Courtesy of THIS Quarterly magazine  
 
 
Lowdown On Constipation  
 
   
     
 

CONSTIPATION OR DIFFICULTY IN PASSING MOTION IS VERY COMMON. EVERYONE HAS EXPERIENCED THIS unpleasant symptom. Most cases of constipation are harmless and easily treated, some are not, while others are positively dangerous. It is best understood by separating it into four types

Temporary acute constipation can occur in any normal individuals after an illness, taking cough mixtures, starting a weight-loss diet or when travelling overseas. Most sufferers would self medicate with over-the-counter laxatives. Once the offending hard stool is passed, one feels greatly relieved and there is no long term side-effect. The wisest thing to do is to prevent this kind of constipation. When travelling overseas, in addition to having adequate fruits, vegetables and fluids, it is very helpful to take packet supplemental fibre and stool-softener.

Chronic curable constipation is estimated to affect 10% of the world population. It is defined as having two of the following symptoms: infrequent bowel movements (more than three days); passing hard stools; constant straining and a feeling of incomplete evacuation. Normal bowel movements require the colon to be filled with formed but soft stools and to possess a rhythmic propulsive force called peristalsis. Small tiny pieces of stools are very difficult to pass, requiring excessive straining, very much like the difficulty in squeezing out toothpaste from a near-empty tube. Children much prefer potato chips and ice-cream to fruits and vegetables. When passing motion is difficult or painful, they tend to hold their stools, sometimes for days. With time the colon becomes lazy and chronic constipation develops. Very often, stimulant laxatives like Senokot, Dulcolax or senna-containing herbal teas are used. This particular group of laxatives stimulates the nerves in the colon forcing it to contact, just like beating a horse to get it to run. The poor sufferers are often labelled as “dependent or additive to laxative”

 

The correct treatment is to use three different groups of laxatives: fibre to provide bulk; softener to loosen hard stools and colonic stimulant to encourage peristalsis. Simultaneously, the patient has to take adequate fruits, vegetables and fluids and to do some exercise. The aim is to train the bowel to get it back to function normally, which may take months. Once achieved, the laxatives are slowly withdrawn starting with the stimulant laxatives, the only group of laxatives that can cause “dependence and addiction”, because they can damage the nerves of the colon and turn the mucosa black. The other group of laxatives like fibres and stool softeners do not, and they can be used for long term maintenance if necessary.

Chronic incurable constipation is seen in patients born with faulty muscles or nerves of the colon, with damaged spinal cord, with damaged colon from stimulant laxative abuse or severe infection, and patients who are terminally ill with no strength to push and are on morphine, which makes the stools very hard. Treatment includes long term combination laxatives, manual evacuations, enemas or appropriate surgery.

Dangerous constipation is seen in patients with bowel obstruction. The two common causes are abdominal adhesions (sticking together of the intestines after surgery) or cancer. The constipation is associated with abdominal pain, distension and vomiting. It is important to relieve the obstruction quickly because obstructed bowel may perforate causing severe abdominal infection or peritonitis. With cancer the treatment is usually surgery.

 

 

 
 
 
DR GOH HAK SU | Colorectal Surgeon
MBBS, FRCS, FAMS

Address
 
Goh Hak-Su Colon & Rectal Centre
6 Napier Road #04-08
Gleneagles Medical Centre
Tel : (65) 6473 0408
Website : www.gohhaksu.sg