Contents
What is constipation?
Constipation is a situation in which a person has no stool for more than 24 hours, or a bowel movement occurs, but after it there is a feeling of incomplete emptying of the intestine.
In a healthy person, the frequency of bowel movements depends on nutrition, habits and lifestyle. People who suffer from constipation often complain of chronic fatigue, bad taste in the mouth, nausea, and decreased appetite. In patients with constipation, the abdomen is swollen, an unhealthy yellowish-brown skin tone, slight anemia and vitamin deficiency may be observed due to non-absorption of nutrients due to the frequent use of laxatives.
Constipation (constipation) affects up to 20% of the world’s population, mainly residents of developed countries. The problem of intestinal dysrhythmias is relevant for all age groups. Most often, constipation develops in people 25-40 years old, and then the problem only gets worse. At the fertile age, constipations are more typical for women. During the period of male and female menopause, statistical differences are minimal. Constipation in older people is about 5 times more common than in young people. These observations are recognized by most researchers involved in the problems of age-related gastroenterology.
Description of the disease
Normal bowel movement is an indicator of human health. Various sources indicate approximate physiological norms for the frequency of defecation, the volume of feces formed per day, the shape and consistency of feces.
The proper functioning of the gastrointestinal tract is characterized by the following features:
Bowel emptying in a healthy person occurs at a frequency of three times a day to three times a week;
The weight of feces is from 100 to 200 grams per day, the minimum rate is 40 grams;
The form remains – in the form of a cylinder (sausage-shaped);
The consistency of feces is soft.
Defecation disorders in some cases are a variant of the norm and are random. Meanwhile, constipation is almost always a sign of gastrointestinal pathologies, manifested by constipation and other symptoms.
In the clinical diagnosis of IBS, the following types of defecation correspond to constipation:
Less than three times a week
Fecal volume less than 40 grams;
The act is accompanied by a strong straining and ends with the release of small dense pieces of feces of a round shape;
In some cases, defecation is possible only by the method of forced emptying of the rectum.
Subjective criteria for constipation in patients with functional constipation syndrome:
Feeling of incomplete emptying of the bowels after a bowel movement;
Sensation of blockage (the presence of a plug) in the rectum.
Constipation is not always true, it can be temporary and short-lived.
The accidental origin of intestinal dysrhythmias is excluded:
Identification of two or more of the above clinical signs of constipation and subjective sensations in patients;
Duration of symptoms of constipation. It is generally accepted to consider constipation true if they continue for twelve weeks during the six months preceding the date of the visit to the doctor (short periods of remission are possible at this time).
Why is constipation dangerous?
Based on the degree of influence of constipation on the quality of life and human health, they are divided into three types:
Compensated. Constipation does not have a noticeable effect on the homeostasis of the body. Many researchers consider this stage to be the upper limit of the physiological norm;
Subcompensated. The boundary state between the norm and pathology. The border with the compensated stage of constipation is conditional. Low or medium danger to the body;
Decompensated. Pathological constipation, often associated with a disease. It has a pathophysiological effect on the body, in some cases causes morphological changes in the internal organs. Medium or high danger to the body.
I. Stage of compensated constipation
Most people suffering from this stage of constipation do not go to the doctors. They are treated with traditional medicine or over-the-counter drugs, prevention is carried out by experimenting with diets. The stage is most typical for persons from 25 to 45 years old suffering from functional constipation. In children, compensated constipation is more often of organic origin, namely, it is the result of an unusual lengthening of some sections of the intestine. Pathological changes in the body associated with constipation are not expressed. First of all, the quality of life suffers.
The stage of compensated constipation is characterized by the following diagnostic features:
When interviewed, patients are diagnosed with neurosis, stress, mental and emotional disorders, as well as peculiar living conditions, when a person is forced to restrain the urge to defecate for a long time;
With in-depth functional and laboratory studies of the gastrointestinal tract, it is possible to identify signs of a violation of the absorption function of the intestine, in some cases, the initial stages of dysfunction of the internal organs associated with the gastrointestinal tract are recorded.
Clinically, the stage of compensated constipation is manifested by the following symptoms:
No bowel movements for two or three days, rarely longer;
Pain and bloating, the intensity directly depends on the duration of constipation;
The urge to defecate is long, the act usually always ends in success;
The shape of feces according to the Bristol scale corresponds to the second, less often to the first type.
For the treatment of compensated constipation, it is advisable to contact a clinical nutritionist or gastroenterologist in order to correct eating behavior and select the optimal laxative. During this period, it is important to normalize the psycho-emotional sphere of life. According to the indications, an appeal to a neurologist or psychologist is recommended.
II. Stage of subcompensated constipation
Often this is a continuation of the negative scenario of compensated constipation. Sometimes it develops as an independent pathology or a symptom of another disease. Functional subcompensated constipation is diagnosed in the older age group (50-60 years), age fluctuations are possible (at an early age with organic constipation). Clinically, subcompensated constipation is diagnosed by exclusion. Differential diagnosis is carried out with the help of instrumental and laboratory studies and functional tests. An in-depth examination is certainly indicated if constipation has not previously been observed in the patient’s history.
Pathological changes are expressed moderately:
When interviewing patients against the background of neurosis, stress, and the like, pathologies of internal organs and systems are revealed (damage to the liver, gallbladder, hemorrhoids, anal fissures);
In-depth studies of the gastrointestinal tract reveal signs of impaired motor, secretory and excretory functions, sometimes symptoms of damage to internal organs and systems.
Clinically, the stage of subcompensated constipation is manifested by the following symptoms:
No bowel movements for three to seven consecutive days or more;
Pain in the abdomen (it is necessary to differentiate pain in the stomach, intestines, rectum and anus);
The urge to defecate is long, the act is very difficult, sometimes help is needed to empty the intestines;
The shape of the feces according to the Bristol scale corresponds to the first or second type.
Correction of subcompensated constipation requires regular in-depth examination, including colonoscopy (endoscopic examination of the distal intestines).
III. Stage of decompensated constipation
Accompanied by pathological changes in the body. It is usually diagnosed at the age of 50-60 years (age deviations are possible). It may be a continuation of the subcompensated stage or act as a symptom complex of the underlying disease. The most alarming sign is the rapid development of constipation against the background of previous intestinal normotonia and the absence of IBS in history. Hospitalization (according to indications) and an in-depth examination are advisable. After eliminating the causes of constipation, you need to continue examinations on a regular basis with the frequency recommended by the doctor.
Pathological changes are expressed moderately or brightly:
During the survey, a previously transferred gastrointestinal disease or a chronic disease of the internal organs is revealed. Particular attention is paid to the rapidity of pathogenesis;
With in-depth studies of the gastrointestinal tract, signs of damage to internal organs and systems are recorded.
Clinically, the stage of decompensated constipation is manifested by the following symptoms:
There is no chair for a week or more;
Pain and bloating are accompanied by loss of intestinal peristalsis;
There is no urge to defecate, help is needed to empty the bowels;
The shape of feces according to the Bristol scale corresponds to the first or second type (with enema there may be a different shape).
Treatment of decompensated constipation is preceded by in-depth examinations of the gastrointestinal tract and other body systems.
Based on the effect of constipation on homeostasis, there are short and long-term consequences that reduce the patient’s quality of life:
Close consequences of constipation – intoxication of the body with feces, dysfunction of the digestive tract, dysbacteriosis;
Long-term effects of constipation – hemorrhoids, inflammation of the intestines, bleeding during defecation, intestinal obstruction, intussusception, polyps and neoplasms in the rectum.
Decreased quality of life – calomania, constant discomfort, fecal incontinence.
Causes of constipation in adults
I. Organic changes in the intestine
Organic changes in the intestines are not the most common causes of constipation in adults. Previously, it was generally believed that organic changes can only be congenital and, accordingly, they should cause constipation in children. However, medical studies of the second half of the last century in some part refute this statement.
Causes of organic constipation in adults – congenital and acquired intestinal anomalies:
Dolihokols – the colon is longer than normal, there is a change in the ganglia of the muscular walls of the intestine. As a result, the passage of feces is lengthened and slowed down. Constipation in the case of congenital dolichocolon without treatment continues into adulthood. In adults, dolichocolon is a consequence of the abuse of enemas and laxatives, as well as metabolic disorders in the walls of the large intestine;
Megacolon – expansion of the colon. For adults, the reasons are the same. Acquired megacolon is considered if there are no congenital changes in the intestinal walls (structure, atresia). A sign of acquired pathology is constipation with the etiology of megacolon, manifested in adulthood;
Dolihosigma – lengthening of the sigmoid colon. Elongation and expansion – megadolichosigma. In this section, there is an accumulation of feces that have moved from the small intestine. Acquired dolichosigma is a consequence of the processes of fermentation and putrefaction in the intestines with a sedentary lifestyle. Changes in the size and morphology of this section are a common cause of congenital constipation. As a consequence of the vicious circle of pathogenesis, dolichosigma is the cause of acquired constipation;
Additional loops of the sigmoid colon. Observed with an abnormal increase in the length of the sigmoid colon, usually by two or three loops. The reasons are the same as with dolichosigma. The presence of additional loops is accompanied by persistent constipation;
Colonoptosis – a congenital or acquired anomaly, a consequence of the prolapse of the colon (weakness of the ligamentous apparatus of the mesentery), in women develops after childbirth. It is characterized by a slowdown in intestinal motility and, as a result, constipation. It is diagnosed by irrigography – an X-ray method for studying the intestine by filling it with a contrast agent;
Transversoptosis – descent into the pelvic region of the transverse colon. The normal position is in the projection above the navel. Transversoptosis is accompanied by pain, adhesions, impaired innervation and, as a result, constipation. Contribute to the development of this disease lordosis, scoliosis and other types of curvature of the spinal column;
Ileocecal valve insufficiency (baugini damper). The ileocecal valve is a morphological formation at the border of the small and large intestines, which prevents the contents of the large intestine from being thrown into the small intestine. There are congenital and acquired anomalies. Clinically, it is manifested by a variety of symptoms, in particular, alternating constipation and diarrhea;
Diverticulosis of the sigmoid colon. A diverticulum is a hernia-like protrusion of the intestinal wall, the result of dystrophic processes in the walls of the large intestine against the background of high pressure in the intestine. It usually develops over the age of 50. It is clinically manifested by a tendency to constipation, anal bleeding, flatulence (frequent discharge of intestinal gases), a feeling of pulling pain and heaviness in the left side, which disappears after defecation.
The causes of organic constipation in adults can also be adhesive inflammatory processes, acute intestinal obstruction (invagination, incarceration of the intestines, volvulus, as well as dynamic and compression obstruction, as a result of the impact of neoplasms on the intestinal wall).
II. Functional bowel disorders
Functional bowel disorders are common causes of constipation in adults. Constipation of functional origin is a type of dyskinesia of the large intestine. Dyskinesia may be accompanied by diarrhea and/or constipation.
Dyskinesia with a predominance in the pathogenesis of constipation is divided into:
Atonic – the result of pathological relaxation of the smooth muscles of the intestine;
Spastic – the result of a reflex spasm of the anal sphincter or the second part of the large intestine.
In clinical practice, difficulties arise in the differentiation of atonic and spastic constipation due to the mutual influence of factors that cause their manifestations.
Meanwhile, it is customary to consider atonic constipation in humans:
Leading a sedentary lifestyle;
Being in a depressed state with mental disorders and various psychosomatic diseases;
Eating mostly high-calorie foods containing animal protein;
Regularly suppressing the natural urge to defecate.
Spasmodic constipation usually develops in individuals who have:
Problems in the anal sphincter area (fissures, hemorrhoids) and dysfunction of organs that cause reflex spasm of the intestines;
Signs of chronic intoxication with salts of heavy metals;
Endocrine diseases (autoimmune lesions of the thyroid gland, diabetes mellitus);
History of chronic diseases and periods of long-term treatment with drugs that disrupt bowel function, including antibiotics.
Constipation after antibiotics
The use of antibiotics, of course, leads to disruption of bowel function. In some cases, constipation is a consequence of antibiotic therapy. The pathogenesis is not fully understood, probably, there is a violation of the basic functions of the large intestine.
The main physiological functions of the large intestine:
The formation of feces before fecal eruption, participation in the act of defecation;
Reabsorption of electrolytes (water) – this function of the intestine is unique, the absorption of water occurs only in the thick section;
Formation of endoecological biocenosis of saprophytic intestinal microflora, which performs the functions of enhancing the physiological activity of the intestine, hormone synthesis, decontamination of metabolites and activation of the immune system.
Therefore, prolonged use of antibiotics (from 30 days) accompanied by dyskinesia in the form of constipation is probably due to:
Dysbacteriosis, due to which the physiological activity of the intestine is weakened (reduction in the form of rhythmic segmentation, pendulum, peristaltic and antiperistaltic movements);
Increased water reabsorption, resulting in the formation of dehydrated chyme;
Slowed peristalsis of the colon, and, as a result, the delay in the contents of the large intestine.
Sitting position is a common cause of constipation
How does a normal bowel cleansing process take place? Defecation is necessary in order to complete the digestion process and rid the body of processed foods.
When the rectum fills with stool, it naturally stretches. The brain receives signals from sensitive cells in the intestines. The older the person, the lower the sensitivity of these receptors. Therefore, to start the process of defecation, people of age require more stretching of the intestine. The lower part of the rectum is most sensitive, which explains the increased urge in the upright position. It is for the same reason that almost all bedridden patients suffer from constipation.
The next stage of the act of defecation is the beginning of involuntary contractions of the muscles of the rectum and sigmoid colon, due to which the feces move towards the anus. A person cannot influence the force of contraction of the muscles of the intestine if he does not take any drugs for this.
But a person can, by an effort of will, control the relaxation and tension of the circular muscles of the anus. Thanks to this, it is possible to restrain the act of defecation until the right moment comes. However, infinite or very long-term control is still impossible.
When a person decides that it is time to empty the intestines from feces, the puborectalis muscle relaxes, the pelvic floor descends and the anorectal angle expands. If the muscles of the anus are not tense at a given time, then the bowel is emptied.
Attitude to the act of defecation in some countries of the world. Most of the peoples of the world do not treat the process of bowel movement as something unaesthetic or indecent. For example, in Africa, not only every child, but also every adult can empty his intestines where he is in need. In India, they continue to sell such toilet bowls, on which you can take the so-called “eagle pose” and empty your intestines as efficiently as possible.