Constipation: what it is and what are the remedies

What is constipation? We may know it by another name: constipation, the term used to refer to an extremely common intestinal problem, associated with risk factors such as an unbalanced diet lacking in foods that promote good bowel motility, or the intake of certain medications

Constipation can also be a symptom of various diseases, which is why patients who complain of typical constipation manifestations should consult their doctor, who will indicate the most appropriate tests to investigate the causes.

Constipation: what is it?

Constipation is defined as a condition in which the individual has less than three stool evacuations per week.

This definition is, however, based on epidemiological studies and is mainly scientific in nature as, more frequently, the patient who defines himself as constipated describes a more vague feeling of intestinal ‘malfunction’ characterised by disturbances of various kinds, such as incomplete evacuation or the presence of stools that are too hard or in small quantities.

What are the causes of constipation?

Constipation can sometimes be caused by:

  • intestinal pathologies (e.g. colorectal cancer);
  • neurological diseases (e.g. Parkinson’s disease);
  • metabolic diseases (e.g. diabetes or hypothyroidism);
  • medication intake.

In most cases, however, these are ‘idiopathic’ cases, i.e. we do not know the cause.

In these cases, several mechanisms underlying the constipation are identified and sometimes these mechanisms can coexist.

Slow intestinal motility is the most common cause; the so-called lazy bowel is in fact at the root of constipation symptoms precisely because of a slower progression of stools.

Constipation can also be caused by a lack of coordination of the pelvic muscles, which do not work synergistically in preparation for and during the act of defecation.

Finally, constipation may be part of a broader procession of abdominal symptoms that are not yet fully understood and are called irritable bowel syndrome, in which intestinal pain and bloating are the predominant complaints.

Constipation is a condition that affects about 15% of the population, and particularly the female sex, due to possible hormonal involvement in bowel motility.

Another category widely affected by constipation is that of the elderly, particularly in relation to increased intake of medication that, in some cases, counts constipation as a side effect, and due to a tendency to drink less water.

Constipation, when to make a gastroenterological examination

As we have specified, constipation is a fairly common disorder that many people live with.

In more severe situations, however, the intervention of a gastroenterologist specialist may be necessary.

In particular, patients should pay special attention to the disorder when there is a progressive worsening of the frequency of evacuations, if there is a family history of gastro-intestinal tract cancer, or if there are additional ‘warning’ signs or symptoms such as

  • weight loss
  • blood in the stool
  • lowered haemoglobin levels (anaemia).

Seeking the advice of a gastroenterologist can also be useful in cases of severe constipation, i.e. when the symptoms associated with infrequent bowel movements (bloating, abdominal pain, the need to strain during expulsion of stools, hard or goat-like stools, the sensation of incomplete emptying of the bowel) worsen the individual’s quality of life.

In these cases, the specialist will question and examine the patient and assess the most appropriate diagnostic pathway for each case.

Further investigations may be necessary by means of X-rays of the intestine, which are specific for studying the timing of stool transit.

Anorectal manometry, to assess pelvic motility, or defecography, to show changes in pelvic floor coordination during faecal expulsion, may also sometimes prove useful.

Finally, the patient may undergo a colonoscopy mainly to rule out colorectal cancer and to help prevent it.

Remedies for constipation

How to treat constipation, then? The gastroenterologist specialist can evaluate the use of supplements or mass-forming laxatives which, combined with adequate hydration, are effective in increasing the frequency of evacuations in the most natural way.

We speak for example of psyllium, or methylcellulose.

Also very effective are osmotic laxatives, such as preparations based on polyethylene glycol or lactulose, which improve the hydration of stools by causing an increase in bowel activity.

Other drugs that may be prescribed by the gastroenterologist are bisacodyl, senna, linaclotide or prucalopride, which, however, are usually preferred not to be taken for prolonged periods.

What to eat with constipation

Constipation is generally worsened by a sedentary lifestyle, a low-fibre diet and poor hydration.

It is therefore essential to combine the treatments indicated by the gastroenterologist with special attention to diet.

A diet rich in vegetables, legumes, fruit and whole grains is therefore recommended, which is useful to increase the intake of fibre, which should reach 20-35 grams per day.

Fibre increases the quantity and hydration of faecal content, resulting in better faecal transit.

It is also important to stay hydrated, as water also facilitates the expulsion of faeces.

Constipation sufferers should drink at least one and a half litres of water every day.

An active lifestyle should also be combined with diet, so limit sedentariness as much as possible, e.g. by walking or cycling.

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