Constipation, pronounced constipacion - not just hard stools

The Rome 111 criteria for chronic constipation also include the need to strain, lumpy stools, feeling as if not emptying completely, feeling of blockage, need to help stools out with hand pressure and less than 3 per week.

I've seen descriptions of the perfect turd re dimensions, shape and which end floats. The main thing is that they are easy to pass and satisfying.

You can also know them by the company they keep. If you feel perfectly well and your bowels have been the same for years, anything goes.

Recent alteration in bowel habit - warrants a check up

"Recent" here could be 18 months even, because a bowel cancer could still be the cause and not have shown up in other ways yet.

If you are pretty sure you know what has altered your bowels, can you reverse the cause? If restoring the previous diet or lifestyle factors completely restores your bowels to their previous condition, you've probably solved the case.

You would need to be pretty certain, though.

If you do go for a medical checkup, be prepared for a rectal examination. If this is not suggested, you should suggest it and if necessary demand it.

Cancer of the rectum is often within reach of the examining finger.

After your checkup, now what?

Assuming that no disease has been found, you have a disturbance of function.

Bodily functions all depend on healthy emotions, exercise, diet, enough sunlight, sleep, mental stimulation and physical contact with mother earth.

Attention to these is the ideal way to deal with any health problem.

These factors can influence our body's water and mineral content, bowel microbes, hormone levels, nervous system etc. Intervention at this level requires further functional testing, using special pathology tests such as those provided by Metametrix and Genova.

The majority of people with constipation have normal bowel transit times and normal anorectal function¹.
If colonic inertia is present however, measures to restore the enteric nervous system are needed.
Pelvic floor muscles can be restored by special physiotherapy techniques.

For tea drinkers

Your cuppa can constipate³, if that's all you drink.

Caffeine is a diuretic. It makes you pee - that is, more than your body intended to do in that regard. This can leave you short of water and your body will save same wherever it can, as from the bowel content. Our large intestine receives liquid content from the small intestine and extracting more of the water from it gives you harder faeces.

Symptomatic management of constipation².

If all else fails or is inconvenient or too expensive, it is back to relief of the symptom, hopefully without causing more trouble.

PEG 3350 (polyethylene glycol) appears to be better than lactulose.

Psyllium (ispagula) is a good choice for a fibre supplement.

A lot of wheat bran can be irritant for some people (and in babies.)

These need to be accompanied by plenty of liquid.

Neuromuscular dysfunction

"The largest age-related decreases in neuronal populations within the enteric nervous system occur in the colon, and physiological studies consistently suggest that colonic function is altered with age."

Cholinergic neurones are more susceptible to neurodegeneration, resulting in sympathetic dominance.

Loss of serotoninergic neurones decreases intestinal motility and slows bowel transit.

Precursors of appropriate neurotransmitters may help the function of remaining neurones, as well as any coexisting depression or heightened reactivity to stress. This needs someone trained in orthomolecular medicine.

Pelvic floor dysfunction

This is postulated spasm of the muscles which hold up everything inside the cavity of our pelvis. These may fail to relax and so prevent passage of faeces.

It can be demonstrated by a "defecating proctogram." You are given an enema of a thick liquid that can be detected with x-ray. A special x-ray video records the movement of your pelvic floor muscles and rectum while you attempt to empty the liquid from the rectum.
Normally the pelvic floor relaxes allowing the rectum to straighten and the liquid to pass out of the rectum. This study will demonstrate if the pelvic floor muscles are not relaxing appropriately and preventing passage of the liquid.

Biofeedback training can be used to bring this to awareness and allow one to learn to relax spastic muscles. This is use of a small balloon or electrical terminal, to monitor the muscle action and an electronic device to display the action visually and/or audibly.

Notes and references

1.Constipation is divided into two groups...

Primary constipation is further divided into 3 groups...

Normal transit - faeces propelled at normal rate through colon, but still have difficulty with straining, infrequent hard stools and feeling of incomplete evacuation.

Slow transit - colonic inertia (so more time for water to be absorbed from the stool,) giving bloating and infrequent movements.

Pelvic floor dysfunction - muscles used to evacuate stool aren't working properly, so stools are retained in the rectum, and one feels incomplete evacuation and obstruction.

Secondary constipation has many causes...

In infants it is fear of more pain, after one poo has hurt. They may appear to be grunting in an attempt to pass a stool, but really they are attempting to stop it passing.

Busy children may just not want to stop playing, and refuse to respond to the call of nature.

At the other end of life, demented people may not be able to recognize the feeling of a full rectum.

Obstructive lesions also occur at any age, from birth on. Nearly half of all infants with Hirschsprung's  disease do not pass meconium within their first 36 hours.

More sinister causes of obstruction must be checked for, as early surgery can be lifesaving.
The sort of things you should remember to tell your doctor about include...
Passage of blood or mucus.
Pain in your rectum.
Change in the calibre of your stools.
Any changes in your general health.
A list of your medications and supplements, prescribed and purchased OTC (over the counter, not needing a prescription.)

2. Treatments for adults.

Bulking agents

Ispaghula (psyllium) and sterculia plus water - (work in 24 hours, maximum 2-3 days.)

Osmotic agents

Lactulose (1-2 days,) macrogol PEG 3350, magnesium sulphate (1 hour,) sorbitol (2-3 days,) sodium phosphate (1/2-6 hours) and sodium picosulphate.

Stool softeners

Docusate (1-2 days)

Stimulant laxatives

Bisacodyl (6-12 hours)

Lubricants

Paraffin emulsion (2-3 days)

The times are for oral use. Medications used rectally work much more quickly, within an hour.

3.    http://www.bmj.com




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Hirschsprung's  disease is where the nerves in a section of the bowel fail to develop, so it can't relax, and needs to be surgically removed.

Meconium is the normal black bowel action of newborns.

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