Constipation

What is Constipation?

Almost everyone gets constipated sometime or other - it is a very common condition.  Constipation means different things to different people - some regard it as the passage of hard stools whilst other the infrequent passage of normal or hard stool.  Some people believe it is vital to have one bowel action every day.   The normal range of bowel frequency varies from three bowel actions per day to one bowel action every three days.

When should I see my doctor?

Constipation becomes an abnormal symptom when:

  • there is a persistent change in your normal bowel habit
  • it is associated with bloating or crampy abdominal pain
  • there is bleeding from the back passage
  • you find yourself spending long periods of time straining on the toilet
  • you need to use your fingers in the back passage, or even the front passage (in women) to get your bowels going
  • you have the feeling that there is a "ball" blocking the bassage of motion in the back passage
  • there is absolute constipation when you do not pass any motion or wind over several days

If you have these symptoms, contact your family doctor who may order some tests or refer you to a Specialist Colorectal Surgeon.

What are the causes of Constipation?

The causes of constipation are many and varied and may be combined together.  Most causes of constipation relate to lifestyle issues:

  • low fibre high fat diet
  • low fluid intake
  • sedentary lifestyle (little exercise)
  • change in daily routine
  • stress and anxiety

Other factors that can aggravate constipation are:

  • pregnancy
  • overuse of laxative
  • side effects of medication especially strong pain killers

Causes of persisting constipation, often associated with other symptoms are:

  • blockage in the bowel by a growth or narrowing (bowel obstruction)
  • a muscle problem either that the large bowel muscle is sluggish (slow transit constipation) or the anal sphincter muscle (at the back passage) does not relax when you are having a bowel motion (obstructed defaecation)
  • Non-specific or functional problem where no immediate cause is obvious

What tests may I need to have?

Your general practitioner may organise these tests or refer you to a Specialist Colorectal Surgeon.

1. Examining the back passage and the inside of the bowel.  This is done to determine if there is a blockage and you may need to have:

  • Internal examination of the anus with the doctors finger and a rigid telescope (sigmoidoscope)
  • Internal examination of the whole large bowel with a flexible telescope - flexible sigmoidoscopy or colonoscopy
  • X-ray examination of the large bowel - barium enema

2. Tests to determine if there is a muscle problem

  • A whole gut transit time.  This is performed either by you taking a tablet containing markers, then having a series of x-rays or having a nuclear medicine scan after taking combined liquid and solid meal (containing Radio Isotope) and scans are then taken.  These tests require x-rays or scans over a period of 5-6 days.
  • Muscle test on the back passsage (Ano-rectal manometry).  A catheter is placed in the anus and measurements of your muscles made including a balloon test
  • Electrical tests on the muscle (EMG).  These tests may be uncomfortable but they are occasionally necessary.

How is Constipation treated?

Maintaining a healthy diet and lifestyle.

  • low fat/high fibre diet
  • regular fluid intake
  • regular exercise

What is fibre?

Fibre is in the cell walls of plants and in the bowel remains undigested.  It acts like a sponge soaking up water into the bowel adding bulk to the bowel content and increasing the passage of digested food through the bowel.

How much fibre do we need?

Most Australians eat about 20gms of fibre per day but the recommended daily intake to remain healthy and have a regular bowel habit is 30gms per day.

Which foods are high in fibre?

  • Breads
  • Cereals
  • Fruit
  • Vegetables
  • Nuts, seeds, legumes (lentils/beans)
  • Foods that are hight fibre are generally low in fat.  A high fibre low fat diet is ideal.

What else can I do to help my bowels?

Fluids - drink plenty of water (2 litres per day). This increases the sponge effect of the fibre. Fitness - have regular exercise, 20 minutes, three times per week - walking is best.  This stimulates bowel function. Fibre supplement - many natural fibre products are available at your pharmacy to add extra fibre.  A formula for fighting constipation - the 5 F's

  • High Fibre
  • Low Fat diet
  • Fluid
  • Fitness
  • Fibre Supplement

What may my doctor do to treat Constipation?

Blockage or bowel obstruction 

Surgery may be required to remove the affected part of the bowel causing the blockage.  Your Colorectal Surgeon will explain the details of these procedures.

Bowel Muscle Problem (Slow Stransit Constipation)

Majority of patients can be treated by a combination of dietary manipulation and laxatives.  Occasionally surgery may be required to remove the large bowel (the sluggish bowel) and join the small bowel to the rectum.  A stoma bag is very rarely required.

Sphincter Muscle Problem (Obstructed defecation)

Treatment is a combination of diet, laxatives and bio feedback - exercises involving pelvic floor rehabilitation (retraining the sphincters to relax), usually under the supervision of a physiotherapist.

Non-specific

Often despite all investigvations performed no specific cause can be found for the constipation though the symptoms persist.  This can be frustrating both for yourself and the doctor but usually a combination of change in lifestyle, diet and laxatives will improve the situation.

General Advice

Should you be concerned about any symptoms or the information contained in this brochure, please feel free to discuss this with your Specialist Colorectal Surgeon or your General Practitioner.

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