Getting to grips with Constipation

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When I was a lad growing up in the UK, each day after breakfast- like clockwork - Dad got up from the table with daily newspaper in hand and disappeared into the toilet .... for at least 20 minutes! And wherever he went in the world, the routine was exactly the same which cannot be said of about 15% of the western world who struggle with constipation and may visit the smallest room perhaps less than 3 times per week!

Constipation is a big problem and a big strain on those who suffer from it - if you'll excuse the pun! One of the problems when talking about constipation though is to determine exactly what the problem is because one patients story may not correspond with another Doctors diagnosis! Is it difficulty passing a motion? Is having to strain to pass a motion? Is it the size or consistency of the stool? Well the correct answer is "yes ... and no.." as there is no one definition of constipation, but the experts have come up with a delightful compromise with the Rome III Consensus which is states that:
"Symptoms should include ≥ 2 of the following during at least 25% of defecations":

• Straining
• Lumpy or hard stools
• Sensation of incomplete evacuation
• Sensation of anorectal obstruction or blockade
• Manual maneuvers to facilitate evacuation
• Fewer than 3 bowel movements per week

but even using this chart, patients ideas of constipation will often differ from their treating physicians in 50% of cases!

But forming and passing a bowel motion doesn't just rely on the proximity of a newspaper and a suitable "drop-off" point!  In fact the mechanism of defaecation is still to be fully elucidated because it's a very complex process. As well as having two types of squeezing mechanisms within the colon - one for gentle mixing of the contents and the other which is much stronger to propel the motion towards the outside world - these contractions need to be coordinated so that the bowel "behind" squeezes whilst the bowel "in front" relaxes. This is all under the influence of nerves, neuro-transmitters and various hormones, and any interference in either one or some of these can lead to reduced bowel activity and hence constipation.

When it comes to diagnosing constipation, the history is useful especially when it come to medications as certain drugs are renowned for causing constipation - codeine, certain blood pressure medications called Calcium Channel Blockers and some anti-depressants - but history is only a guide, so the experts have come up with some really Hi tech and Low tech investigations which help work out the why's and the wherefores. They will also flash out what is know in their trade as the "Bristol Stool Chart" (which I won't publish here to save the blushes of those of a tender disposition) which is a pictorial depiction of various species of Stool!

When it come to treatment there are some new medications entering the "market" and which seem to be a big step forward in managing this dispiriting condition and that's great news. Old fashioned things such as Prunes do work: soluble fibre such as psyllium does work although Bran doesn't: exercise is definitely a great idea not only for bowels but for general health too - so keep moving to keep moving -: and laxatives that contain Polyethylene Glycol PEG are also effective.

But like all things medical, if you've had a constipation problem for more than 3 months you must see your Doc first before starting to self medicate - especially if you're over 40 or have a strong family history of bowel cancer when you should see your Doc at the first sign of any change in your bowel habit.
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