Constipation is a very common problem that I come across in my daily practice. Due to the change in eating habits and lifestyle constipation has now become a universal problem. This problem is seen right from small children to the aged. This article is written in order to make people understand what constipation is and how it can be prevented and tackled.

WHAT IS CONSTIPATION?

Constipation is not a disease but a symptom that can be caused by many different conditions. There is no fixed definition of constipation. The normal frequency of stools can range from 3 stools per day to 3 stools per week. However as a rule if more than 3 days pass without a bowel motion then the person is said to be constipated. Or constipation can be defined as passage of infrequent and difficult stool. Straining to pass stool and the feeling of incomplete evacuation is also considered as constipation.

Misconceptions about Constipation

There are a number of misconceptions about what is a normal bowel movement. The most common one is that you have to pass motion everyday. Some people become obsessed with this and start abusing their system with laxatives or enemas when there is no real need. In fact this leads to actual constipation and other side-effects.
Another common misconception is that if you don't pass stool everyday then the body absorbs the waste products, which are poisonous and dangerous to health.

WHAT CAUSES CONSTIPATION?

There are several different causes that can give rise to constipation. I have listed out the most common ones. Each age group also has certain different common causes.

1. Poor diet - this is the most common cause for constipation in all age groups. It is also the one cause that can easily be rectified. A person needs atleast 25 to 35 grams of fiber in their diet everyday. This helps form bulky and frequent stools. Nowadays due to the hectic pace of life and urbanization we tend to consume more refined and ready-to-eat food available in packages. This processed food has negligible amounts of fiber leading to constipation. Also people who consume a lot of dairy products like cheese, ice-cream, milk tend to get constipated. The hard core non-vegetarians who live on meat and eggs will also suffer. Remember vegetables and fruits are a must in everyone's diet.

2. Lack of Fluids - water is very necessary for passing a soft stool. If the fluid intake is poor then the stool becomes hard and causes discomfort while passing.

3. Imaginary Constipation - like I have written earlier some people have this misconception that they have to pass stools everyday otherwise it is harmful to health. In order to do this they abuse their system by taking laxatives and enemas which in turn cause actual constipation.

4. Bad bowel habits - all of us at one time or the other tend to ignore the urge to pass stool. This could be either due to unavailability of a decent restroom or because of some other important work. This is also a common cause in children who are too busy playing or have poor toilet training.

5. Travel - traveller's constipation is very common. This happens when you take a long journey or have to change to different time zones. Some people find it hard to pass stools in a strange environment and need their usual surroundings.

6. Irritable bowel syndrome - another very common cause of constipation is Irritable bowel syndrome. In this disorder the patient suffers from alternate diarrhoea and constipation. Here the contents of the intestine move slower than normal because of spasms of the colon.

7. Medications - there are a lot of medicines that can cause constipation. The most common ones are certain types of painkillers, antacids containing aluminum, antispasmodic drugs, anticonvulsant drugs, a few types of antihypertensive medicines. Also some form of iron supplement may cause constipation. As written earlier taking too many laxatives and enemas can actually cause a rebound effect and more constipation.

8. Pregnancy - pregnancy can cause problems in two ways. Mechanical pressure of the pregnant uterus compresses the intestines causing constipation. Certain hormonal changes can also add to the problem.

9. Hormonal disturbances - this is especially seen in women. Some get slightly constipated before, during or after their periods. Also those suffering from Hypothyroidism suffer from symptoms of constipation. This symptom has also been seen in some diabetics.

10. Fissures and haemorrhoids - a person suffering from fissures tends to have spasm of the anal sphincter which does not allow the stool to pass. But constipation can also give rise to fissures and piles.

11. Specific disease - there are a number of disorders which can give rise to constipation. Here are few of the common ones.
Neurological Disorders like Parkinson's Disease, Multiple Sclerosis, Chronic Idiopathic Intestinal Pseudo-obstruction, Stroke, Spinal cord injuries.
Systemic Disorders like Amyloidosis, systemic Lupus, Scleroderma etc…
Problems with the colon and rectum like Hirschsprung's disease, tumours, intestinal obstruction, diverticulosis, colorectal stricture, cancer.

12. Loss of body salts - sometimes constipation is a sign of dehydration and loss of body salts. This occurs when there is profuse vomiting and decrease intake of fluids and food.

13. Age - constipation is most common in the older age group. This may be due to a number of reasons. They lose interest in eating or stop eating in depression. Also loss of teeth leads to eating soft and easy processed food which is poor in fiber. This age group also has to take a number of medications listed above causing constipation.

As I have mentioned earlier these are only a few of the common causes for constipation. In each individual the cause may differ. Constipation in children is also common with different set of causes.

IS CONSTIPATION A SERIOUS PROBLEM?

Many patients ask me this question. No, although very annoying and troubling constipation by itself is not dangerous. However the underlying cause of constipation can be a serious problem. In some cases of colorectal cancer constipation may be the only symptom. Also constipation can cause other problems like fissures, piles, rectal prolapse, bleeding from the rectum, fecal impaction etc…
Anal fissures are caused when a hard stool stretches the anal sphincter muscles. Piles are caused due to straining and pressure exerted while passing stool. Due to straining sometimes a small amount of intestinal lining also protrudes from the anal opening leading to rectal prolapse.
Fecal impaction takes place when the hard stool is packed so tightly in the intestine that the normal pushing and straining action is not enough to expel it. The stool has to be mechanically removed either with a finger or by some other method.

HOW CAN WE PREVENT CONSTIPATION?

There are some causes that can easily be corrected avoiding constipation from occurring. We have to find the underlying cause of the constipation first. Most of the time it is just a simple fault in the diet and lifestyle.
1. Diet - we need atleast 25 to 35 grams of fiber in our daily diet in order to have a soft, bulky stool. Natural fiber is available in Fruits, Vegetables like sprouts, cabbage, carrots, Whole grains, Bran cereals, Lapsi, Dalia, Oats, Beans etc… People who live on dairy products like milk, ice-cream, cheese, meat and processed food get little or no fiber from their diet and end up with constipation.

2. Fluids - you must drink atleast 10 to 12 glasses of water minimum if you want to avoid constipation. Liquids in the form of soups, fruit or vegetable juices, dals are also useful. However liquids containing caffeine like coffee, colas etc… and alcohol have a dehydrating effect and do not help.

3. Exercise - the role of exercise is still unclear but in a certain study done it showed that regular exercising did prevent constipation from occurring.

4. Do not ignore the urge to pass stool - doing this makes you prone to develop constipation. Also allow yourself everyday enough time to pass a normal motion.

5. Specific causes - if you have a hormonal imbalance like in case of Hypothyroidism the appropriate medication will help. If your blood pressure medicine is causing problems then ask your doctor to change it if possible. In these cases the constipation will be relieved if the cause is treated and the correct lifestyle followed.

HOW IS CONSTIPATION TREATED?

There are a number of laxatives and enemas available in the market. Some of the different types are:-
1. Bulk forming laxatives - this type is said to be the safest.
2. Stimulants
3. Stool softeners
4. Lubricants
5. Saline laxatives
Some people also take enemas which can be plain hot water or medicated. All these have their own set of side-effects and if taken repeated the body becomes use to it and then higher and bigger doses are required. If there is a mechanical problem like tumour or intestinal obstruction then a surgical procedure maybe needed.

Some people also take certain ayurvedic concoctions which help them pass normal stools daily. But the best treatment for mild constipation is just correction of diet and lifestyle as described above and no medicines are needed.

However if the person is suffering from constipation and problems arising from it like piles and fissures then Homoeopathy should be given. There are a number of excellent remedies in our system of medicine which have proven extremely effective for these problems. In Homoeopathy each patient is treated as a different person with his or her own set of symptoms. Therefore no two people suffering from the same problem will necessarily receive the same drug. But there are some medicines which have proven more effective where the symptoms are present. Here are a few.

AESCULUS HIPPOCASTANUM

I had a very interesting case of a 40 year old man who came with piles problem. He was constipated and described his stool as being very hard, knotty and dry. He said he felt as if his anus was full of small sticks which caused the aching pain and soreness. After passing stool the pain remained for hours.
On examination the piles appeared purplish in colour, and were protruding out. Patient said the pain was sharp, shooting and went up his back. All his problems were worse on walking and standing and he felt better only by cold bathing. But there was hardly any bleeding from the haemorrhoids.

I gave him Aesculus 200, 5 pills 4 times a day with the correct diet which got rid of the problem.

CAUSTICUM

If the constipation is due to partial paralysis of the rectum then this remedy should be thought of. The patient will complaint of ineffectual urging to pass stool but will pass only very small bits. The stools are hard, small and covered with mucous that makes it look shiny like grease. The rectum feels sore and burns. This is only better by cold water. This is also useful where the large piles are obstructing the passage of stool.
There might be prolapse of the anus while coughing. All the symptoms are aggravated by walking.

Causticum 200, 5 pills 4 times a day should be given in order to relieve the symptoms.

NUX VOMICA

A 30 year old male patient came to my clinic with the complaint of constipation. While taking the case I found out that his diet consisted of only junk food. He would not eat any vegetables and only live on very spicy, fast food especially from outside. For the last few months he was taking laxatives every day in order to relieve the constipation but now even this was not working.
He described his symptoms by saying that he had a constant urge to pass stool. He would go to the toilet but pass only little and feel unsatisfied. Because of his frequent use of laxatives and purgatives he would even suffer from diarrhoea alternating with constipation. The more he strains at stool the worse it gets.

I prescribed Nux Vomica 200, 5 pills in repeated doses till he was cured.

RATANHIA

This is a very useful remedy in cases of fissures of the anus caused by constipation or vice versa. The anus feels very sore and constricted. The patient describes the pain as if the rectum is full of broken glasses. There are sudden spasms with knife-like stabbing pains.
Fissures of the anus is a prominent symptom. Here cracks develop around the anus. Stools have to be expelled with great effort and the rectal area aches and burns for hours after stool. Only cold water gives some relief. Ratanhia has also proved to be a very useful remedy in treating pinworms.

Ratanhia IM, 5 pills 4 times a day will heal the rectal area and fissures.

As I have written earlier different age groups have different common causes for constipation. In the next article we will deal with the common causes of constipation in children and old people and how they can be tackled. Constipation in women and during pregnancy will also be written about in a separate article.