(Konstipasi) DEFINISI

Sembelit (Konstipasi) adalah suatu keadaan dimana seseorang mengalami kesulitan buang air besar atau jarang buang air besar. Konstipasi akut dimulai secara tiba-tiba dan tampak dengan jelas. Konstipasi menahun (kronik), kapan mulainya tidak jelas dan menetap selama beberapa bulan atau tahun.
PENYEBAB

Konstipasi sering disebabkan oleh berubahnya makanan atau berkurangnya aktivitas fisik. Obat-obat yang bisa menyebabkan konstipasi adalah: - Aluminium hidroksida (dalam antasid yang dijual bebas) - Garam bismut - Garam besi - Antikolinergik - Obat darah tinggi (anti-hipertensi) - Golongan narkotik - Beberapa obat penenang dan obat tidur. Konstipasi akut kadang-kadang bisa disebabkan oleh keadaan yang serius, seperti: - penyumbatan pada usus besar - berkurangnya aliran darah ke usus besar - cedera pada saraf atau urat saraf tulang belakang. Kurangnya aktivitas fisik dan terlalu sedikitnya serat dalam makanan merupakan penyebab yang sering ditemukan pada konstipasi menahun. Penyebab lainnya adalah: - aktivitas kelenjar tiroid yang kurang (hipotiroid) - kadar kalsium darah yang tinggi (hiperkalsemia) - penyakit Parkinson - penurunan kontraksi usus besar (kolon inaktif) - rasa tidak enak (tidak nyaman) pada waktu buang air besar (defekasi). Sedangkan faktor psikologis berperan pada konstipasi akut maupun konstipasi menahun.
GEJALA

Penderita konstipasi memiliki tinja yang keras, yang mungkin sulit untuk dikeluarkan. Penderita juga merasakan rektumnya belum sepenuhnya kosong.
DIAGNOSA

Diagnosis ditegakkan berdasarkan gejala-gejalanya.

PENGOBATAN

Jika konstipasi disebabkan oleh suatu penyakit, maka penyakitnya harus diobati. Jika tidak ditemukan penyakit lain sebagai penyebabnya, pencegahan dan pengobatan terbaik untuk konstipasi adalah gabungan dari olah raga, makanan kaya serat dan penggunaan obatobatan yang sesuai untuk sementara waktu. Sayur-sayuran, buah-buahan dan gandum merupakan sumber serat yang baik. Supaya bisa bekerja dengan baik, serat harus dikonsumsi bersamaan dengan sejumlah besar cairan.

OBAT-OBAT PENCAHAR Banyak orang menggunakan obat pencahar (laksatif) untuk menghilangkan konstipasi. Beberapa obat aman digunakan dalam jangka waktu lama, obat lainnya hanya boleh digunakan sesekali. Beberapa obat digunakan untuk mencegah konstipasi, obat lainnya digunakan untuk mengobati konstipasi. Golongan obat-obat pencahar yang biasa digunakan adalah:
1. 2. 3. 4. 5. Bulking Agents Pelunak Tinja Minyak Mineral Bahan-bahan Osmotik Pencahar Perangsang.

Bulking Agents. Bulking agents (gandum, Psyllium, kalsium polikarbofil dan Methylcellulose) bisa menambahkan serat pada tinja. Penambahan serat ini akan merangsang kontraksi alami usus dan tinja yang berserat lebih lunak dan lebih mudah dikeluarkan. Bulking agents bekerja perlahan dan merupakan obat yang paling aman untuk merangsang buang air besar yang teratur. Pada mulanya diberikan dalam jumlah kecil. Dosisnya ditingkatkan secara bertahap, sampai dicapai keteraturan dalam buang air besar. Orang yang menggunakan bahan-bahan ini harus selalu minum banyak cairan. Pelunak Tinja.

Docusate akan meningkatkan jumlah air yang dapat diserap oleh tinja. Sebenarnya bahan ini adalah detergen yang menurunkan tegangan permukaan dari tinja, sehingga memungkinkan air menembus tinja dengan mudah dan menjadikannya lebih lunak. Peningkatan jumlah serat akan merangsang kontraksi alami dari usus besar dan membantu melunakkan tinja sehingga lebih mudah dikeluarkan dari tubuh. Minyak Mineral. Minyak mineral akan melunakkan tinja dan memudahkannya keluar dari tubuh. Tetapi bahan ini akan menurunkan penyerapan dari vitamin yang larut dalam lemak. Dan jika seseorang yang dalam keadaan lemah menghirup minyak mineral secara tidak sengaja, bisa terjadi iritasi yang serius pada jaringan paru-paru. Selain itu, minyak mineral juga bisa merembes dari rektum. Bahan Osmotik. Bahan-bahan osmotik mendorong sejumlah besar air ke dalam usus besar, sehingga tinja menjadi lunak dan mudah dilepaskan. Cairan yang berlebihan juga meregangkan dinding usus besar dan merangsang kontraksi. Pencahar ini mengandung garam-garam (fosfat, sulfat dan magnesium) atau gula (Lactulose , Sorbitol , Polyethylene glycol). Beberapa bahan osmotik mengandung natrium, menyebabkan retensi (penahanan) cairan pada penderita penyakit ginjal atau gagal jantung, terutama jika diberikan dalam jumlah besar. Bahan osmotik yang mengandung magnesium dan fosfat sebagian diserap ke dalam aliran darah dan berbahaya untuk penderita gagal ginjal. Pencahar ini pada umumnya bekerja dalam 3 jam dan lebih baik digunakan sebagai pengobatan daripada untuk pencegahan. Bahan ini juga digunakan untuk mengosongkan usus sebelum pemeriksaan rontgen pada saluran pencernaan dan sebelum kolonoskopi. Pencahar Perangsang. Pencahar perangsang secara langsung merangsang dinding usus besar untuk berkontraksi dan mengeluarkan isinya. Obat ini mengandung substansi yang dapat mengiritasi seperti Senna , Bisacodyl , Cascara, Tegaserod , ,atau minyak kastor. Obat ini bekerja setelah 6-8 jam dan menghasilkan tinja setengah padat, tapi sering menyebabkan kram perut. Dalam bentuk supositoria (obat yang dimasukkan melalui lubang dubur), akan bekerja setelah 15-60 menit.

Penggunaan jangka panjang dapat menyebabkan kerusakan pada usus besar, juga seseorang bisa menjadi tergantung pada obat ini sehingga usus menjadi malas berkontraksi (Lazy Bowel Syndromes). Pencahar ini sering digunakan untuk mengosongkan usus besar sebelum proses diagnostik dan untuk mencegah atau mengobati konstipasi yang disebabkan karena obat yang memperlambat kontraksi usus besar (misalnya narkotik).
PENCEGAHAN

Pencegahan terbaik untuk konstipasi adalah gabungan dari olah raga yang teratur dan makanan kaya serat.

What causes constipation in pregnancy?

Constipation is common in pregnancy because the pregnancy hormone progesterone relaxes and slows down the movement of food through your intestines. You are likely to suffer from constipation if you:

are generally prone to constipation have pregnancy sickness and are struggling to eat as much as usual have irritable bowel syndrome (IBS)

Anaemia may contribute to your constipation. And some iron tablets used to treat anaemia may actually make constipation worse. If you don't exercise much, your whole system will be sluggish. As your pregnancy progresses, and your baby gets bigger, increased downward pressure on your pelvic area makes constipation more likely. If you have severe constipation and strain to poo, it increases your risk of developing piles (haemorrhoids).

How can I prevent constipation?

Constipation doesn't cause any particular medical complications, but it is uncomfortable and can make haemorrhoids worse. So it's best to tackle constipation before it becomes a problem. Eat a high-fibre diet which contains lots of wholegrain cereals, wholemeal bread and fruit and vegetables. This will provide you with roughage to aid your digestion. But you should also make sure you drink at least 1.5 litres (2.6 pints) of water every day. Try to avoid drinks which make you wee more often, such as tea, coffee, cola and alcohol. These diuretics may dehydrate you and make your constipation worse. Don't rely on taking bran to avoid constipation, unless you also significantly increase your fluid intake. Without extra water, bran will bulk up your poo, making it hard and less able to pass along your intestines. Large amounts of bran may also interfere with your body's ability to absorb certain nutrients from your food. Staying active and exercising will help to prevent constipation. Walking, swimming or aquanatal classes, gentle cycling on an exercise bike, or pregnancy exercise classes can all help. Some yoga positions can be practised to keep constipation at bay, and pilates is particularly effective. Tai chi or qi gong may help you to maintain physical and emotional health and wellbeing

through a gentle sequence of structured movements. They also aid balance and mobility, and may help to prevent or treat your constipation.

What tips can I try to ease constipation?

Drink at least 1.5 litres (2.6 pints) of water daily and start your day with a cup of warm water with a slice of lemon before you have anything else to eat or drink. Start each meal with salad or raw vegetables or fruit, and eat high-fibre foods (roughage). Include plenty of these in your diet:

Fresh fruit, such as oranges, grapefruits, tangerines and blackcurrants.

Dried fruit, such prunes and apricots.

Vegetables, such as celery, watercress, cabbage, spinach and artichokes.

Wholegrain cereals and wholemeal bread, as well as beans, lentils and pulses.

Psyllium (ispagula husks), the seeds from plantain, may be effective for constipation, especially if you have irritable bowel syndrome (IBS). Psyllium can be bought in health food stores and contains mucilage, which bulks up your poo. You must also drink at least eight glasses of water daily to keep the poo moving along your gut. You may, however prefer to eat prunes, as they may be more effective and taste nicer. Don't use psyllium if you are taking medication for a heart complaint. Linseeds (flaxseeds) are rich in fibre and essential fatty acids, and are an alternative to psyllium. But drink at least one large glass of water for each dessertspoonful of linseeds you have. Try sprinkling the seeds on your breakfast cereal, salads, or yoghurt. But be aware that too many linseeds may cause diarrhoea and, very rarely, can trigger allergic reactions. Herbal remedies You could drink dandelion or mallow tea, made from the leaves of the plants. Steep the leaves in boiling water and drink it daily to ease constipation. Senna is a traditional remedy for constipation and is safe in small doses and for short periods in pregnancy under the supervision of your doctor or midwife. Some experts believe it should be avoided in the third trimester, as it may stimulate your uterus (womb) and cause Braxton Hicks

contractions. Aromatherapy Add three to four drops of essential oils such as sweet orange, lemon, lime, grapefruit or bergamot to a teaspoonful of carrier oil (preferably grapeseed) to your bath. Relax in the warm water for a while, perhaps massaging your tummy gently with soap lather in a clockwise direction. Don't massage too firmly, especially if you have any risk of premature labour, or if your placenta is lying low in your uterus (placenta praevia). Reflexology You can try a simple reflexology treatment at home. Ask your partner or a friend to massage the arches of your feet. The arches correspond to the digestive system. Your partner should massage in a circular, clockwise motion, as this is the same direction as the movement of the intestines. Ask your partner to spend about five minutes on each foot. If you would like to massage yourself, try using the hand reflexology zones. Massage the dip in the palms of both hands in a clockwise movement. Or put two bottles under the arches of your feet while you're sitting, and gently roll them backwards and forwards on the floor. Acupressure or acupuncture An acupressure or acupuncture point related to your digestion is located in the middle of your tummy. About three finger-widths below your navel (point CV6), gently press intermittently, about 20 to 30 times, and repeat several times a day. Homeopathy Ideally, see a qualified, registered homeopath, as homeopathic remedies should be prescribed according to your precise symptoms. Take one 30c strength tablet three to four times daily, for about five days. The remedy should suit your particular symptoms. Try:

Nux vomica, if you constantly want to poo and have an unfinished feeling. Also if you have associated backache, pass large, hard stools and are quarrelsome, irritable, and find it hard to say no.

Sepia, if you have a bloated feeling in your tummy, and feel as if there is a round ball in your bottom. Also if you feel worse at midday and in the evenings, but better if you get some exercise, and are emotionally indifferent, snappy, weary and worn out.

Lycopodium, if you pass hard, knotty stools, have a lot of wind, feel worse when hot and in the evenings, but feel better if you have a warm drink. Also if you are anxious, lack self-confidence, but put on a brave front.

Graphites, if your stools are large, contain mucus and are sour-smelling, and you pass large quantities of sour-smelling urine at night. Also if you feel worse when cold and at night, and are apprehensive and tearful.

Supplements If you need an iron supplement because you are prone to anaemia, try a multivitamin preparation or a liquid iron supplement, but check with your midwife first. Try to eat some red meat or pulses, and include dark green vegetables in your meals. Ask your doctor to change you to a different brand of iron tablet if the one you are taking causes constipation. If constipation becomes a more serious problem, your doctor or midwife may prescribe a laxative which is safe to use in pregnancy. Pelvic floor relaxation When you feel the need to go to the toilet, make sure you have privacy and time. Sit on the toilet, breathe deeply, then exhale so your pelvic floor muscles relax, but try not to strain. Standing up just before trying to pass the stool can sometimes help. Bend one knee and put your foot on a chair or the edge of the bath. This encourages pelvic floor relaxation more than when you sit on the toilet.

Which complementary therapies could I try?

If your constipation persists, you could consult a qualified practitioner of acupuncture or shiatsu to help to rebalance your internal energies. Osteopathy or chiropractic may correct any misalignments in your skeleton. This may be from a previous injury putting stress and tension on soft parts of your body, including your stomach and intestines. If you'd like to try Chinese medicine, acupuncture, or ayurvedic medicine, consult a practitioner who is registered, insured, and has experience of treating pregnant women. Colonic irrigation is not recommended in pregnancy as it can affect the normal pH and bacterial balance of your lower colon. There is a possible risk of mild complications such as vaginal infections, or more serious problems.