【Medicine Life】Constipation

By Little pill  2022-07

Constipation is a common problem that most people experience at least once in their lifetime. However, constipation can be a temporary or chronic condition, affected by lifestyle, related to age, caused by medical conditions, or secondary to medications.

We can think of the colon (large intestine) as a dehydrator, usually absorbing water as food moves through, forming bulk waste, what we call stool (or poo). Muscle contractions then push the stool through, and by the time the stool reaches the rectum, water is mainly absorbed, making the stool solid. Conversely, when the colon’s muscle contractions are slow or sluggish, the stool moves through the colon too slowly, resulting in hard, dry stools because too much water is absorbed.

The lifestyle of a proper diet with regular bowel movements and daily exercise is essential to maintain healthy bowel function. Unfortunately, some people are too busy to have regular meals and replace them with unhealthy snacks such as chips, cookies, and chocolates, and take vitamins as nutritional supplements. They don’t have time to drink enough fluid. A proper diet should contain sufficient roughage (20 to 35 grams of fiber) (whole-grain bread and cereals, bran, fruit, and green, leafy vegetables), with 6 to 8 full glasses (8 ounces each) of liquids each day to help in the formation of soft, bulky stool. Also, for individuals who have problems with constipation, foods such as pastries, puddings, sugar, candy, cake, and cheese may make constipation worse.

Older adults eat and drink less, avoid leafy vegetables with unsuited dentures, avoid fruits due to acid reflux, and slow bodily function as they age. Kids have hard stool likely from ignoring the urge to defecate or not drinking enough liquid. Other causes of constipation include underlying medical conditions such as irritable bowel syndrome, diabetes, and diverticulitis; medications such as antipsychotics and narcotic analgesics. Chronic use of laxatives can lead to dependence as the colon muscles’ tone weakens, and they become less sensitive to the defecation urge.

Symptoms vary among individuals and may include difficult and painful bowel movements; decreased frequency; bloating, uncomfortable, and sluggish with or without abdominal pain. These symptoms of constipation may resemble other medical issues.  Consult your doctors for a physical examination that can help detect abdominal tenderness or obstruction and the amount and caliber of stool. In addition, according to the patient’s age, they would consider whether there is blood in the stool, recent changes in bowel habits, or weight loss to determine if further diagnostic tests and procedures are needed.

Some people drink 4 to 5 cups of coffee daily, believing it can help resolve constipation. However, the coffee-drinking report linking to a reduced risk of chronic constipation is from a research study, “coffee and digestion,” funded by the European coffee industry! In addition, even though coffee can stimulate muscle contractions in the colon, the extent of promoting bowel movements is questionable. Therefore, coffee cannot be considered to treat constipation. Caffeine can adversely affect sleep, attitude, overstimulation, and jitteriness.

Laxatives may be helpful after diet and lifestyle changes have failed. Medication that induces constipation may benefit from temporarily using laxatives or changing the causative medication. Laxatives are also valuable for patients when straining should be avoided. The underlying medical conditions could worsen during strain, such as heart disease, high blood pressure, stroke, hemorrhoids, or impede the healing process. Also, after surgery or vaginal delivery, straining may cause rectal prolapse; a small amount of intestinal lining pushes out from the anal opening. Finally, fecal impaction is a complication of constipation. The stool hardens and packs the intestine and rectum so tightly that the regular pushing action of the colon is not enough to expel the stool. The use of laxatives in this situation should be under medical surveillance.

There are four main types of laxatives.

  1. Bulk-forming laxatives work by increasing the “bulk,” which in turn stimulates the bowel to move. The psyllium fiber is a water-loving substance, a non-digestible carbohydrate that expands after absorbing water. Therefore, it is essential to drink enough fluid during the day for the psyllium to absorb and retain moisture, softening the stool to relieve constipation. The powder is mixed with water to drink immediately. Otherwise, it will thicken into a gel. Psyllium is a gentle and natural substance with minimal side effects, used as prevention for individuals who do not eat enough fiber, particularly the elderly and the kids.

It’s branded as “Metamucil®” but also available as generic “Psyllium” or “Fibers.”

  1. Osmotic laxatives would draw water from the body into the bowel, softening stool and making it easier to pass. These substances can potentially cause nausea, stomach pain, and gas, but if misused with high doses and frequency can cause dehydration and electrolyte deficiency. Signs of dehydration include muscle weakness, cramps, and dizziness. This laxative type is helpful in people with stool impaction and for patients who should avoid straining, and as maintenance therapy for constipation prevention.

Lactulose® is a non-absorbable sugar solution. Hence blood sugar in diabetic patients is not affected at the standard dose but should be avoided in patients with aspiration risk.  Polyethylene glycol is marketed as Lax-A-Day® and Restorlax® for constipation; It’s a flavorless powder that can be mixed into any liquid and drank gradually. A higher dose with added electrolytes is marketed as PegLyte® for bowel cleansing before procedures.  Magnesium salt derivatives are a salt osmotic that may be marketed as a supplement to prevent constipation.

  1. Stimulant laxatives stimulate the intestinal muscles to increase muscle contractions that propel the stool mass to the rectum to be excreted. The stimulant effect acts faster than other types, becomes a popular choice for self-treatment, and leads to dependence as the colon muscle tone weakens and becomes less sensitive to the defecation urge. Side effects commonly include stomach or abdominal pain or cramping, nausea, diarrhea, and weakness. Recommend temporary and short-term use after surgery or secondary to narcotic analgesics unless prescribed by your doctor for a chronic condition. Sometimes, it’s combined with stool softener or lubricant to avoid straining, damaging, or tearing the rectum tissues. Urine turning reddish-brown may occur but is harmless. Senokot® is a marketed brand but is also available as senna-based laxatives.
  2. A stool softener is an emollient helping liquids mix into the stool and preventing dry, hard stool masses. It does not stimulate or cause a bowel movement but allows the patient to have a bowel movement without straining. Commonly used in the elderly and patients with heart disease without long-term side effects but should be avoided during risk of diarrhea such as antibiotic use.

Colace® brand is the most well-known brand but is widely available as a generic brand.  Sometimes Mineral oil is prescribed as a lubricant laxative in combination with a stimulant laxative in patients with stool impaction.

Constipation is a bothersome condition that can cause loss of appetite and restlessness until the hardened stool can be softened and expelled from the body. There are people appear restlessly and lose interest in doing anything but decline to listen to the message that God can help them. The Bible describes when one’s heart is hardening, one will not be able to see or understand. Even Jesus’ followers failed to recognize the power of Jesus and were concerned about not having enough food. Jesus warned them, “…Do you still not see or understand? Are your hearts hardened? Do you have eyes but fail to see, and ears but fail to hear? And don’t you remember? ”(Mark 8:17-18) If our hearts are hardened, we will not be able to take God’s message. If the gut is filled with stool, we will not be able to enjoy food. Quoting Jesus’ Sermon on the Mount, “Blessed are the pure in heart! For they shall see God.” (Matthew 5:8). A pure heart is free from arrogance, pride, anger, greed, envy, anxiety… With purification, one would be able to see the goodness of our Almighty God.