Constipation

• Reduced bowel movement of less than three times a week
• Passing hard and lumpy stools
• Straining while passing stools
• Feeling of fullness, even after passing stools
• Feeling of not being able to completely evacuate the stools from the rectum
• Feeling of a blockage in the rectum that prevents passing stools
• Some people may even need digital evacuation of stools
• Bloating
• Feeling sluggish
• Abdominal pain

Some of the common causes of constipation include:

1. Poor dietary habits
   One of the common causes of constipation is poor dietary habits that can affect bowel movements. If your diet fails to include foods rich in fiber such as fruits and vegetables in the right quantity, it can affect digestion and the passage of stools. This is because fiber acts as a natural laxative, holding water in the stool, increasing its bulk, and making it easier to pass.
2. Insufficient fluid intake
   Lack of sufficient water in the body can lead to dehydration, which is another factor that can cause constipation. When you suffer from dehydration, the body tries to conserve water by removing it from the stools. As a result, the stools contain less water, making them harder to pass from the rectum.
3. Use of certain medicines
   Constipation can be caused as a side effect of certain medicines such as iron salts, opioids, sedatives, over-the-counter antacids, and some drugs used to lower blood pressure. If you are taking any of these medicines, consult your doctor. They may either change the dosage or help you treat constipation with other medications or laxatives. The following medicines can cause constipation:
   • Paracetamol - if more than seven tablets are taken in a week
   • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
   • Iron and calcium supplements
   • Aluminum-containing antacids
   • Anticholinergic agents or medicines that oppose the actions of the neurotransmitter acetylcholine, including drugs for Parkinson’s disease, depression, delusions, hallucinations, and muscular spasms
   • Anticonvulsants (drugs used to treat seizures) such as carbamazepine, phenobarbital, and phenytoin
   • Cancer drugs such as vinblastine, vincristine, vindesine, and vinorelbine
   • Calcium-channel blockers such as verapamil
   • Water pills (diuretics) such as furosemide
4. Underlying medical conditions
   Constipation can be caused by various health conditions, including:
   • Irritable bowel syndrome
   • Endocrine disorders like diabetes, hypothyroidism, hyperparathyroidism, hypercalcemia, hypokalemia, and insufficient production of pituitary hormones
   • Tumor of the adrenal gland
   • Delayed emptying of the colon caused by pelvic floor disorders and colon surgery
   • Diverticular disease
   • Bowel obstruction
   • Narrowing of the colon or bowel stricture
   • Colorectal cancer
   • Other abdominal cancers that press on the colon
   • Rectal cancer
   • Lazy bowel syndrome, characterized by slow movement of waste through the digestive tract
   • Neurogenic disorders like spinal cord injury, stroke, multiple sclerosis, Parkinson’s disease, and brain injury
   • Structural defects in the digestive tract like fistula, imperforate anus, and malrotation
   • Diseases like amyloidosis, lupus erythematosus, and scleroderma
5. Overuse of laxatives
   Laxatives are common medications used to treat constipation. In many cases, people with this condition do not consult a doctor but use laxatives to relieve constipation. However, overuse of laxatives is not good for health. People who frequently use laxatives tend to lose the ability to pass stools without such aids. Hence, in the long run, it can lead to increased laxative use and a higher risk of constipation. Conventional laxatives, as a first step for treating constipation, are not effective in many cases. Moreover, laxatives can cause drug interactions with other medications.

The risk factors for constipation include:

• Age - constipation is more common in older adults
• Gender - constipation occurs more frequently in women
• Resisting or delaying the urge to pass stools
• Travel or other changes in daily routine
• Less physical activity - people with a more sedentary lifestyle are more likely to have constipation
• Stress
• Depression or any eating disorder
• Pregnancy, especially during the last months
• During menopause

Constipation is a common symptom during pregnancy, but this doesn’t mean that every pregnant woman will suffer from constipation. If you are pregnant and experiencing constipation, here’s a quick guide with tips to help control the condition.

The diagnosis of constipation depends largely on the patient’s history. The doctor will take:

• Medical history (other health problems and medications taken)
• Dietary history (intake of fiber and water)
• Symptoms history (duration and severity)
• Physical examination

This may include:

1. Abdominal examination to assess for distension. An enlarged or swollen bowel may indicate constipation.
2. Rectal examination to check for scars, hemorrhoids, fistulas, or fissures around the perineum (the area between the anus and scrotum in males or vulva in females).

Laboratory tests may be conducted to identify underlying conditions that cause constipation. These may include:

1. Blood tests to evaluate hemoglobin, thyroid stimulating hormone (TSH), calcium, and glucose levels, which can reveal signs of risk factors such as anemia, hypothyroidism, hyperparathyroidism, and diabetes.
2. Stool examination to check for signs of infection, inflammation, or cancer.
3. Radiology tests such as abdominal X-ray, CT scan, or MRI of the colon to assess the length and width of the colon or any lesions that may cause obstruction.
4. Barium enema study, an imaging study that uses X-rays along with an enema containing barium to detect abnormalities inside the colon. The contrast solution is injected into the rectum, producing clearer images compared to other imaging studies.
5. Defecography, a modification of the barium enema examination, involves inserting a thick paste of barium into the rectum to examine the process of defecation and provide information about anatomical abnormalities of the rectum and pelvic floor muscles.
6. Magnetic resonance imaging defecography, a recent advancement for evaluating defecation, uses MRI instead of X-rays to provide images of the rectum during defecation.
7. Colonic transit (marker) studies, which involve consuming a small amount of a radioactive substance, typically in pill form, and tracking the time and manner in which the substance moves through the colon.
8. Colonoscopy or endoscopy of the colon, a diagnostic method in which a long, flexible, lighted tube is inserted through the rectum to visualize the colon. During this procedure, a biopsy may also be taken to test for cancer or other issues.

• Eat a high-fiber diet comprising fruits, vegetables, legumes, and whole grains. Restrict foods with low amounts of fiber, such as processed and packaged foods, milk, and meat products.
• Drink a minimum of 8 glasses of water each day. Limit intake of alcohol and caffeine, including coffee and soft drinks, as they can lead to dehydration.
• Stay active and exercise regularly.
• Do not delay the urge to pass stools.
• Try to manage stress.

Treatment for constipation mainly includes lifestyle changes and medications to soften the stools or stimulate their movement through the colon. Mild constipation often improves with lifestyle modifications, while severe constipation may require medications.

1. Lifestyle Modifications

Constipation can be easily avoided by making a few changes to daily habits, including diet and lifestyle. These include:

Dietary Changes

• Drink at least 3 liters of water daily. Water hydrates the body, softens stool, and aids its movement through the colon.
• Include fiber-rich vegetables such as carrots, cabbage, cauliflower, broccoli, spinach, and various gourds in your diet. Blanch the vegetables and add seasoning and spices. Aim for portions of 250-300 grams daily.
• Consume a variety of fruits daily, such as oranges, apples, papayas, dates, and figs. These fruits are rich in dietary fiber and nutrients.
• Substitute white rice and polished wheat with whole grain products like brown rice and unpolished wheat. Oats also provide similar benefits. Aim for a cup of these healthy grains daily.
• Avoid certain foods during constipation. Read more!

Lifestyle Changes

• Use the toilet at a fixed time every day to establish a routine for defecation. The morning is the best time to start this habit.
• Avoid alcoholic drinks as much as possible, as alcohol dehydrates the body and hardens stool.
• Engage in exercises like jogging, cycling, running, and swimming to boost your metabolic rate and combat constipation.
• Reduce or eliminate the consumption of oil and sugar-rich foods, which can upset digestion, cause constipation, and lead to obesity.

2. Medicines

Laxatives are compounds that promote bowel movements and are used to relieve and prevent constipation. Some laxatives are available over the counter (OTC) and come in various forms, including capsules, suppositories, enemas, pills, gums, and liquids. Most laxatives are advised for short-term use only; consult your doctor before using any medications.

• Bulking agents: Bran and psyllium are fiber supplements recommended for normal constipation. They add bulk to stools and help them move quickly through the colon. Drink ample amounts of water when using bulking agents to maintain hydration.
• Lubricants: Help in the smooth movement of stools through the colon (e.g., mineral oil).
• Stool softeners: Work by moistening the stools (e.g., docusate sodium).
• Osmotic laxatives: Stimulate water absorption from the body to soften stools (e.g., lactulose, lactitol, polyethylene glycol).
• Stimulant laxatives: Help contract the muscles in the intestines rhythmically (e.g., castor oil, sodium picosulfate, bisacodyl).
• Enemas: Use a thin tube to inject a liquid or gas into the rectum to expel its contents (e.g., phosphate enema, mineral oil retention enema, soapsuds enema).
• Suppositories: Containing glycerin or bisacodyl are placed into the rectum.
• Chloride channel activators: Such as Lubiprostone are used to treat chronic constipation.

Here’s more information about different types of laxatives and how they work. Click to read!

Constipation, if left untreated or if experienced for a prolonged period, may lead to the following complications:

• Hemorrhoids: A condition that results in swollen veins in the rectum and anus.
• Rectal prolapse: A condition in which part or the entire wall of the rectum stretches and protrudes from the anus.
• Anal fissures: Small tears in the anus that can cause pain and bleeding.
• Fecal impaction: A condition where hardened stools become lodged in the intestines due to long-term constipation.

Biofeedback
It is used to treat chronic constipation. It involves training of pelvic floor muscles for passing stools by electronic monitoring.

Natural Products
Many natural products may help with constipation, including:

• Psyllium husk or Isabgol
• Methylcellulose
• Calcium polycarbophil
• Guar gum

Foods to Relieve Constipation
Fruits, cereals, leafy vegetables, curd, and seeds can help manage constipation. These foods are known to add bulk to stools, increase bowel frequency, soften stools, and decrease gut transit time (the time taken by food to move through the digestive tract). However, monitor your fiber intake, as excessive fiber can worsen constipation. Here are some common foods to relieve constipation:

1. Kiwi
   Green kiwi fruit increases stool frequency, softens stools, and eases defecation. This is attributed to the presence of fiber (2-3 g of dietary fiber per 120 g of fruit), which plays a key role in stool bulking and relieving constipation. It also contains an enzyme that stimulates motility in the upper gastrointestinal tract.
   Tip: Peel the fruit, cut it into thin slices, and eat it raw or add it to salads or smoothies to combat constipation.
2. Banana (Kela)
   A medium-sized banana (approximately 100 g) contains about 3 g of fiber. It absorbs water to soften stools and improves stool movement through the intestinal tract.
   Tip: Eat a banana daily for regular bowel movements and to prevent chronic constipation. Bananas are best consumed whole, not in smoothies or milkshakes.
3. Prunes
   Dried plums, or prunes, contain around 6.1 g of fiber per 100 g, which is high compared to other fruits. They are rich in fructose and have a high sorbitol content (14.7 g per 100 g), a sugar compound with laxative properties.
   Tip: Consume prunes whole. Avoid prune juice for constipation relief, as it has less sorbitol and fiber.
4. Apple (Seb)
   A medium-sized apple contains around 4.4 g of fiber, mostly pectin. This fiber is broken down into short-chain fatty acids by intestinal bacteria, which absorb water, soften stools, and decrease intestinal transit time.
   Tip: Eat the apple with its peel to increase fiber intake. Add apples to fruit salads.
5. Pear (Naspati)
   A medium-sized pear provides around 22% of your daily recommended dietary fiber. In addition to fiber, pears are rich in fructose and sorbitol.
   Tip: Pears are best eaten whole. Drinking pear juice is usually recommended for children whose intestinal function is not fully matured.
6. Figs (Anjeer)
   Both raw and dried figs are excellent sources of fiber, aiding in constipation relief and promoting a healthy bowel. Approximately 75 g of dried figs contains 7.3 g of fiber, while raw figs contain 2 g.
   Tip: Snack on figs by including them in fruit salads, juices, or smoothies, but eating them whole is the best way to increase fiber intake.
7. Spinach (Palak)
   Spinach is a common leafy vegetable loaded with fiber, as well as various minerals and vitamins that improve digestion. A cup of spinach contains around 4 g of fiber, which adds bulk to stools and facilitates movement through the gut.
   Tip: Prepare palak parathas, palak paneer, or add spinach to smoothies or salads.
8. Oats
   Oats are beneficial for constipation sufferers due to their high fiber content. Oat bran, the outer covering of the grain, is particularly rich in fiber. Adding around 8 g of oat bran to your diet daily can reduce the need for laxatives.
   Tip: Incorporate oat bran into wheat flour, granola mixes, or baked goods. Use oat bran instead of ready-to-eat oats, which contain less fiber.
9. Flaxseeds (Alsi)
   Flaxseeds are a traditional remedy for constipation, acting as a natural laxative due to their soluble and insoluble fiber content. A tablespoon of roasted flax seeds contains around 3 g of fiber.
   Tip: Add flaxseeds to cereals or salads. Flaxseed powder can be mixed with wheat flour or milk.
10. Sweet Potato (Sakargandi)
    Unlike regular potatoes, sweet potatoes are high in fiber. A medium-sized sweet potato contains around 3.8 g of both insoluble fibers (cellulose and lignin) and soluble fiber (pectin), which facilitate bowel movement and add weight to stools.
    Tip: Consume sweet potatoes boiled or roasted to increase fiber intake. Alternatively, steam, mash, and incorporate them into curries or salads.
11. Probiotics
    Probiotics contain bacteria such as bifidobacteria and lactobacilli, which help maintain the balance of good bacteria in the digestive tract, aiding proper digestion.
    Tip: Curd and buttermilk are excellent natural sources of probiotics that are readily available. Incorporate curd into your diet.

A few examples of natural drinks that help relieve constipation instantly.

Yoga for Constipation
Yoga offers several poses that stimulate peristaltic action and increase blood flow to the gut. When practiced regularly, yoga can help promote regular bowel movements.

• Matsyasana (Fish Pose)
• Anjaneyasana (Crescent Pose)
• Pavanamuktasana (Wind-Relieving Pose)
• Balasana (Child’s Pose)