Chronic or occasional constipation

La Constipation is a delay or difficulty in passing stool. It can be occasional (travel, pregnancy, etc.) or chronic. We are talking about chronic constipation when the problem lasts for at least 6 to 12 months, with more or less marked symptoms.

The frequency ofstool evacuation varies from person to person, ranging from 3 times a day to 3 times a week. We can talk about constipation when the stools are hard, dry and difficult to pass. Usually this happens if there is less than 3 bowel movements per week.

Constipation can be either transit (or progression), that is, stools stagnate for too long in the colon, either terminal (or evacuation), that is, they accumulate in the rectum. The 2 problems can coexist in the same person.

In North America, it is estimated that 12% to 19% of the population, both children and adults, suffer from Constipation chronic⁹.

Causes

Intestines that contract

During digestion, the intestines contract to move food through the digestive tract. This phenomenon of contractions is called peristalsis. In case of Constipation, peristalsis is slowed down and stools stay in the colon for too long. In the vast majority of cases, no organic cause is found and the constipation is said to be “functional”.

Bad eating habits

Most of the time, functional constipation is caused by bad eating habits, physical inactivity, stress, anxiety, or the presence of hemorrhoids or anal fissures that cause the person to hold back from having a bowel movement.

Constipation may result from food allergies or intolerances, especially to lactose in the cow milk, a situation that is less rare than one might think in young children with chronically constipated1,2.

Refraining from going to the bathroom

Delay the evacuation of stool when the urge is felt is another common cause of constipation. The longer they stay in the colon, the harder the stools become like stones and difficult to pass. This is because the body reabsorbs a lot of water from the stool through the colon. Holding back their evacuation can also cause pain and anal fissures.

Contraction of the sphincter

In some people, during a bowel movement, the muscle in the anus (the anal sphincter) contracts instead of relaxing, which blocks the passage of stool^14,15. To explain this poor synchronization of reflexes, hypotheses often point to psychological factors¹⁶. In many cases, however, there is no cause or trigger.

A consequence

La Constipation can also result from more complex disease or accompany it (irritable bowel syndrome, in particular). It can also be diverticulitis, an organic lesion of the colon (colorectal cancer, for example), an abnormality of the metabolism (hypercalcemia, hypokalaemia), or an endocrine problem (hypothyroidism) or neurological (diabetic neuropathy). , Parkinson’s disease, spinal cord disease).

Bowel obstruction

In rare cases, constipation is caused by occlusion (or obstruction) intestinal, which corresponds to a total blockage of intestinal transit. Constipation then occurs suddenly and is accompanied by vomiting. It requires an emergency consultation.

Many pharmaceuticals can also cause Constipation, including, paradoxically, certain laxatives when taken for long periods, anxiolytics, antidepressants, morphine, codeine and other opiates, certain antispasmodics (anticholinergics), anti-inflammatories, muscle relaxants, certain antihypertensives (especially calcium channel blockers like diltiazem), diuretics, antacids containing aluminum, etc. Some iron supplements can also cause constipation, but not all have this effect.

Finally, in rare cases, in children and Constipation may be a sign of Hirschsprung’s disease, a disease present from birth related to the absence of certain nerve cells in the intestine.

When to consult?

La Constipation, especially when it comes on suddenly, can be a sign of a serious illness, such as colon cancer. This symptom should therefore not be overlooked. It is advisable to consult a doctor in the following cases.

• Recent constipation or accompanied by blood in the stool.
• Bloating, pain, or constipation that alternates with diarrhea.
• Weightloss.
• Stools that are continually decreasing in size, which may be a sign of a more serious bowel problem.
• Constipation that lasts for more than 3 weeks.
• Constipation that persists in newborns or very young children (because Hirschsprung’s disease must be ruled out).

Possible complications

In general, the Constipation is benign and goes away on its own within a few days, thanks to a diet adapted. However, if it persists, certain complications can sometimes occur:

• hemorrhoids or anal fissures;
• bowel obstruction;
• fecal incontinence;
• fecal impaction, which is an accumulation and compaction of dry stools in the rectum, which occurs mainly in the elderly or bedridden;
• abuse of laxatives.