Contrary to popular belief, it is not necessary for good health to have a bowel movement every day. However, when a person passes fewer than three stools a week, which are frequently hard, lumpy or small-sized stools, this would constitute a constipation problem. The need to strain excessively when passing motion or feeling blocked at the rectum (the final portion of the large intestines for temporary storage of feces) may point to constipation as well.
Constipation is not a disease on its own but rather a symptom resulting from some underlying causes.
One of the most common causes of constipation is a low-fibre diet. Besides this, people lacking in physical activities (e.g. people with sedentary lifestyles, those who are bedridden) are also at risk. Some medication or supplements such as narcotic painkillers (e.g. codeine), aluminium- or calcium-containing antacids, antidepressants (e.g. amitryptyline), blood pressure medication (e.g. diltiazem, nifedipine), antipsychotics and iron supplements may also lead to constipation. While laxatives could treat constipation, frequent use or abuse may also be a cause for constipation.
Pregnancy is also another risk factor for constipation in women, due to hormonal changes and compression of the intestine by the uterus. Next, ignoring the urge to pass motion due to emotional stress and a hectic lifestyle may also lead to constipation. Some people may suffer from constipation while travelling, due to changes in external factors such as the weather, food or liquid intake and physical activity.
Constipation may also be a symptom of other underlying health conditions such as diabetes, nerve disorder (e.g. stroke, Parkinson's disease or spinal cord injuries), thyroid diseases, Irritable Bowel Syndrome (IBS) or other problems related to the colon or rectum, including tumours.
While most of the constipation problems are temporary and will go away without treatment, some may need further evaluation and treatment.
In most cases, constipation may be treated by simple dietary and lifestyle changes. One may consume more high-fibre foods such as whole grains, beans, fresh fruits or vegetables. Liquid intake should be increased especially during hot weather, engagement in physical activities or intake of alcoholic beverages which may cause water loss. When the urge of a bowel movement comes, one should not ignore it. Regular exercise improves bowel movement and is beneficial for our health as well.
If the problem persists even after doing some lifestyle modifications, laxatives could be recommended for a short period under the advice of healthcare professionals.
Bulk laxatives (e.g. isphagula or psyllium husk) provide bulk to the stool to stimulate normal bowel movement while stimulant laxatives (e.g. senna, bisacodyl) actually act on the intestinal muscle wall resulting in faster bowel movement. Osmotic laxatives (e.g. lactulose) and saline laxatives work by increasing the amount of fluid in the stools, making them softer and easier to pass out.
Finally, lubricants (e.g. liquid paraffin) make the stool move easily through the intestines while stool softeners (e.g. docusate sodium) prevent the formation of hard and dry stools.
For any constipation caused by medication, do speak to your healthcare professionals for alternatives. Constipation caused by other underlying diseases requires specific treatment to target those diseases.
Though constipation does not seem life-threatening, prolonged constipation problems could lead to other health conditions such as piles and anal fissures (tears on the skin around the anus). Hardened stools formed in the rectum that could only be removed manually, a condition known as fecal impaction, may also surface as a result of severe constipation.
When to see a doctor
If your constipation is severe and lasts for more than three weeks, or you have unexplained changes in bowel habits (e.g. alternating between diarrhoea and constipation) or weight loss, you should consult your doctor for further evaluation. Besides, any intense pain in the abdomen or rectum, blood in stool or passing out unusually shaped stools warrants a doctor's visit.