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Constipation is infrequent or uncomfortable bowel movements. The bowel movements may be small, hard or dry. The number of times a person opens her bowels (defecates) daily varies. It could be 2-3 times a day or once in 2-3 days. Constipation is considered to be present when a person defecates twice a week or less, and is associated with straining. Constipation is more common in women.

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Symptoms
Causes
Management
New Lifestyle

* Stools are drier and harder and more difficult to pass
v Straining to pass motion
v Pain during bowel movement
v Cramps in abdomen

Causes

1. Simple Constipation
    A. Rectal stasis, which in turn may be due to
        - Faulty habits
        - Pain in the anal region
        - Impaired consciousness, due to over-sedation.
    B. Colon stasis, which in turn may be due to
        - insufficient food intake (insufficient cellulose residue in the diet)
        - altered tone of the bowels, due to endocrine dysfunction
        - use of certain drugs e.g. iron, codeine

2. Organic Constipation
    This may be caused by
        - Disease conditions e.g. diabetes, peptic ulcer with obstruction, depressive states.
        - Colonic, rectal and pelvic diseases.
        - Pressure on the rectum e.g. during pregnancy, due to pelvic tumors

Consult Your Doctor When
     v Constipation develops as a new symptom after the age of 40.
     v Constipation becomes more painful, severe and more frequent.
     v Stools become blood stained – dark, tar-like stools.
     v There is a change in bowel motion.Constipation alternating with diarrhea.
     v Constipation that does not improve with self-care medication.

Management

The doctor should be consulted to determine the underlying cause of the chronic constipation.
    v Slow transit constipation – (due to consumption of low residue diet), can be treated by
        changing to a high fibre diet, with plenty of fluid and regular exercise. Foods high in fibre
        are bran, dried fruits, nuts and pasta. Vegetables and fruits contain non-absorbable
        cellulose and pectin that are also useful for treatment of constipation.
    v Pharmacological preparations which are bulk-forming agents, e.g. methyl cellulose and
        isphaghula husk, are useful when diet alone does not relieve symptoms.
    v Osmotic laxatives e.g. magnesium sulphate or hydroxide are useful.
    v Stimulant laxatives – increase intestinal motility e.g. senna
    v Fecal softeners, e.g. liquid paraffin, are a short-term aid in softening stools in the
        presence of anal disease.
    v Prokinetic agents e.g. cisapride, shorten the intestinal transit time.

New Lifestyle

Diet
    - include more fibre in the daily diet.
    - drink 6-8 glasses of fluid e.g. juices, water, tea, coffee

Exercise
    - start a new exercise program, or brush up sports enjoyed in the past.

Habits
    - open bowels regularly and don’t ignore the urge
    - control stress and learn to relax
    - don’t apply too much pressure on a child’s toilet training.
    - don’t self medicate with too many antacids

Constipation should not be ignored, but should be overcome at an early stage, when the root problem has been identified after discussion with your doctor.