What is constipation?
Constipation refers to a condition characterised by infrequent bowel movements, difficulty passing stool, or having hard and dry stools. It can result from various factors such as inadequate fiber intake, dehydration, lack of physical activity, certain medications, or underlying medical conditions.
Constipation can vary from person to person, and while infrequent bowel movements or difficulty passing stool are common symptoms, what’s considered normal can differ from individual to individual. It’s important to pay attention to your body’s signals and seek medical advice if you’re experiencing persistent discomfort or changes in bowel habits.
What causes constipation?
Constipation can be caused by a variety of factors, including:
- Low fiber diet: Not consuming enough fiber-rich foods can lead to difficulty in passing stool.
- Dehydration: Inadequate fluid intake can result in hard and dry stool, making it harder to pass.
- Lack of physical activity: Regular exercise helps stimulate bowel movements, so a sedentary lifestyle can contribute to constipation.
- Certain medications: Some medications, such as certain painkillers, antacids containing calcium or aluminum, antidepressants, and iron supplements, can cause constipation as a side effect.
- Changes in routine or lifestyle: Traveling, changes in diet, or disruptions to your regular schedule can affect your bowel habits.
- Ignoring the urge to have a bowel movement: Ignoring the body's natural urge to defecate can lead to constipation over time.
- Specific health conditions: Certain medical conditions such as irritable bowel syndrome (IBS), hypothyroidism, diabetes, neurological disorders, and intestinal obstruction can cause constipation.
- Aging: As people age, the digestive system may slow down, leading to constipation.
- Psychological factors: Stress, anxiety, or depression can affect bowel habits and contribute to constipation.
- Hormonal changes: Hormonal fluctuations, such as those occurring during pregnancy or menstruation, can also lead to constipation in some individuals.
What are the symptoms of constipation?
The symptoms of constipation can vary from person to person, but common signs include:
- Infrequent bowel movements: Passing stool less frequently than usual, typically fewer than three times a week.
- Difficulty passing stool: Straining during bowel movements or feeling like you can't completely empty your bowels.
- Hard or lumpy stool: Stool that is hard, dry, or difficult to pass.
- Abdominal discomfort or bloating: Feeling bloated or experiencing discomfort in the abdomen.
- Rectal discomfort: Pain or discomfort in the rectum or anal area.
- Feeling of incomplete evacuation: Sensation that you haven't fully emptied your bowels after a bowel movement.
- Rectal bleeding: Occasionally, constipation may cause small amounts of bright red blood on the toilet paper due to straining.
- Decreased appetite: Some individuals may experience a decrease in appetite due to discomfort or bloating associated with constipation.
- Nausea: In severe cases of constipation, individuals may experience nausea or vomiting.
- Fatigue or irritability: Feeling tired, sluggish, or irritable due to discomfort and difficulty with bowel movements.
If you experience persistent or severe symptoms of constipation, it’s important to consult with a specialist for proper evaluation and management.
How is constipation diagnosed?
Constipation is typically diagnosed based on a combination of medical history, physical examination, and possibly additional tests if necessary. Here’s an overview of the diagnostic process:
- Medical history: Your doctor will ask about your symptoms, including the frequency and consistency of your bowel movements, any associated discomfort or pain, recent changes in diet or lifestyle, medications you're taking, and any underlying health conditions.
- Physical examination: Your doctor may perform a physical examination to check for any signs of abdominal tenderness, bloating, or other abdominal issues. They may also perform a digital rectal exam to assess the tone of the muscles in your anus and rectum.
- Diet and lifestyle assessment: Your doctor may inquire about your diet, fluid intake, exercise habits, and toileting routine to identify any factors that may be contributing to your constipation.
- Laboratory tests: In some cases, your doctor may order blood tests to check for signs of underlying medical conditions such as thyroid disorders or electrolyte imbalances, which can contribute to constipation.
- Imaging tests: If necessary, your doctor may recommend imaging tests such as abdominal X-rays or abdominal ultrasound to evaluate the structure and function of your gastrointestinal tract. These tests can help identify any obstructions, abnormalities, or other issues that may be causing constipation.
- Colonoscopy or sigmoidoscopy: In certain cases, your doctor may recommend a colonoscopy or sigmoidoscopy to examine the inside of your colon and rectum for any abnormalities or signs of disease, especially if you have risk factors for colorectal cancer or if your symptoms are severe and persistent.
Based on the findings of the evaluation, your doctor will develop a treatment plan tailored to your specific needs, which may include dietary and lifestyle modifications, over the counter or prescription medications, and management of any underlying medical conditions contributing to constipation.
How is constipation treated?
Constipation treatment typically involves a combination of lifestyle changes, dietary modifications, and, if necessary, medications. Here’s an overview of treatment options:
- Dietary changes: Increasing fiber intake is often the first step in managing constipation. Consuming fiber-rich foods such as fruits, vegetables, whole grains, and legumes can help add bulk to stool and promote regular bowel movements. Additionally, drinking plenty of water throughout the day can soften stool and make it easier to pass.
- Lifestyle modifications: Regular physical activity can help stimulate bowel movements by promoting the natural contractions of the intestines. Establishing a regular toileting routine and allowing yourself adequate time to have a bowel movement can also be beneficial.
- Over-the-counter remedies: If dietary and lifestyle changes alone are not sufficient, over-the-counter laxatives may be used on a short-term basis to relieve constipation. These include bulk-forming agents (e.g., psyllium), osmotic laxatives (e.g., polyethylene glycol), stimulant laxatives (e.g., senna), and stool softeners (e.g., docusate sodium). It's important to use laxatives as directed and not to rely on them long-term without medical supervision.
- Prescription medications: In cases of chronic or severe constipation that does not respond to other treatments, your doctor may prescribe medications such as prescription-strength laxatives or prokinetic agents to help improve bowel motility and promote regular bowel movements.
- Biofeedback therapy: For individuals with chronic constipation related to pelvic floor dysfunction, biofeedback therapy may be recommended. This therapy involves exercises and techniques to retrain the muscles of the pelvic floor to improve bowel function.
- Surgery: In rare cases, surgery may be considered as a last resort for treating severe or refractory constipation that does not respond to other treatments. Surgical options may include removal of a portion of the colon (colectomy) or correction of structural abnormalities.
Treatment for constipation is individualised based on the underlying cause, severity of symptoms, and the patient’s overall health. It’s important to consult with a gastroenterologist for proper evaluation and personalised management.
What is diverticular disease?
Diverticular disease refers to a condition characterised by the presence of small pouches or sacs, called diverticula, that form in the wall of the colon (large intestine). When these pouches become inflamed or infected, the condition is known as diverticulitis.
Diverticula themselves typically do not cause symptoms and are often discovered incidentally during diagnostic tests such as colonoscopies or imaging studies. However, when diverticula become inflamed or infected, symptoms can occur and may include abdominal pain (often in the lower left side), fever, nausea, vomiting, changes in bowel habits, bloating, and rectal bleeding.
Diverticular disease is more common in older adults and is believed to be associated with factors such as a low-fiber diet, lack of physical activity, obesity, smoking, and certain medications. A low-fiber diet can contribute to constipation, which in turn may lead to increased pressure in the colon and the formation of diverticula.
Treatment for diverticular disease depends on the severity of symptoms and may include dietary modifications (such as increasing fiber intake), antibiotics to treat infections, pain management, and, in severe cases or for complications such as abscesses or bowel obstructions, surgery may be necessary.
It’s essential for individuals with diverticular disease to work closely with their healthcare providers to manage symptoms, prevent complications, and maintain overall digestive health.
What causes diverticular disease?
Diverticular disease, particularly diverticulosis (the presence of diverticula without inflammation) and diverticulitis (inflammation or infection of diverticula), is believed to be caused by a combination of factors. While the exact cause is not fully understood, several factors are thought to contribute to the development of diverticular disease:
- Low-fiber diet: A diet low in fiber and high in processed foods can contribute to the development of diverticular disease. A lack of fiber can lead to constipation and increased pressure in the colon, which may promote the formation of diverticula.
- Aging: Diverticular disease is more common in older adults, suggesting that age-related changes in the structure and function of the colon may play a role in its development.
- Genetics: There may be a genetic component to diverticular disease, as it tends to run in families. Individuals with a family history of diverticular disease may have a higher risk of developing the condition themselves.
- Lifestyle factors: Certain lifestyle factors, such as obesity, lack of physical activity, and smoking, have been associated with an increased risk of diverticular disease.
- Chronic inflammation: Chronic inflammation of the colon, possibly related to conditions such as inflammatory bowel disease (IBD), may contribute to the development of diverticular disease.
- Microbiome imbalance: Imbalances in the gut microbiome, the community of bacteria and other microorganisms living in the digestive tract, may play a role in the development of diverticular disease.
- Connective tissue disorders: In rare cases, connective tissue disorders such as Ehlers-Danlos syndrome or Marfan syndrome may be associated with an increased risk of diverticular disease.
While these factors are believed to contribute to the development of diverticular disease, the exact mechanisms underlying its pathogenesis are still being studied. By addressing modifiable risk factors such as diet and lifestyle, individuals may be able to reduce their risk of developing diverticular disease or experiencing flare-ups of diverticulitis.
What are the symptoms of diverticular disease?
Diverticular disease typically refers to two conditions: diverticulosis and diverticulitis.
Diverticulosis
This condition occurs when small, bulging pouches (diverticula) develop in the lining of the digestive system, usually in the lower part of the colon. Most people with diverticulosis don’t experience any symptoms. However, if symptoms do occur, they may include:
- Abdominal pain (usually occurs in the lower left side of the abdomen, but can occur on the right side as well)
- Bloating
- Constipation or diarrhea
- Flatulence
- Rectal bleeding (typically painless and manifests as bright red blood in the stool)
Diverticulitis
This condition occurs when one or more diverticula become inflamed or infected. Symptoms of diverticulitis can be more severe and may include:
- Abdominal pain (typically sudden and severe, often focused on the lower left side of the abdomen)
- Fever
- Nausea and vomiting
- Changes in bowel habits (such as diarrhea or constipation)
- Rectal bleeding (Less common in diverticulitis compared to diverticulosis but can occur if inflammation leads to the rupture of a blood vessel near a diverticulum).
If you’re experiencing any symptoms of diverticular disease, it’s essential to consult a gastroenterologist for proper diagnosis and treatment. Severe cases of diverticulitis may require medical intervention, including antibiotics or, in rare cases, surgery.
How is diverticular disease diagnosed?
Diagnosing diverticular disease typically involves a combination of medical history assessment, physical examination, and diagnostic tests. Here’s how it’s typically diagnosed:
- Medical History and Physical Examination: Your doctor will ask you about your symptoms, including any abdominal pain, changes in bowel habits, and other relevant details. He will also perform a physical examination, including palpating your abdomen to check for tenderness, bloating, or masses.
- Blood Tests: Blood tests may be conducted to check for signs of infection or inflammation, such as an elevated white blood cell count.
- CT scan (Computed Tomography): This imaging test is often used to diagnose diverticulitis. It can help identify inflamed or infected diverticula, abscesses, or other complications.
- Colonoscopy: This procedure involves inserting a flexible, lighted tube with a camera into the rectum to examine the entire colon. Colonoscopy can help rule out other conditions and may be recommended if there are concerns about more serious conditions like colorectal cancer.
- Barium Enema or CT Colonography (Virtual Colonoscopy): These tests may be used to visualise the colon and detect diverticula or other abnormalities.
- Stool Tests:Stool samples may be collected to check for signs of infection or bleeding.
The specific tests ordered may vary depending on the individual’s symptoms and clinical presentation. If diverticular disease is diagnosed, further evaluation may be necessary to determine the severity of the condition and the appropriate treatment plan. Always consult a gastroenterologist for proper diagnosis and management of diverticular disease.
How is diverticular disease treated?
The treatment for diverticular disease depends on whether the condition is asymptomatic (diverticulosis) or if it has progressed to diverticulitis, as well as the severity of symptoms. The treatment also depends on presence of complications of diverticular disease. Here’s an overview:
Diverticulosis
- High-Fiber Diet: Increasing dietary fiber intake can help soften stools and prevent constipation, which may reduce the risk of diverticulitis.
- Hydration: Drinking plenty of fluids helps keep stools soft and can prevent constipation.
- Regular Exercise: Physical activity can help promote regular bowel movements and overall digestive health.
- Monitoring: If diverticulosis is asymptomatic, your doctor may recommend regular monitoring without specific treatment.
Diverticulitis
- Antibiotics: If diverticulitis is accompanied by infection, antibiotics may be prescribed to clear the infection.
- Clear Liquid Diet: In mild cases of diverticulitis, a clear liquid diet may be recommended for a few days to rest the bowel and allow inflammation to subside.
- Low-Fiber Diet: Initially, a low-fiber diet may be advised during acute episodes of diverticulitis to reduce bowel irritation. However, once symptoms improve, gradually reintroducing high-fiber foods is important.
- Pain Management: Over-the-counter pain relievers or prescription medications may be used to manage pain associated with diverticulitis.
- Hospitalisation: Severe cases of diverticulitis may require hospitalisation for intravenous antibiotics, hydration, and close monitoring.
- Surgery: In rare cases of complications such as abscesses, perforation, or recurring episodes of diverticulitis, surgery may be necessary to remove the affected portion of the colon (colon resection).
Complications of diverticular diseas
- Abscess Drainage: If an abscess forms, it may need to be drained using a needle or a catheter inserted through the skin under imaging guidance.
- Emergency Surgery: In cases of severe complications such as peritonitis (inflammation of the abdominal lining) or perforation, emergency surgery may be required.
It’s important to follow your doctor’s recommendations and attend regular check-ups to manage diverticular disease effectively. Dietary and lifestyle changes play a crucial role in both preventing and managing diverticular disease symptoms. Always consult with a healthcare professional for personalised advice and treatment.
