Constipation

Constipation is one of the most common symptoms arising from the digestive tract. Usually it is rather a nuisance but not a serious finding. Under certain circumstances (described below), however, we have to approach to this issue with caution.

Causes

Dietary influence, lifestyle

In Western society constipation is often associated with poor dietary habits. Lack of fiber is probably the most important factor. The less fiber we eat, the smaller stool volume and the stiffer consistency. Inadequately low fluid intake also contributes. Solid stool passes through bowels only slowly and with problems causing constipation. This condition is closely related do diverticulosis occurrence. The general situation is further worsened by lifestyle lacking physical activity.

Medication

A number of drugs are associated with constipation. Typical examples are strong opiates used as potent painkillers and many antidepressants.

Psychic and age influence

In younger people constipation can occur during stress events or location change (travelling, vacation, etc.). Bowel habits of older people depend on their mental health and neurological diseases. Depressive syndrome, dementia, advanced age and Parkinson's disease, those are the factors associated with slower passage of stool and constipation.

Laxative overuse

Excessive use of laxative agents for a long time can weaken bowel muscles and thus, paradoxically, result in constipation. Therefore, it is preferable to try to solve constipation primarily by dietary and lifestyle changes.

Metabolic causes

Decrease of gut motility (followed by constipation) occurs especially during serum changes of potassium and calcium ion levels (hypocalcaemia, hypokalemia), in underactive thyroid gland a prolonged diabetes damaging functions of organ nerves.

Hemorrhoids

If hemorrhoids are painful, the expectation of pain by bowel movements leads to more or less conscious effort to put off defecation. It is associated with decreased gut motility and consequent constipation.

Anal fissure

It is the same problems as hemorrhoids. The fissure itself does not form an obstacle, but sharp pain during bowel movement may significantly negatively affect the frequency of defecations.

Colon Cancer

This is obviously one of the most serious causes of constipation. Some colon tumors grow into the bowel cavity and cause obstruction of certain level. It is more typical for tumors of left colon and classic symptom is alternating diarrhea and constipation. If this symptom is present, cautious approach is needed, especially when accompanied with other cancer symptoms such as blood in stool, weight loss or night sweats.

Diagnostic approach

Medical history (lifestyle, eating habits, length of problems, presence of other symptoms, current medication, etc.) should be followed by physical examination focusing on abdomen including digital rectal exam. Blood tests can inform us about inner environment, serum ion levels and blood count. Blood cont is especially important, because hemoglobin decrease (anemia) often accompanies colorectal cancer. Fecal occult blood test is also a good option as it can diagnose small traces of blood in stool invisible by naked eye.

 

Imaging methods usually include abdominal ultrasound (and possibly computed tomography). Endoscopic methods such as gastroscopy or colonoscopy are used less frequently. Especially colonoscopy is in case of constipation a valuable examination method where the doctor can view the entire colon, remove polyps and take biopsy samples from suspicious lesions.