What is constipation?
Constipation (also called constipation or constipation) means that bowel movements decrease compared to normal. In fact, constipation is not a disease, but a symptom that can be seen in many conditions.
Intestinal function normally varies from individual to individual. Defecation is normal for one person, 3 times a day for another and normal for another person. By definition, constipation is defined as defecation of 2 or less weeks. Some people accept the meaning of constipation as difficulty in defecation or hard stool. This is a false belief.
Constipation (constipation) is a very common condition all over the world. There are difficulties in defining objective criteria in the definition of constipation and certain criteria (Roman criteria) have been identified in international meetings. If at least two or more of the criteria listed below continue for at least 12 weeks within one year (not necessarily consecutive), it is agreed that the condition will be considered constipation.
Rome II Criteria
Breeding During Defecation
Need for straining more than 25% of all defecation
Making Piece or Hard Stools
Making part or hard stools in more than 25% of all defecation
Feeling Full
More than 25% of all stools have a feeling of not fully discharging
Blockage during defecation
Blockage during defecation in more than 25% of all defecation
Support during defecation
Supporting the pelvic floor with finger or hand during defecation in more than 25% of all defecation
Defecation 2 or less per week
How Does Normal Defecation Occur?
In order to better understand constipation, let us first look at how normal defecation occurs.
After meals, undigested food passes through the small intestine and reaches the large intestine within 2-3 hours. Residues coming into the large intestine are excreted as feces only in 2-5 days. Normally, wastes coming into the large intestine are in liquid form. As it progresses through the large intestine, water is absorbed and begins to solidify on the right side of the intestine. The left side of the large intestine serves as a depot. When a person eats food, foods coming from his stomach send a warning to the large intestine through a special reflex (gastrocolic reflex) in the intestine. This reflex pathway leads to contraction of the large intestine and occurs when the defecation function is appropriate in the social environment. This is the reason why one often feels the need for defecation during breakfast. When food residues reach the last part of the large intestine (rectum), there is a need for defecation. Muscles (levator ani, puborectalis) that form the base of the pelvis (inner pelvis) are active during defecation. The puborectal muscle supports stool control by supporting the lower part of the large intestine from below. Another important structure for stool control is the muscles surrounding the breech. These muscles are called breech control muscles (anal sphincter). These muscles are 2 pieces inside and outside of the breech and they are called internal and external anal sphincter muscles.
Accumulation of food residues in the rectum (the last part of the large intestine) causes the need for defecation. The sensation of defecation causes relaxation of the muscle inside the breech. This allows the stool to move further towards the breech and to understand what the feeling of defecation occurs by the body. Thus, one can perceive whether the sensation of defecation is from gas or solid food residues. This prevents going to the toilet every time to extract gas.
The defecation function requires relaxation of the puborectalis and breech-controlling muscles. By pelleting, the pelvic floor is flattened, the angulation between the anal canal and the rectum disappears. Sitting during defecation increases intra-abdominal pressure and helps the person to defecate more easily.
The most important task of the colon (colon) is to ensure that the body needs water to be sucked back into the blood, thereby preventing fecal and water loss. Therefore, when water and food residues come to the colon (large intestine), excess water is absorbed. Absorbs 90% of the fluid in the large intestine (bile, digestive fluids, food-borne fluid). Feces are formed from the remaining digested food residues. The undigested fibers in the feces have water retention. With the rate of water held by these fibers, the stool softens, forms and facilitates defecation function.
Risk Factors for Constipation
Constipation is one of the most common diseases of the gastrointestinal tract. Although it is observed at the most advanced age, it can affect all segments of the society. Women are affected by 2-3 times more than men.
There are many factors in the formation of constipation. However, the most important risk factor is malnutrition. It may cause constipation in different environments due to additional stress and travel. Another point to remember is the development of constipation due to the underlying diseases. Therefore, a good differential diagnosis is necessary.
How does constipation develop?
Muscle contractions in the wall of the large intestine allow the stool to progress to the anus. This is also regulated by nerve impulses. Irregularity in muscle and nerve stimulation prolongs the passage of the large intestine. This causes constipation. When bowel functions are impaired due to other diseases that cause constipation, the stool progresses slowly. This causes the column to absorb too much water and to produce hard and dry faeces. Hardened stools cause pain when moved.
What Causes Constipation?
Defecation disorders are a common problem. About 70-80% of people complain of constipation for a period in their lives. There may be many causes of problems such as forced emptying or a small number of defecation.
Before identifying the causes, the first step is to distinguish between short-term (acute) and persistent (chronic) constipation. Short-term and non-recurring constipation usually occurs with short-term changes in our habits. Acute constipation can be defined as persistent changes in bowel habits for less than three months. In acute constipation, the problem is often unique and can be easily treated.
In chronic constipation, changes in intestinal habits are more than three months and the causative factors are more complex. Disease known as functional constipation is rare. The reason is unclear.
Many factors can cause constipation. The main causes of constipation are;
Insufficient water consumption is the most important problem.
Insufficient Fiber in the Diet: The amount of fiber normally consumed daily is about 25-30 grams. With modern living and fast, easy food solutions, the daily intake of fiber leads to constipation.
Changes in Routine Life: Many people complain of constipation from time to time. Conditions such as change of environment, travel, changes in eating habits, and pregnancy can cause difficult defecation.
Impairment of Pelvic Floor Muscles: Constipation can be seen due to the involuntary muscle of the striated muscles of the pelvic floor during defecation.
Side Effects of Medications Used: The use of certain medications may cause constipation or exacerbate symptoms. Painkillers, anti-depressant drugs, antiparkinsonian drugs, trancilisants, blood pressure regulating drugs (calcium channel blockers), diuretics (causing potassium loss), iron preparations, calcium use, and antacids containing aluminum or calcium can cause constipation.
In fact, some non-constipated individuals may become drug-dependent due to some laxatives they take to make defecation every day. This causes the problem to grow further.
Intestinal Diseases Causing Congestion: The important thing is the sudden constipation that occurs when there is no reason. In this case, a mechanical obstruction blocking the intestine should be considered. This obstruction may be due to cancer, an inflammatory condition (diverticulitis, Crohn's Disease) or adhesions. These sudden obstructions are usually accompanied by nausea, vomiting, abdominal pain, and fever.
Irritable Bowel Syndrome (IBS): Bowel spasms in patients with irritable bowel syndrome may change the patient's habit of defecation. Intermittent constipation and diarrhea attacks can be seen in these patients. In addition, abdominal distention, pain, gas complaints may be.
Hormonal Diseases: Constipation may occur during the course of hypothyroidism (inadequate functioning of the thyroid gland), diabetes and rheumatic diseases.
Disorders of the intestine: Constipation may also occur in structural disorders, stenosis and congestive diseases of the large intestine.
Irregularities in nerve and muscle stimulation: Muscle contractions in the wall of the large intestine allow the stool to progress to the anus. This is also regulated by nerve impulses. Irregularity in muscle and nerve stimulation prolongs the passage of the large intestine. This causes constipation.
In addition, during defecation, the puborectalis and the external muscles that control the breech are not sufficiently relaxed prevent defecation. Again, non-coordinated functioning of the muscles in this region causes functional congestion. Constipation begins in childhood due to irregularities in muscle relaxation in Hirschsprung disease, a congenital disease.
Existence of Systemic Diseases: Feces progress slowly when bowel contractions are disrupted due to other constipation diseases (listed below). This causes the large intestine (column) to absorb too much water and to produce hard and dry faeces. Hardened stools cause pain when moved.
Constipation Diseases
Diseases of the large intestine
Irritable bowel syndrome
Large Bowel Cancer
diverticulitis
Crohn's Disease
Continuous use of laxatives
Pelvic floor damage
Anal diseases
Neurological
Multiple sclerosis
Parkinson's disease
Paralysis
Spinal cord injury
the pSEUDOOBSTRUCTION
Metabolic
Pregnancy
Diabetes
Thyroid disease (Goitre)
Parathyroid disease
Uremia
Systemic diseases
Amyloidosis
Lupus
scleroderma
Surgery - Surgical treatment (intra-abdominal adhesions, Hirschsprung's disease)
Poor eating habits (high caffeine intake, irregular feeding times, etc.)
Less exercise
Low fluid intake
Preventing intestinal motions voluntarily
Stress and anxiety
Symptoms of Constipation
Constipation manifests itself with a feeling of fullness.
Although it does not seriously affect our daily work, it can make one feel uncomfortable.
Hard and dry stools make the passage difficult and cause the passage to be painful. Blood may be seen due to irritation caused by constipation.
Some people may occasionally experience fullness, abdominal distension, and displaced abdominal pain.
Many people complain of constipation from time to time. Changes in the environment, travel, changes in eating habits can cause difficult defecation. Constipation and bloating (abdominal distension) may develop as a result. These (constipation swelling) is corrected when the environment returns.
What matters is constipation that suddenly occurs for no reason. Serious diseases can cause constipation and constipation. Unexplained constipation, worsening abdominal pain and accompanying fecal blood (constipation blood) and mucus, decreased bowel movements, nausea, vomiting and difficulty in defecation can be seen. In this case, a mechanical obstruction blocking the intestine should be considered. This obstruction may be due to cancer, an inflammatory condition (diverticulitis, Crohn's Disease) or adhesions. These sudden obstructions are usually accompanied by nausea, vomiting, abdominal pain, and fever.
Generally;
Decrease in number of defecations per week (Less than normal bowel movements)
Coexistence of dry, hard stools and difficulty in their passage and feeling of pain, constipation and abdominal pain
Feeling of fullness and incomplete emptying of the rectum (the last part of the large intestine) after defecation
Individuals with the above symptoms may require medical attention due to constipation.
Is your habit of defecation regular?
Many people feel constipated and irregular when they can't defecate once a day. This may not always be true. Normally, the number of defecation ranges from 3 times a day to 3 times a week. Therefore, hard defecation should not mean constipation. Again, the lack of defecation for 2 days is not constipation.
Do Drugs Affect the Time of Transition of the Large Intestine?
Some drugs used in addition to the above diseases cause prolongation of the passage of the large intestine and develop constipation. These medications cause constipation by blocking the nervous movement of the large intestine, muscle movements or by holding water. Patients with constipation problems should carefully read the side effects of all medications they use and consult their physician. Some of the drugs that cause constipation are listed below.
Constipation of Unknown Cause (Chronic Idiopathic Constipation)
Disease known as functional constipation is rare. The reason is unclear. Drug treatment is sometimes not helpful in individuals who have been constipated for long periods of time. There may be many problems under this. Hormonal changes can cause muscle and nervous system problems of the large intestine. This type of constipation is more common in children and women.
This may be caused by prolonged passage of feces through the large intestine or by problems in the muscles that provide progressive bowel movements in the intestinal wall. In this case, the feces accumulated in the rectum (the last part of the large intestine) cannot be thrown out because of weakness in muscle movements.
When to see a doctor?
It is usually a temporary condition that can be easily corrected. However, it can sometimes point to more serious problems. If you have any of the following conditions, you should go to the doctor for a medical examination (constipation examination);
Persistent constipation and unexplained constipation status
Changes in intestinal habits (increase or decrease in frequency)
Stool thinning (fine defecation) and bloody defecation
Constipation lasting more than seven days despite dietary changes and constipation diet
Stool blood, abdominal pain or tenderness
Defecation is extremely painful (painful defecation)
Consequence of constipation diarrhea attacks
Other signs and symptoms suggesting that there may be a problem in the body with constipation
There is no special area (ie constipation doctor) that is referred for constipation complaints. You can refer to the internal medicine, gastroenterology (gastrointestinal diseases department) and general surgery departments of the hospitals.
Constipation Diagnosis - Investigation of Causes of Constipation
Tests for Constipation Diagnosis
There are many causes of constipation. It is important to identify the cause for simple or specific treatment. The doctor will investigate mechanical obstacles - anatomical causes of narrowing or obstruction in the colon (within the colon).
First, a careful history of the disease, drugs used, defecation pattern, stool type, straining and feeling of full ejaculation are questioned by the doctor. Large bowel cancer should be investigated in patients over 40 years of age. After that, the breech region (anorectal) is examined by finger. Examination of the intestine by endoscopy (colonoscopy) or barium radiography (medicated colon film) studies Polyps help to investigate the causes of severe constipation, such as tumors. If an anatomic problem is detected, treatment is directly related to this reason.
In addition, investigations of functional disorders can be made. Some of these are described below.
Large Intestine Transit Test
It is used to calculate the passage time of feces through the large intestine. A capsule with a large number of small rings is administered to the patient. Since the rings in the capsule are seen on the abdominal X-ray, its progression in the intestine is followed by radiographs. Normally, 80% of the rings are excreted with feces 5 days after the capsule is removed. The presence of more than 20% of the rings in the intestine on the fifth day of abdominal x-ray indicates the length of intestinal transit time. Constipation can be diagnosed based on the graph result.
Balloon Excretion Test
Evaluate the emptying function of the rectum.
Anal manometry
Evaluates the coordination between the rectum and the rectum and muscles functions.
electrophysiology
It controls the neural stimulation of the muscles that control the breech.
Defecography
It is a radiograph taken during defecation and evaluates the excretory function.
As a result of these tests, many anatomical or functional reasons causing constipation can be detected.
Does constipation cause any problems?
Sometimes constipation can be a problem. Prolonged sitting in the toilet causes straining hemorrhoids (Hemorrhoids / Mayasıl) to become prominent. In addition, the hard stool may damage the breech (anus) as it passes through the breech (anus) and an anal fissure (rupture) occurs. The patient has pain, bleeding and burning in each toilet.
Excessive strain may cause the lining of the intestine to rotate outwards. This condition is called rectal prolapse.
Some patients cannot remove hard and dry stools. The feces accumulated in the rectum (the last part of the large intestine) become stoned and may cause obstruction.
All the above diseases are prevented by relieving constipation.
What Should You Know About Posa?
One of the best ways to treat common constipations is higher fiber intake in the diet. Fibers are indigestible parts of plants. It gains volume and softens the feces with the water they hold and makes them easy to dispose of.
Fiber Foods
Posa (Fiber) Rich Foods
Fibers are available in two different types and both types are required for regular bowel function.
1. Soluble Fiber
It is a water-soluble gelatinous substance. Provides defecation pattern and facilitates soft stool formation. Oats, beans, fruit varieties and products containing psyllium are good sources.
2. Insoluble Fiber
Insoluble in water. They pass through the digestive system very quickly and in one piece. It helps to regular defecation and to make the stool voluminous. Cereals, porridge and various vegetables are good sources.
Are There Easy Ways to Increase Fiber?
Adding fiber to the diet is easier than you think. Some tips for starting;
Bran bread, brown rice, high-fiber foods such as fruit and vegetables, white bread white rice and chips-confectionery should be preferred to low-fiber foods.
Try to gain the habit of eating more raw vegetables and unpeeled fruits. Cooking vegetables reduces the amount of fiber in them. Shells are also good sources of fiber.
High-fiber food should be taken at each meal. Floury porridge can be a good start, but with fruit and vegetables.
Two important points;
Increasing the amount of fiber slowly. The rapid onset of large amounts of fibrous food can cause uncomfortable bloating, flatulence and pain.
It should not be forgotten that at least 8-10 glasses of fluids should be taken with fibrous food.
Questions About Fiber
How much fiber do you need per day?
Diet experts recommend 25-35 grams of fiber per day.
What are the best ways to increase fiber intake?
Taking a wide variety of high fiber foods.
Replacing low-fiber foods with high-fiber foods in daily foods.
Plenty of fruit and vegetables to be eaten.
To what extent should fiber uptake be increased?
It should gradually increase. Too early and too much fiber intake can cause bloating and abdominal pain. It may take several weeks to increase. When working for this job, it should be remembered that you necessarily get enough liquid.
Is it suitable to take laxatives?
The doctor may prescribe laxatives (Laxatives). There are many types of laxatives and there are varying benefits and side effects depending on the patient.
Increasing the amount of feces (Fiber Containing Products) Laxatives
They increase the fiber rate in the stool. They act by absorbing the liquid in the intestine. This produces soft stools and increases bowel movements. They may interfere with the absorption of the medication used. They work in natural ways because they mimic the normal function of the body. They are the most reliable of laxatives. However, they can lead to increased gas production. Commercially available: Psyllium seed husk (GNC), Metamucil®, Citrucel®, Serutan®
Stool Softeners
They do not increase bowel movements but facilitate the difficult passage caused by hard stools. They secrete water and electrolytes from the large intestine. They soften dry and hard stools and diarrhea occurs. It is good for short term treatments. It may be preferable in cases where it is inconvenient to avoid twisting [during pregnancy, breech (anorectal) surgery, breech pain]. Long-term constipation does not give good results. Commercially available: Colacel®, Dialose®, Surfak®
Another fecal emollient is mineral oil that lubricates the feces and makes it progress. It can be preferred for constipation due to prolonged bedtime. During use, it is necessary to ensure that the drug does not enter the respiratory tract.
Stimulating Laxatives
In addition to increasing water and electrolyte secretion, it acts by increasing muscle contraction in the intestine. Not all stimulant laxatives work essentially the same way, but are not the same. They can cause cramps, nausea and vomiting. These drugs include anthraquin derivatives (cascade, senocide, castor oil, ricinoleic acid) and diphenylmethane derivatives (bisacodyl). Should not be used for a long time.
Brown pigment accumulation in the intestine occurs in those who use anthrax species. These medications should be preferred in cases of severe constipation and unresponsive to other medications. Addicts may be used for a long time. It should be cut slowly. Commercially available: Dulcolax®, Senokot®
Osmotic Laxatives
They absorb water into the intestine, causing the pressure to rise and send a message to the bowel to discharge. Absorbing too much water causes loss of bowel movements and deterioration of the body's water balance. There are two types. It consists of weakly absorbed ions (Magnesium citrate®, fleet phospho soda) and poorly absorbed sugars (lactulose, polyethylene glycol, sorbitol solution 70%). It can be used for a short time in patients with constipation problems due to long-term bedtime. These drugs should not be used in patients with heart failure and fluid loss. It should be kept in mind that phosphate or magnesium poisoning may develop in patients with renal insufficiency.
Polyethylene glycol solution (Golytely) and sodium phosphate (fleet phospho soda) should be preferred when rapid bowel emptying is required (before colonoscopy, before surgery).
Prokinetic Drugs
Accelerates bowel movements. cisapride
Enemas
It is applied from the rectum. The large intestine is filled with liquid. Fecal softening and bowel movements are increased. Tap water or phospho soda can be used for this purpose.
Since there are many products available, the doctor will make the right choice for the individual.
It is the right way to solve the problem of constipation in natural ways and to avoid taking long-term medication. Prolonged use of stimulant laxatives leads to loss of normal tone of the large intestine, causing loss of contraction, constipation and dependence. Bulk-forming laxatives are safe for long-term use.
biofeedback
Biofeedback is another option in treatment. In simple terms, it is necessary to ensure the body's perception of how the breech and surrounding organs work with the help of a catheter. The aim of this treatment is to control the relaxation of the puborectal and external breech muscle by a computer.
Surgical Treatment of Constipation
Finally, in some patients, surgical treatment is recommended if the transit time of the large intestine is longer than normal, ie if food residues and feces do not progress in the large intestine. Surgical procedure removes a large part of the large intestine and maintains the intestinal continuity by joining the small intestine to the large intestine.
What should we do to prevent constipation?
With some simple applications it is possible to reduce symptoms and prevent constipation. Following the recommendations below are effective at the time of constipation and help resolve constipation.
Drinking more water (8-10 glasses of water or liquid per day for constipation)
Consuming more fiber (fiber food)
Eating peels of fruits without peeling
Dried fruit ingestion (apricot, grape, plum etc.)
Consuming raw vegetables in shells
Regular exercise (regular walking, abdominal exercises)
Gaining the habit of regular defecation
Defecation warnings are not blocked. (When defecation should not be postponed. Without rushing, relaxed and forced to do defecation. Delay will cause more tension in the future.)
Constipation nutrition - regular ingestion. (Good and slow chewing of food)
Attention to drugs that show side effects of constipation.
Stress reduction (stress is very effective in the formation of constipation.)
In case of significant and prolonged changes in bowel habits, consult a physician.
Points to Remember
Constipation is the defecation process of 2 or less weeks.
Constipation is not a disease but a symptom that can be seen in different ways from person to person.
Constipation is one of the most common diseases of the gastrointestinal tract. Although it is observed at the most advanced age, it can affect all segments of the society.
Muscle contractions in the wall of the large intestine allow the feces to progress to the anus. This is also regulated by nerve impulses. Irregularity in muscle and nerve stimulation prolongs the passage of the large intestine. This causes constipation.
Many people complain of constipation from time to time. Changes in the environment, travel, changes in eating habits can cause difficult defecation. They recover when the environment returns.
The important thing is that suddenly there is no reason, constipation. In this case, a mechanical obstruction blocking the intestine should be considered.
Intestinal functions and diet training, behavior modification, drug therapy and rarely surgical - surgical treatment may be recommended to the patient. With some simple applications, it is possible to reduce symptoms and avoid constipation.
43AXX
Prunelax Ciruelax Natural Laxative Regular Tablets, 60 Count
