Constipation is a Preventable Condition


Constipation is a Preventable Condition


Constipation is a common problem, experienced by almost all of us. It means either going to the toilet less often than usual to pass stool or passing hard or painful stools. It affects people of all ages, worldwide. Although uncomfortable, it is usually not dangerous.

What is constipation?

Constipation is a medical term that can refer to either a reduction in the number of bowel movements each week or pain or difficulty passing stool (fecal matter).

The American College of Gastroenterology defines constipation based upon the symptoms. According to this definition, constipation is unsatisfactory defecation (passing stools) with either infrequent stools, difficult stool passage, or both.

What is a normal bowel habit?

The normal frequency of bowel movements varies widely from person to person. Some people normally go to the toilet to pass stools 2-3 times per day. Others have them just a few times a week.

In general, passing a soft stool at least three times a week is considered normal. After 3 days, your stool gets harder and more difficult to pass. So having infrequent bowel movements does not necessarily indicate a problem.

Why does constipation happen?

Typically, a person’s stool (fecal matter) is made from waste products and undigested food material. The fecal matter so formed will combine with water to be eliminated as stool via the rectum and anus.

Constipation most commonly occurs if one has a longer transit time of food in the colon. A long transit time means fecal matter passes slowly through the colon. As a result, the fecal matter stays longer in the colon so more water is absorbed than the usual amount. With the loss of moisture, the stool becomes hard and dry. A  hard and dry stool will make it difficult to pass the stool which leads to constipation.

The other contributing factors include:

  • gradual enlargement of the rectum
  • poor coordination of the muscles of the pelvic and anus
  • a combination of these processes occurs

What is the transit time?

The transit time is the duration between when food enters the mouth and when leftover waste finally passes out as stool. A meal could take anywhere from 12-72 hours to travel through the digestive tract.

Usually, before food enters the colon, most of the nutrients have been absorbed into the body . The colon’s role is to remove water.

Factors that can contribute to constipation, often by altering transit time, include:

  • Diet and lifestyle choices: such as consuming a diet too low in fiber and fluid, inadequate amount of food, insufficient physical activity, and chronic use of laxatives, etc
  • Side effects of certain medicines that affect the nervous system: e.g., some narcotics, antidepressants, codeine, calcium, or iron supplements
  • Diseases/conditions that cause physiological changes in the body:e.g., radiation therapy, inflammatory bowel disease, colon cancer, diabetes, stroke, hypothyroidism, or Parkinson’s disease
  • Functional disorders: such as irritable bowel syndrome, intestinal obstructions, or strictures resulting from surgery

What happens in constipation?

  • Passing stools becomes more difficult and less frequent than usual (< 2 times a week)
  • Stools will be hard, dry, and lumpy, as well as unusually large or small.
  • Presence of feeling of incomplete bowel emptying
  • Straining to start or complete a bowel movement
  • Each individual may experience symptoms of constipation differently
  • However, some of the  other most common symptoms include
    • stomach ache and cramps
    • feeling bloated
    • feeling sick
    • loss of appetite
    • lethargy

Types of constipation:

There are two main types of constipation: primary and secondary.

  • Primary constipation occurs without any clear cause for it, so this type is also known as functional or “idiopathic” constipation.
  • Secondary constipation is that which occurs as a result of an underlying illness or lifestyle.

Common causes of constipation 

The causes of constipation are varied and may be multifactorial and include the following

  • Intake of a low-fiber diet
  • Chronic dehydration
  • Taking certain drugs, such as narcotic pain medication or antidepressants, antacid medicines that have calcium or aluminum
  • Ignoring the urge to pass the stool
  • Immobility or lack of exercise
  • A change in one’s routine or lifestyle, such as a change in eating habits
  • Having limited privacy when using the toilet
  • Overuse of laxatives
  • Problems with the nerves and muscles in your digestive system
  • Diseases and conditions that affect the hormones may lead to constipation, including:
    • Diabetes, Overactive parathyroid gland (hyperparathyroidism), and Underactive thyroid (hypothyroidism)

Who is at risk for constipation?

  • Eating a poor diet and not exercising are major risk factors for constipation.

You may also be at greater risk if you’re:

  1. An older adult (>65 yr of age). Then you tend to be less physically active, have underlying diseases, and eat poorer diets.
  2. Confined to bed. Those who have certain medical conditions, such as spinal cord injuries, often have difficulty with bowel movements.
  3. A woman or child. Women have more frequent episodes of constipation than men, and children are affected more often than adults
  4. Taking certain medications. This includes sedatives, opioid pain medications, some antidepressants or medications to lower blood pressure,  treat Parkinson’s disease,  nutritional supplements like iron tablets
  5. Having certain health problems. Neurological conditions like Parkinson’s disease, multiple sclerosis, mental health issues like depression or an eating disorder or digestive disorders, colon cancer, irritable bowel syndrome, etc. all can cause constipation.
  6. Pregnant: Constipation occurs during pregnancy because your body produces more of the female hormone progesterone, which acts as a muscle relaxant. An increase in progesterone makes it more difficult for the bowel muscles to contract, making it harder to move waste products.

Complications of constipation

Constipation may be acute or chronic. Acute constipation begins suddenly and noticeably. Chronic constipation may begin gradually and persists for months or years.

  • Short-term constipation or intermittent bouts of constipation are unlikely to cause any long-term problems. Sometimes a split or tear in the anal skin (an anal fissure) can occur with the passage of particularly big or hard stools
  • Chronic constipation means the problem has been present for at least 12 weeks out of the past 6 months. Chronic constipation may cause hemorrhoids or piles, hardened stool get stuck in the rectum, and overhanging intestine through the anus.

How to Prevent Constipation

Changing your diet and increasing your physical activity level are the easiest and fastest ways to treat and prevent constipation.

Prevention tips include:

1.Eat a well-balanced diet with adequate fiber.

Increasing your fiber intake: 

Recommended  daily intake of fiber for 14 g  fiber/1000 kcals

  • Adults up to age 50: 25 g for women and 35 g for men
  • Adults older than 50: 21 g for women and 30 g for men
    • Fiber-rich foods include, such as fruits, vegetables, and whole grains. Just remember to drink plenty of fluids because fluids help fiber work more efficiently.


PN: Those who have slow transit constipation type may respond poorly to increased fiber.

2.Drinking more water: Aim for eight glasses daily of unsweetened, decaffeinated fluids, like water, to hydrate the body and avoid dehydration.

3.Stay as active as possible and try to get regular exercise: Regular exercise can help keep stool moving through the colon.

4.Don’t ignore the urge to pass stool: If you feel the urge to have a bowel movement, don’t delay. The longer you wait, the harder your stool can become.

5.Try to create a regular schedule for bowel movements, especially after a meal. As a rule, it is best to try going to the toilet first thing in the morning or about 30 minutes after a meal. This is because the movement of stools through the colon is greatest in the mornings and after meals.

6.Position on the toilet is also important: It is important especially for elderly people with constipation. Western-style toilets actually make things more difficult; squatting is probably the best position in which to pass stools.

7.Learn to manage stress.

8.Use food-based laxatives: Laxatives are a type of medicine that helps a person empty their bowels

    • Dried fruits can help in relieving constipation because of their high sorbitol content. Sorbitol is a type of sugar alcohol and is an osmotic laxative. It will cause water to be pulled into the colon thus softens the stool. They may take up to 2-3 days before they start to work. About six prunes twice a day were found to be effective in one small study.
    • Psyllium husk acts as a gentle, bulk-forming laxative. It can absorb water and become a thick, viscous compound. The common dosage of Psyllium husk used is 6–12g, with meals, at least once per day. one gram husk requires 30ml water to form a gel. You should begin to feel relief within 12 hours to 3 days.
    • PN: Please do check with a doctor if you have any medical issues and medications before using Psyllium husk.

9.Use other prescribed laxatives for a short period as advised by your doctor. Never use laxatives for more than two weeks without talking to your doctor.

By being aware of and attending to changes in the bowel pattern, at the early stage, one can prevent developing constipation. So now you too agree with me that “constipation is a preventable condition”.