Thursday, Dec 20 2007

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Constipation - The Common Problem

By Mumtaz Khalid Ismail

More Links Causes of constipation Bowel habits Types of constipation Administration of purgatives Management of Constipation

Constipation is one of the commonest gastrointestinal symptoms suffered by human being. This condition is truly universal and seen in all age groups, sex, socio-economic classes and races. Constipation implies infrequent and incomplete evacuation of hard dried faeces. Wrong eating habits, sedentary lifestyle and sluggish intestines are the main reasons for constipation. If the bowel is not cleared well it can lead to lot of problems such as mood disturbances, headache, flatulence, coated tongue, foul breath and lack of appetite. These symptoms disappear after clear evacuation. A diet that is low in fruits, vegetables and whole grain has made constipation a common problem.

Fibre and starch are fermented in the large bowel and provide the bulk that helps to stimulate the muscles of the colon so that digested food can be pushed through the gut. The longer the digested food residue remains in the bowel the more water is reabsorbed from it, the harder it gets and the more difficult to pass. In chronic constipation straining during evacuation may lead to fissure, piles, prolapse of rectum or hernia. This again aggravates constipation. It is dangerous for a patient with coronary heart disease to strain during defecation. Worry, anxiety and fatigue are other factors, which affect adversely the normal rhythm of evacuation. So, it is always better to make it a practice to answer nature's call in the morning.

1. Irregular eating time.
2. Faulty dietary habits like use of highly refined foods.
3. Inadequate intake of water or fluids.
4. Lack of sufficient rest.
5. Change in ones usual routine due to illness, in travel, nervous tension, and worry.
6. Poor muscle tone of small intestines due to lack of exercise in invalids and the aged.
7. Intake of drugs and medicines like antispasmodic, antimotility drugs, codine, opiate, antacids etc.
8. Difficult or pain full evacuation due to conditions like fissures.
9. Irregular times of evacuation.
10. Due to an abnormally large colon.
11. Decreased movement of intestine as in habitual constipation and pregnancy.
12. In Irritable bowel syndrome.
13. In association with gastrointestinal disease like vomiting, intestinal obstruction.
14. In gastrointestinal malignancies.
15. Systemic diseases like diabetes, hypothyroidism, hypoparathyroidism etc.

One stool a day is necessary for good health for most of the individuals. Some individuals pass motions even twice or thrice a day despite in perfect health and some may pass only every second or third day. Regular bowel movements indicate a healthy bowel and reduce the risk of large bowel disease particularly cancer of colon.

Atonic Constipation.

Atonic constipation is due to lack of adequate intake of fluids, lack of roughage in the diet. Irregular habits of the bowel movement and constant use of purgatives or enemas will result in loss of natural reflexes. It can also be due to fasting or avoiding foods containing unabsorbable cellulose in the form of vegetables and fruits. This leaves little residue for evacuation. Vitamin B deficiency and lack of potassium may result in loss of bowel tone.

Spastic constipation

Spastic constipation is due to irritating foods, irregular bowel movements, due to nervous disorders, excessive use of purgatives or mental stress.

Obstructive constipation

Obstructive constipation is due to the obstruction of the large bowel or malignancy of the colon.

The routine administration of any purgatives to children and adults to clean the bowels affects the tone of the intestines and ultimately leads to constipation, which persists throughout life. Normal healthy individuals should not use purgatives but increase the fluid intake, fruits like prunes, raisins, banana, figs and vegetables and whole grain products. The habitual use of enema or bowel wash leads to increasing constipation as the natural reflexes is not allowed to act. The occasional use of an enema is not harmful. A low enema may be necessary to initiate an excretory reflex during an acute illness or before and after an operation. Similarly a bowel wash is some times indicated as a preparation for surgery of intestine.

Exercise
Exercise is an important factor in the management of constipation. Regular exercise especially for the abdominal muscles or brisk walking is recommended according to the age and physical stage of the individual.

Diet
The calories are recommended according to age, sex and physical activity. 60- 80 gm of protein is advised per day. Fats stimulate the flow of bile and also lubricate the lower bowel. Fat containing foods like butter, cream, ghee, and oils in reasonable amounts are use full for some because of the stimulating effect of the fatty acids on the mucous membranes.

A diet rich in bulk in the form of vegetables and fruits, which are rich in unabsorbable cellulose and unrefined cereals, which contain bran, should be taken. Bran is use full for some patients but excess are to be avoided since it may act as an irritant to sensitive intestinal tracts.

Leafy vegetables like cabbage, spinach, carrots, and radish are also good for regular bowel habit. Fresh fruits are of great value in over coming this condition since it contain roughage in the form of cellulose. Bananas, dried fruits like prunes, figs, raisins, dates, apricots are very use full. B vitamin and potassium in the form of brewer's yeast and vegetable soup, oral potassium salts (kala namak) and juices help to prevent the constipation.

Liberal intake of fluids of about 10 - 12 glasses of water per day is advisable. Warm water with lime and honey or weak tea on the empty stomach early morning is very help full.

1. Fibre increases the bulk and help in intestinal motility.
2. Fats stimulate the flow of bile and also lubricate the lower bowel.
3. A diet rich in bulk in the form of vegetables and fruits.
4. Bananas, dried fruits like prunes, figs, raisins, dates, apricots are use full.
5. Liberal intake of fluids of about 10 - 12 glasses of water per day.
6. Practice regular bowel habit.

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