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Constipation
Constipationisthepassingofhard,drybowelmotions(stools)thatmaybeinfrequentordifficult topass.Themostcommoncausesofconstipationincludeachangeinroutine,notenoughfibrein thedailydiet,notenoughfluidsandlackofexercise.Insomecases,constipationiscausedby moreseriousillnessesandevents,includingtumoursandsystemicdiseases. Seeyourdoctorfordiagnosisandtreatment.Itisimportantnottoovertreatconstipationwith laxativesinplaceofseekingmedicaladvice. Symptoms Thesymptomsofconstipationinclude: Needingtoopenthebowelslessoftenthanusual Hard,drystoolsthatmaybepainfultopass Strainingtopassthemotion Havingtositonthetoiletformuchlongerthanusual Thesensationafterwardsthatthebowelhasntfullyemptied Bloatedabdomen Abdominalcramps.

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Stools explained Foodnutrientsareabsorbedinthesmallintestine.Wasteismassageddownthelengthofthelarge intestinebywavesofmuscularcontractions(peristalsis).Oncetheexcesswaterisremoved,the wasteistemporarilystoredintherectum.Theanusisamuscularring(sphincter)thatcanbe openedatwilltoallowtheremovaloffaeces. Watermakesupaboutthreequartersoffaecalcontent,whiletherestiscomposedofsolids includingundigestedfibre,intestinalbacteriaanddietaryfats. A range of lifestyle-related causes Constipationcanbecausedbymanydifferentlifestylefactorsthatoftenworkincombination, including: A change in routinenormalbowelmotionsdependontheregularandrhythmic contractionofthebowels.Thisispartofthebodysinternalclockandisoftenupsetwith changesinroutine.Thistypeofconstipationisoftenseeninshiftworkersandtravellers. Low fibre dietasfibreisindigestible,itaddsbulktothefaecesmakingitmoreeasily pushedalongthedigestivetract.Therearetwobroadtypesoffibre,solubleandinsoluble. Solublefibrehelpstosoftenthefaeces.Goodsourcesofsolublefibreincludelegumes, fruitsandvegetables.Insolublefibreaddsbulktothefaeceshelpingittomovemore quicklythroughthebowel.Goodsourcesofinsolublefibreareinwheatbran,wholegrain breadsandcereals. Insufficient waterthefibreinfaeceswillonlyplumpupwithwater.Constipationcan occurfromahighfibredietifinsufficientwaterisconsumed. Lack of regular exerciselivingasedentarylifestyleorbeingrestrictedinmovement duetoadisabilityarecommoncausesofconstipation. A tendency to put off going to the toiletignoringtheurgetogomeansthatmore waterwillbeextractedfromthestools,makingthemdifficulttopass.Regularlyignoring thisurgemaymakethebodylesssensitivetonormalsignalstogotothetoilet. Some medicationssuchasnarcotics,antidepressants,ironsupplements,calciumchannelblockers(antihypertensives)andnon-magnesiumantacidsareknowntoslow bowelmovements. Pregnancytheactionofhormones,reducedactivityandthepressureofthegrowing uterusagainsttheintestinesmeanthatconstipationiscommonduringpregnancy.

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Advancing ageconstipationismorecommonintheelderly.Thisisduetoanumberof factors,includingreducedintestinalmusclecontractionsandrelianceonregular medications.

Medical causes Constipationissometimessymptomaticofunderlyingmedicalproblems,suchas: Slow transit somepeoplenaturallypassmotionslessoftenthanmostpeople.Itseems theirbowelpacemakermaybelessactive.Theseindividualsaremorelikelytobecome constipatedwithminorchangesintheirroutine. Anal fissureatearintheliningoftheanus(analmucosa).Thepersonmayresistgoing tothetoiletforfearofpain. Obstructiontherectumoranusmaybepartiallyobstructedby,forexample, haemorrhoids(piles)orarectalprolapse. Rectocoeletherectumpushesthroughtheweakenedrearwallofthevaginawhenthe womanbearsdownorstrains. Herniaanabdominalherniacanreduceintra-abdominalpressure,whichmakesitmore difficulttopassamotion. Abdominal or gynaecological surgery acombinationofchangeinroutine,strange surroundings,post-operativepainandcodeine-containinganalgesicsisapotentcauseof constipationandoftenneedspreventivecare. Irritable bowel syndromecharacterisedbyabdominalpain,bloating,andeither constipationordiarrhoeaoralternatingconstipationanddiarrhoea. Problems of the endocrine systemsuchashypothyroidism,diabetesmellitusor hypopituitarism. Tumour painwhiletryingtopassastoolcouldbeasymptomofrectalcancer. Diseases of the central nervous systemsuchasmultiplesclerosis,Parkinsons diseaseorstrokeareassociatedwithanincreasedsusceptibilitytoconstipation.

Complications of chronic constipation Someofthecomplicationsofchronicconstipationinclude: Faecal impactionthelowerbowelandrectumbecomesopackedwithfaecesthatthe musclesofthebowelscantpushanyofitout. Faecal incontinenceanoverfullbowelcanresultininvoluntarydribblingofdiarrhoea. Haemorrhoidsconstantstrainingtoopenthebowelcandamagethebloodvesselsof therectum. Rectal prolapsetheconstantstrainingpushesasectionofrectalliningoutoftheanus. Urinary incontinencetheconstantstrainingweakenspelvicfloormuscles.Thismakes theinvoluntarypassingofurinemorelikely,especiallywhencoughing,laughingor sneezing.

Diagnosis Theunderlyingreasonfortheconstipationmustbefound.Diagnosismayinclude: Medicalhistory Physicalexamination Detailedquestioningaboutmedications,diet,exerciseandlifestylehabits Colonoscopy.

Treatment Treatmentdependsonthecause,butcouldinclude: Removal of the impacted faeceswhichmayinvolveenemas,stoolsoftenersanda short-termcourseoflaxatives. Dietary changessuchasincreasingtheamountoffibreinthedailydiet.Dieticians generallyrecommendabout30goffibreeveryday.Goodsourcesoffibreinclude wholegraincereals,fruits,vegetablesandlegumes.Theintakeoffoodssuchasmilk, cheese,whiterice,whiteflourandredmeatshouldberestricted,becausetheytendto contributetoconstipation. More fluidsliquidshelptoplumpoutfaeces.However,itisimportanttorestrictthe intakeofdiureticdrinkssuchastea,coffeeandalcohol.

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Fibre supplementsthesemaybehelpfulifthepersonisreluctantorunabletoinclude morewholegrainfoods,freshfruitsorvegetablesintheirdailydiet.Asfibresupplements canaggravateorcauseconstipation,alwayscheckwithyourdoctorordieticianwhenusing them. Exerciseoneofthemanybenefitsofregularexerciseisimprovedbowelmotility. Ideally,exerciseshouldbetakeneverydayforabout30minutes.Peoplewithacondition thataffectsmobilityneedtobeasactiveaspossibleeachday,aseverylittlebitofregular exercisehelps. Treatment for underlying disorder suchassurgerytorepairanabdominalhernia, hormonereplacementtherapyforhypothyroidism,oranaestheticcreamandsitz(salt water)bathsforananalfissure. Laxatives therearetwomaintypes:bowelstimulantsandagentsthatincreasethe watercontentofthestool.Bowelstimulantsincreasebowelcontractionsbutmaycause cramps.Agentsthatincreasethewatercontentmayinterferewiththeabsorptionofwater fromthebowel,orswellorbulkupthestoolwithfluid.Whenusedappropriately,laxatives cangreatlyrelieveacuteandchronicconstipation.Thereislittleevidencethatchronicuse oflaxativesatappropriatedoseswillleadtoalazyortwistedbowel.

Where to get help Yourdoctor Anaccreditedpractisingdietitian,contacttheDietitiansAssociationofAustralia Yourlocalpharmacist

Things to remember

Mostcasesofconstipationaresuccessfullytreatedbyeatingadiethighinfibre,drinking morefluidsandexercisingdaily. Complicationsofchronicconstipationincludehaemorrhoids,faecalimpactionandrectal prolapse. Over-the-counterlaxativesarefineintheshortterm,butseekadviceiftheproblem persists.

This page has been produced in consultation with, and approved by:

CanberraHospital-GastroenterologyUnit

Copyight 1999/2009StateofVictoria.ReproducedfromtheBetterHealthChannel(www.betterhealth.vic.gov.au)at nocostwithpermissionoftheVictorianMinisterforHealth.Unauthorisedreproductionandotherusescomprisedinthe copyrightareprohibitedwithoutpermission. ThisBetterHealthChannelfactsheethaspassedthrougharigorousapprovalprocess.Forthelatestupdatesandmore informationvisitwww.betterhealth.vic.gov.au.

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