped under the more precise definition of Obstructed Defecation Syndrome (ODS).
These symptoms include excessive straining during defecation, a feeling of incomplete evacuation, the need to use fingers to facilitate evacuation, the misuse of laxatives, or the need for frequent enemas. The frequency of bowel movements varies widely and depends on various factors. Men tend to be more regular and typically have one bowel movement per day. In women, 2-3 bowel movements per week are considered normal. The urge to evacuate increases as the rectum fills with feces. If a person does not feel the urge for days, it means their rectum is not filled with feces, indicating a slow intestinal transit (true constipation).
However, if a person feels the urge but cannot expel feces (requiring manual maneuvers, changes in sitting position, enemas, or the use of laxatives) or experiences fragmented and incomplete evacuation, it means their rectum is filled with feces, but there is a pathological condition preventing normal evacuation (constipation due to obstructed defecation). A significant factor influencing bowel function is diet. It should include at least 25-30 grams of fiber per day (bran, wheat, leafy vegetables, and fruits) and adequate water intake (1.5-2 liters per day). Physical activity is also important, with 30 minutes of daily walking recommended, along with engaging in sports.
WHAT ARE THE CAUSES OF CONSTIPATION?
There can be numerous and concurrent causes. Among the most common causes are inadequate fiber and liquid intake in the diet, a sedentary lifestyle, and environmental and lifestyle changes. More serious causes include the development of neoplasms in the colon-rectum, especially after the age of 50, making it advisable to consult a specialist if constipation persists. Constipation can also be the first symptom of diabetes. It may also be associated with neurological diseases (Parkinson's, multiple sclerosis) or endocrine system disorders (e.g., thyroid diseases). In the case of constipation due to obstructed defecation, the most frequent causes are associated with the presence of rectal prolapse, rectocele, enterocele, dysfunction of the puborectalis muscle, or other perineal dysfunctions. These pathologies are often concurrent.
CAN CONSTIPATION BE CAUSED BY MEDICATIONS?
Yes. Many medications, such as analgesics, antidepressants, tranquilizers, antihypertensives, diuretics, and medications containing calcium, iron, and aluminum, can slow down intestinal transit, leading to constipation.
WHEN SHOULD YOU CONSULT A SPECIALIST FOR CONSTIPATION?
Every time there are changes in bowel habits (especially if periods of constipation alternate with periods of diarrhea), it is advisable to consult a colon-proctology specialist. If there is also bleeding, a medical examination is strongly recommended.
HOW CAN THE CAUSES OF CONSTIPATION BE DETERMINED?
First and foremost, the colon-proctology specialist performs a digital examination and anorectoscopy. These two simple procedures are essential to rule out the presence of organic causes in the anorectal area. Subsequently, the assessment of the intestine may involve performing a colonoscopy, which can be traditional or virtual, or performing a CT colonography.
Double-contrast barium enema is less commonly used today. With these methods, diverticula, polyps, neoplasms of the colon-rectum, and other possible causes of constipation can be identified. Transit time through the intestines can be calculated using the transit time with markers. For functional assessment of the anorectal tract, manometry is useful. For the study of constipation due to obstructed defecation, defecography (cinedefecography, colpocistoenterodefecography, and pelviperineography) and magnetic resonance imaging (MRI) are used to detect the presence of rectocele, rectal prolapse, enterocele, or pelvic floor disorders, all of which can cause obstructive symptoms.
HOW IS CONSTIPATION TREATED?
Most patients benefit from adding fiber and liquids to their diet and engaging in physical activity. These measures also reduce cholesterol levels in the blood, thereby reducing the risk of colon tumors. Fiber (bran, wheat, leafy vegetables, fruit, etc.) should be consumed in adequate amounts for extended periods, and the use of laxatives should be completely avoided. Sometimes, substances that soften stools (mucilages) may need to be prescribed. However, laxatives or enemas should be used only under close medical supervision.
These measures often resolve or at least improve constipation due to obstructed defecation as well. However, when diet, physical activity, and stool softeners are not sufficient, surgery may be necessary (see the chapter on "rectocele and obstructed defecation"). If constipation is of organic origin (colon polyps or tumors), treatment must necessarily involve surgery, either alone or in combination with radiotherapy or chemotherapy.
Commonly, constipation refers to a condition of slowed intestinal transit, whether associated with a reduction in the volume and weight of feces or not. These conditions lead to a decrease in the frequency of bowel movements. The definition of constipation also includes a range of symptoms now grouped under the more precise definition of Obstructed Defecation Syndrome (ODS).
These symptoms include excessive straining during defecation, a feeling of incomplete evacuation, the need to use fingers to facilitate evacuation, the misuse of laxatives, or the need for frequent enemas. The frequency of bowel movements varies widely and depends on various factors. Men tend to be more regular and typically have one bowel movement per day. In women, 2-3 bowel movements per week are considered normal. The urge to evacuate increases as the rectum fills with feces. If a person does not feel the urge for days, it means their rectum is not filled with feces, indicating a slow intestinal transit (true constipation).
However, if a person feels the urge but cannot expel feces (requiring manual maneuvers, changes in sitting position, enemas, or the use of laxatives) or experiences fragmented and incomplete evacuation, it means their rectum is filled with feces, but there is a pathological condition preventing normal evacuation (constipation due to obstructed defecation). A significant factor influencing bowel function is diet. It should include at least 25-30 grams of fiber per day (bran, wheat, leafy vegetables, and fruits) and adequate water intake (1.5-2 liters per day). Physical activity is also important, with 30 minutes of daily walking recommended, along with engaging in sports.
WHAT ARE THE CAUSES OF CONSTIPATION?
There can be numerous and concurrent causes. Among the most common causes are inadequate fiber and liquid intake in the diet, a sedentary lifestyle, and environmental and lifestyle changes. More serious causes include the development of neoplasms in the colon-rectum, especially after the age of 50, making it advisable to consult a specialist if constipation persists. Constipation can also be the first symptom of diabetes. It may also be associated with neurological diseases (Parkinson's, multiple sclerosis) or endocrine system disorders (e.g., thyroid diseases). In the case of constipation due to obstructed defecation, the most frequent causes are associated with the presence of rectal prolapse, rectocele, enterocele, dysfunction of the puborectalis muscle, or other perineal dysfunctions. These pathologies are often concurrent.
CAN CONSTIPATION BE CAUSED BY MEDICATIONS?
Yes. Many medications, such as analgesics, antidepressants, tranquilizers, antihypertensives, diuretics, and medications containing calcium, iron, and aluminum, can slow down intestinal transit, leading to constipation.
WHEN SHOULD YOU CONSULT A SPECIALIST FOR CONSTIPATION?
Every time there are changes in bowel habits (especially if periods of constipation alternate with periods of diarrhea), it is advisable to consult a colon-proctology specialist. If there is also bleeding, a medical examination is strongly recommended.
HOW CAN THE CAUSES OF CONSTIPATION BE DETERMINED?
First and foremost, the colon-proctology specialist performs a digital examination and anorectoscopy. These two simple procedures are essential to rule out the presence of organic causes in the anorectal area. Subsequently, the assessment of the intestine may involve performing a colonoscopy, which can be traditional or virtual, or performing a CT colonography.
Double-contrast barium enema is less commonly used today. With these methods, diverticula, polyps, neoplasms of the colon-rectum, and other possible causes of constipation can be identified. Transit time through the intestines can be calculated using the transit time with markers. For functional assessment of the anorectal tract, manometry is useful. For the study of constipation due to obstructed defecation, defecography (cinedefecography, colpocistoenterodefecography, and pelviperineography) and magnetic resonance imaging (MRI) are used to detect the presence of rectocele, rectal prolapse, enterocele, or pelvic floor disorders, all of which can cause obstructive symptoms.
HOW IS CONSTIPATION TREATED?
Most patients benefit from adding fiber and liquids to their diet and engaging in physical activity. These measures also reduce cholesterol levels in the blood, thereby reducing the risk of colon tumors. Fiber (bran, wheat, leafy vegetables, fruit, etc.) should be consumed in adequate amounts for extended periods, and the use of laxatives should be completely avoided. Sometimes, substances that soften stools (mucilages) may need to be prescribed. However, laxatives or enemas should be used only under close medical supervision.
These measures often resolve or at least improve constipation due to obstructed defecation as well. However, when diet, physical activity, and stool softeners are not sufficient, surgery may be necessary (see the chapter on "rectocele and obstructed defecation"). If constipation is of organic origin (colon polyps or tumors), treatment must necessarily involve surgery, either alone or in combination with radiotherapy or chemotherapy.