CONSTIPATION

INTRODUCTION

Constipation is long term infrequency of bowel movements, or difficult passage of stool. Constipation is generally described as having three or less bowel movements in a week. Although occasional constipation is commonplace, chronic constipation (constipation that lasts more than a few weeks) is distressing and can interfere with performance of daily tasks. Chronic constipation may also lead to fecal impaction (hard, immobile stools that are difficult to pass without medication or manual impaction), or fecal incontinence (leaking liquid stool).

Constipation can occur in babies, adults and children, and affects twice as many women as men. Older people are five times as likely to have constipation than younger adults.

Toilet habits vary greatly amongst people, and it is difficult to describe what a normal bowel habit is. Some people go everyday or more than once a day, while some may go once every few days which may be the norm for them. Individuals who experience prolonged periods of going without passing stool away from their normal going habits will experience constipation.

When you are constipated, you feel that passing stools has become more difficult than it used to be. It may feel more difficult for several reasons. For example, you may be going significantly less frequently or much less effectively (you feel you are unable to completely empty your bowel).

Passing stools may also seem more difficult because your stools are:

  • dry, hard and lumpy
  • abnormally large
  • abnormally small

As well as causing a change in your normal bowel habits, constipation can also cause the following symptoms:

  • stomach ache and cramps
  • feeling bloated
  • feeling nauseous
  • loss of appetite

 CONSTIPATION IN CHILDREN

Along with difficulty passing stool, children may also experience the following symptoms when constipated:

loss of appetite

lack of energy

irritability

foul smelling wind and stools

abdominal pain and discomfort

CAUSES OF CONSTIPATON

Although identifying the underlying cause of constipation is difficult and it may often go undiagnosed, there are many known causes of constipation, which may point towards the underlying problem. These include:

Not eating enough fiber

change in daily activities or routines

lack of exercise

ignoring the urge to pass stool

not drinking enough fluids

being overweight or underweight

anxiety or depression

many medications may also have the side effect of causing a change in bowel habits, usually constipation. Medications that cause constipation include:

  • antacids
  • antipsychotics
  • antidepressants
  • calcium supplements
  • iron supplements

Pregnancy may also cause constipation, which occurs in apx. 40% of women.

Constipation in children is often caused by lack of dietary fiber, poor toilet training, or very strict toilet habits enforced by parents, which may lead to a fear of using the toilet. In rare cases, few genetic diseases may cause constipation in children, which manifests very early on in life. These conditions include:

Hirshprung’s disease

malformations of the anus or rectum

spinal cord malformation

cystic fibrosis

MANAGEMENT

The first step towards the management of constipation is life style change, so that medication may not be required for you to get rid of it. This calls for overhaul of your diet, especially if it contains too much processed foods and not enough natural fiber from fruits and vegetables. Ideally you should be getting 18-30 grams of fiber daily. Add bulking agents such as wheat bran to your daily diet.

Along with adding dietary fiber, another crucial change is increasing your amount of water intake. Try and consume 6-8 glasses of water each day. Also incorporate physical activity into your daily routine if you follow a sedentary lifestyle.

If lifestyle changes do not work for you, you may be prescribed an oral laxative. Laxatives are a type of medicine that help you pass stools. There are several different types and each one has a different effect on your digestive system. Lots of laxatives are safe for pregnant women to use because most are not absorbed by the digestive system.

If your baby is constipated but has not yet started to eat solid foods, the first way to treat them is to give them extra water between their normal feeds. If you are using formula milk, make the formula as directed by the manufacturer and do not dilute the mixture.

Adding sugar to feeds or water is no longer recommended as the infant’s metabolism is not able to deal with this sugar load.

You may want to try gently moving your baby’s legs in a bicycling motion or carefully massaging their abdomen (tummy) to help stimulate their bowels.

 

 

Dr. Annie

Physician, mom and wife

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