Understanding the Causes of Constipation and exploring the Best Laxatives and Stool Softeners

Causes of constipation

Constipation is not always related to an underlying condition. It may be caused by one of the following reasons

• Insufficient quantities of fiber in meals
• Inadequate intake of fluid resulting in dehydration
• Physical inactivity
• Changes in diet or normal activities
• Resisting the urge to have a bowel movement.
• Drugs such as narcotics, antidepressants, and anti-acids (incredibly those rich in Calcium and Aluminum)

Medical Causes Of Constipation:

Sometimes constipation may signify an underlying health condition. Your doctor will ask you questions and might run tests to make sure you don’t have any other organic cause of constipation.

1. Irritable bowel syndrome: It is a chronic gastrointestinal disorder that affects the large intestine causing diarrhea, abdominal pain, bloating, and flatulence. Symptoms may include abdominal discomfort or pain and diarrhea alternating with constipation.
2. Hypothyroidism: A condition resulting from decreased production of thyroid hormones. Symptoms may include weight gain, increased sensitivity to colds, and constipation.
3. Bowel Obstruction: An obstruction in the small or large intestine causes difficulty in passing digested materials, usually through the bowel. Symptoms may include abdominal pain, constipation, and bloating.
4. Neurological Disorders: This might include spinal cord injury, multiple sclerosis, Parkinson’s disease, and stroke.
5. Anal Fissure: A small tear in the lining of the anus may cause pain and bleed with bowel movements. Usually, causes because by constipation or passing large and hard stools. Symptoms may include constipation, pain during bowel movements, itching, or irritation around the anus.
6. Colon Cancer: Colon cancer begins in the last part of the digestive tract-colon (Large intestine). Symptoms may include a change in bowel habits, diarrhea/constipation, and blood in the stool.

What are the clinical features of constipation?

• Fewer than three bowel movements a week
• Stools are dry, hard, and lumpy
• Stools are difficult or painful to pass
• You have a stomachache or cramps
• Feel bloated and nauseous
• Feel that you haven’t completely emptied your bowels after a movement

How will your doctor evaluate constipation?

Constipation is a clinical diagnosis- your doctor can make based on your symptoms. Your doctor will ask you about the duration of the symptoms. You might be asked if you have any other symptoms associated with constipation. Your doctor will also inquire about any medications you have been taking recently.

Diagnosis of constipation relies on symptomatic criteria, which include at least three months of:

1. Straining with defecation at least one-fourth of the time.
2.  Lumpy or hard stools (or both) at least one-fourth of the time.
3.  A sensation of incomplete evacuation at least one-fourth of the time or,
4.  Two or fewer bowel movements in a week.

⇒ Constipation may be considered chronic if you’ve experienced two or more of these symptoms for over three months.

What kind of tests may be required to evaluate constipation?

In addition to a general physical exam and a digital rectal exam, doctors use the following tests based on your characteristics such as age, duration of symptoms, and other associated symptoms, which include:

Blood tests: Your doctor will look for systemic conditions such as low thyroid  (hypothyroidism) or calcium levels.

• X-ray of the abdomen:  An X-ray can help your doctor determine whether your intestines are blocked and whether stool is present throughout the colon.
• Imaging tests: Computed tomography (CT) or lower gastrointestinal tract series may be ordered to identify other problems that could be causing your constipation or to make sure you don’t have a bowel obstruction.
• Colonoscopy: A colonoscopy is done with a long flexible tube with a camera at one end to view and take pictures of your intestines. During this procedure, a small tissue sample (biopsy) may be taken to test for cancer or other problems, and any found polyps will be removed.
• Colorectal transit studies: These tests involve consuming a small dose of a radioactive substance, either in pill form or in a meal, and then tracking the amount of time and how the substance moves through your intestines.

Home remedies for constipation

Natural remedies for constipation:

You can use some home-based methods to treat constipation and prevent it from becoming a chronic problem.

• Include plenty of high-fiber foods, including beans, vegetables, fruits, whole grain cereals, and bran.
• Drink plenty of fluids.
• Stay as active as possible and try to get regular exercise.
• Try to manage stress.
• Don’t ignore the urge to pass the stool.
• Try to create a regular schedule for bowel movements, especially after a meal.

Constipation treatment

There are many over-the-counter (OTC) medications available to treat constipation. However, it is important to use these medications only as directed and to consult with a healthcare provider if you have any questions or concerns. It is also important to address the underlying causes of constipation, such as poor diet or lack of exercise, to prevent the condition from recurring. Additionally, it is always a good idea to consult with a healthcare provider before starting any new medication or treatment. Your doctor might recommend a combination.

1. Bulk-forming agents: These medications work by absorbing water in the intestines, which helps to soften and bulk up the stool, making it easier to pass. Examples of bulk-forming agents include psyllium husk (Metamucil), methylcellulose (Citrucel), and polycarbophil (FiberCon).
2. Stool softeners: These medications work by drawing water into the stool, making it softer and easier to pass. Examples of stool softeners include docusate sodium (Colace) and docusate calcium (Surfak).
3. Osmotic laxatives: These medications work by drawing water into the intestines, which helps to soften and bulk up the stool, making it easier to pass. Examples of osmotic laxatives include magnesium hydroxide (Milk of Magnesia), polyethylene glycol (Miralax), and lactulose (Constulose).
4. Stimulant laxatives: These medications work by stimulating the muscles in the intestines to contract, which helps to move stool through the intestines. Examples of stimulant laxatives include bisacodyl (Dulcolax) and senna (Senokot).
5. Lubricants: These medications work by coating the stool, making it easier to pass. Examples of lubricants include mineral oil.

→ You can also use fiber products such as psyllium, methylcellulose, calcium polycarbophil, and wheat dextrin.

Additionally, some medicines help make bowel movements easier to get out, which include:

• Osmotic agents: Miralax, milk of magnesia.
• Lubricants: Mineral oil enemas.
• Stimulants: Bisacodyl, Sennosides
• Stool softeners: Docusate sodium and Docusate calcium

When to consult a doctor?

• Your constipation has lasted more than three weeks.
• You see blood in your stool.
• You are losing weight unintentionally.
• You have severe pain with bowel movements.
• You have symptoms of outlet dysfunction constipation.
• If you have new constipation without a change in your medicines or diet and have never had constipation in the past.
• Other people in your family have had colorectal cancer or inflammatory bowel disease.

Questions to your doctor?

• What’s the most likely cause of my symptoms?
• What kinds of tests do I need, and how do I prepare for them?
• What treatment do you recommend?
• Am I at risk of complications related to this condition?
• If Initial treatment doesn’t work, what will you recommend next?
• Are there any dietary restrictions that I need to follow?
• I have other medical problems. How can I manage these along with constipation?

References

• https://www.niddk.nih.gov/health-information/digestive-diseases/constipation
• https://patient.gastro.org/constipation/
• https://gi.org/topics/constipation-and-defection-problems/