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Constipation may be associated with a decreased intake of the amount of fiber and/or liquids. You could think of. It basically what goes in has to come out. And so there are at least two things operative here. A decreased amount of fluid intake will result in a more condensed hard stool, which is actually harder to pass. If a patient has a slow motility or slow bowel movements that, let’s say the colon contracts and relaxes at a slower pace, that will definitely manifest itself as constipation. As far as decreased fiber, well, fiber attracts water into the gut. Less fiber in your diet, less water attracted to your gut. That’s right. Your stool become concentrated and you will become constipated. Now, are there hormonal differences or causes of constipation? Yes, we talked about in a previous episode, the effect of the thyroid gland. And the thyroid gland is like a thermostat. And so if your thyroid functions at a lower level, your intestinal movements will move more slowly and that will result in constipation. Also, we’ve noticed that in females when they’re pregnant, due to the interactions of hormones, that they may become constipated as well. And so, yes, hormones, medications, diet, liquid, all impact constipation.
There may be several ramifications or adverse effects related to being constipated especially over a prolonged period of time. If you have, if you can imagine if you have a large rock hard stool resting in your rectum, it may rub against the rectal wall and cause what we term a stercoral ulcer. Okay, this is because the large hard stool has actually scraped away some of the surface lining of the rectum. And that can result in pain upon defecation. it can definitely cause a patient to avoid going to the restroom and so it can make constipation worse, and it can also result in bleeding and anemia if this condition is allowed to persist over time. As far as causing pain, especially rectal pain or lower abdominal pain, yes, this can adversely affect individuals. Let’s say for example, if a patient has coronary artery disease. Okay, quite frequently when patients are admitted to a coronary care unit, they’re actually given stool softeners because you don’t want to have a patient straining when they have a bowel movement. That can put increased stress on the heart. And so, aside from diminution in appetite, fear of evacuation, there are a number of ramifications of side effects, which can be directly attributable to severe constipation.
What about testing? It depends on the age of the patient and their associated symptoms. Let’s say for example, we have a young person who is in great health who’s noticed some constipation. Well, the physician would then probably do a detailed history, physical exam, ask about things such as change in diet. Are they hydrating themselves appropriately? Have they started a new medication which can contribute to constipation, etc? And then if, if the answers to those questions reveal just quote on quote garden variety constipation, we’d make some changes in their diet, etc. Perhaps give them a stool softener, encourage increased fiber in the diet, and monitor the patient. If the patient complained of chronic constipation, this is the same young individual, then we might go a step further and perhaps do a test called a sitz marker test. That’s a fancy word, but basically what the patient would do is consume some pellets. These are barium sulfate type tablets, and then they would get an x-ray, perhaps four days later. And what you would look for is to see the migration of these radio opaque markers and see if the patient were able to expel them within four days period of time. If the patient retained those pellets beyond four days, then that would be grounds to say that this person had some significant low colonic transit. Okay. It may be useful to see if the pellets collected in the rectum or if they were hung up throughout all areas of the colon. That may give you some idea as to the cause, whether it’s outlet obstruction versus general slow motility. And lastly, if the patient were older, and if the patient had some warning signs, some signs you might be concerned about, such as significant weight loss or blood per rectum, or decrease in appetite, then we would probably recommend that the patient go for a colonoscopic exam.
In reference to what type of fiber should one consume? Well, it’s actually your choice. It’s ideal if you have enough fiber in your diet, fresh fruits, vegetables, a salad a day is great, but if that’s not possible or feasible for whatever reason, then yes, fiber powder, supplement, or capsule will do the trick just as well.
What about treatments? Initially when we see patients who have constipation, we’ll recommend pretty much dietary intake, fluid intake. Now, if that doesn’t help, then we also encourage folks to make sure that they have increased fiber in their diet. Let’s say, they’ve tried it, doesn’t work, then we would move on to stool softeners. But let’s say patient tried it, didn’t work. What else? Well, you want to make sure that when you’ve done your assessment of the patient that hey, are they taking pain medications? Are they taking certain types of anti-histamines things which can dry the patient out? And so therefore, constipation is a natural consequence. You have to try to eliminate and remove all those types of things. And then, let’s say, you’ve done that. Patient still has constipation. There are some new agents such as linaclotide, which can be used for patients who have significant chronic constipation. And one other thing I should mention, in the case of patients who have to take chronic opioids, there are also new medications which can help with constipation and still allow the patient to have the pain-relieving effect of medication.
So what about home remedies? The mineral oil as your grandmother might recommend, can be effective. However, you have to be very careful if a patient consumes mineral oil, because suppose it goes down the wrong way. It goes down and their windpipe, that that can cause significant problems as far as, uh, inflammation and irritation of the lung. And so mineral oil by mouth is probably not preferred. A better method would be a mineral oil enema. So basically you’re lubricating the tract, making it easier for the patient to pass a stool.
So what are other things that patients can do? Well, naturally, if they’ve noted that prune juice or consuming raisins help them, that’s natural, is a good source of fiber to get things going. So we oftentimes will recommend that. Now, if there are certain types of herbal remedies, certain types of medications that are used by other disciplines that you’re not familiar with the ingredients, it’s probably best to avoid those.
So what can you do to prevent constipation? Well, as we mentioned, consume appropriate amounts of fluid, make sure you have enough fiber in your diet, get eight hours of sleep at night, because that’ll help you if you can, and also exercise within your limits.
So in summary, constipation. As we mentioned, constipation is a symptom characterized by when a patient has either difficulty passing a stool normally, and especially if the patient hasn’t passed a stool within five days time. Now, there are a number of reasons why this may occur. If there’s a decrease in the amount of fiber in the diet or if there’s a decrease in the amount of fluid that a patient consumes, or if a patient is taking medications such as pain medication, which may slow down intestinal transit. What to do about it. If you notice that you have any of the warning signs, rectal bleeding, losing weight, pain, which is relatively not easily controlled, and this goes on for several days, you should bring this to the attention of your physician. We talked about testing and how most individuals who are in good health, you want to do a good history and physical, and then try some things to see if you can get the bowels moving. But if you have any warning signs, bleeding, weight loss, fever, intractable pain, then further investigation is required.
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