Constipation is a common complaint in clinical practice and usually refers to persistent, difficult, infrequent, or seemingly incomplete defecation.

Because of the wide range of normal bowel habits, constipation is difficult to define precisely. Most persons have at least three bowel movements per week; however, low stool frequency alone is not the sole criterion for the diagnosis of constipation. Many constipated patients have a normal frequency of defecation but complain of excessive straining, hard stools, lower abdominal fullness, or a sense of incomplete evacuation. The individual patient’s symptoms must be analyzed in detail to ascertain what is meant by “constipation” or “difficulty” with defecation.

Stool form and consistency are well correlated with the time elapsed from the preceding defecation. Hard, pellety stools occur with slow transit, while loose watery stools are associated with rapid transit. Both small pellety or very large stools are more difficult to expel than normal stools.

Psychosocial or cultural factors may also be important. A person whose parents attached great importance to daily defecation will become greatly concerned when he or she misses a daily bowel movement; some children withhold stool to gain attention or because of fear of pain from anal irritation; and some adults habitually ignore or delay the call to have a bowel movement.

Causes
Pathophysiologically, chronic constipation generally results from inadequate fiber or fluid intake or from disordered colonic transit or anorectal function.

These result from neuro gastroenterologic disturbance, certain drugs, advancing age, or in association with a large number of systemic diseases that affect the gastrointestinal tract.

Constipation of recent onset may be a symptom of significant organic disease such as tumor or stricture.

In idiopathic constipation, a subset of patients exhibit delayed emptying of the ascending and transverse colon with prolongation of transit (often in the proximal colon) and a reduced frequency of propulsive HAPCs.

Outlet obstruction to defecation (also called evacuation disorders) may cause delayed colonic transit, which is usually corrected by biofeedback retraining of the disordered defecation.

Constipation of any cause may be exacerbated by hospitalization or chronic illnesses that lead to physical or mental impairment and result in inactivity or physical immobility.

COMMON CAUSES OF CONSTIPATION:
– Colonic obstruction: Neoplasm, stricture, ischemic, diverticular, inflammatory
– Anal sphincter spasm
– Anal fissure, painful hemorrhoids
– Medications
– Irritable bowel syndrome
– Colonic pseudo-obstruction
– Disorders of rectal evacuation
– Hypothyroidism
– Hypercalcemia
– Pregnancy
– Depression
– Eating disorders
– Drugs
– Parkinsonism
– Multiple sclerosis
– Spinal cord injury
– Progressive systemic sclerosis

MANAGEMENT OF THE CONDITION:

A careful history should explore the patient’s symptoms and confirm whether he or she is indeed constipated based on frequency (e.g., fewer than three bowel movements per week), consistency (lumpy/hard), excessive straining, prolonged defecation time, or need to support the perineum or digitate the anorectum.

In the vast majority of cases (probably >90%), there is no underlying cause (e.g., cancer, depression, or hypothyroidism), and constipation responds to ample hydration, exercise, and supplementation of dietary fiber (15-25 g/d).

A good diet and medication history and attention to psychosocial issues are key.

Physical examination and, particularly, a rectal examination should exclude fecal impaction and most of the important diseases that present with constipation and possibly indicate features suggesting an evacuation disorder (e.g., high anal sphincter tone).

The presence of weight loss, rectal bleeding, or anemia with constipation mandates either flexible sigmoidoscopy plus barium enema or colonoscopy alone, particularly in patients >40 years, to exclude structural diseases such as cancer or strictures.

Colonoscopy alone is most cost effective in this setting since it provides an opportunity to biopsy mucosal lesions, perform polypectomy, or dilate strictures.

HOMOEOPATHIC APPROACH:

NUX VOMICA:
Ineffectual urging for stool,stools are passed unsatisfactorily
Constipation resulting after over use of medications and taking rich and spicy foods
Person feels that something is still left behind after passage of stool

BRYONIA:
Constipation ,hard dry stools are passed with much difficulty
Stiching type of pain in the rectum
Obstinate constipation
Stools are black s if burnt

ALUMINA:
Constipation resulting after eating potatoes and lead poisoning
Soft stools are passed with much difficulty
Constipation is accompanied usually by leucorrhoea

SILICEA:
Constipation due to inefficiency of anal sphincter
Stools recedes back
Suits chronic constipation

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Category: Medicines and Remedies
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