Continued from here: Queries about Constipation Blocking your Mind? Clear them Here (Part1)
The role of diet in the smooth and efficient transit of the bowel contents, especially the vegetarian diet, has become established. The much talked about fibre diet in layman’s parlance is nothing but a vegetarian diet. The diet suits a human being because his digestive system is built to suit such a diet as exemplified by the dental structure and the compositions of the intestinal juices, which are primed to such a diet. Constipation is a social disease.
Factors causing constipation:
The environment also plays a major role in this ailment. Even travel to another place is known to inhibit bowel movement. Mental tension, change of duty hours, jet lag, a dirty toilet are well known to contribute towards inhibitions of the bowel movement. The other contributing factors include low intake of fluids especially in summer, low residue diet, growing use of fast food or a liquid diet, which may be worse confounded by an illness where such a diet is needed, and metabolic disorders like diabetes. In diabetes apart from the excessive loss of fluids as urine the associated neuropathy (nerve degeneration) of the bowel may lead to slowing of the bowel.
Also read: Hypertension in the elderly
Constipation in the elderly:
Geriatrics has become a speciality, with more and more people ageing into that group. Constipation in this age group may be silent. The patient may not be aware of it. He may be mistaken for intestinal obstruction, which in fact us due to a lazy bowel movement and the consequent impaction of the faecal matter. There may however, be a lurking like cancer at this age which may trigger off this constipation, which should not be ruled out.
Drugs prescribed for certain illness may have an undesirable fallout of constipation. Commonly prescribed antacids can lead to constipation. The list of drugs includes those administered for nervous and psychiatric disorders, iron supplements, and contraceptives. The list goes on. Such patients may need some mild laxatives if the drug therapy is mandatory.
Local problems like fissures, piles, prolapse (slipping down of the rectum) or at times the dreadful disorder of cancer (especially in the elderly) may be associated with constipation, though there are often other associated manifestations like pain, bleeding etc., in these disorders.
Pic courtesy: timesofindia
Fallout of constipation:
The fallout of constipation is plenty. The irritability of the constipated individual has been documented in the literature. In progressive and severe cases of constipation referred to as obstipation, the abdomen may even get bloated and this distension may be severe enough to be referred to as a ‘pseudo-obstruction’ in the medical literature, since it is often mistaken for a real obstruction of the bowel, say due to cancer.
An alert physician often makes it out, by a careful analysis of the case history, a physical examination including a digital examination of the rectum. The relief that such a patient gets on the removal of the impacted faecal matter is to be seen to be believed. Often even the obtund mind of such a patient clears remarkably fast.
Diet forms the essence of management of constipation. The need for roughage and fibre in the diet cannot be over-emphasised. Adequate physical activity keeps the bowel active. Even in bedridden patients physiotherapy helps. Enemas had their days till recently. History records some Maharajas who would be conducting the Durbar, when clandestinely they would be enjoying an enema, to relieve the bowel into a golden commode!
Treatment options:
Various drugs are available as a therapy for constipation. There are drugs which increase the bulk of the bowel content (Isabgol act this way), there are lubricants like liquid paraffin, there are drugs which are osmotically active (polyethylene glycol). Suppositories help I stimulating the rectal muscles to evacuate.
Also read: Disease after deluge
Surgery has its role to play in constipation. As referred to earlier, in Hirschsprung’s Disease occurring in children, a resection of the segment of the bowel (wherein the neutral ganglia are missing) cures the illness.
Severe constipation in adult patients may manifest as an irreversible ‘obstruction.’ Here, the surgeon must take care to rule out an underlying disorder like cancer. Some of these obstinate cases may need surgery, which includes removal of part or whole of the large bowel which had become totally inactive as it were.