Chronic constipation

Chronic constipation is a complex of several different symptoms that indicate that there are difficulties with bowel movements. Usually, the diagnosis of constipation means either rare (less than 3 times in 7 days) bowel movements, or problems in the process of defecation, in which less than 35 g of its contents are released from the intestine per day.

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Epidemiology

Epidemiological studies have shown that constipation affects approximately 5-21% of all people (the average is 14%). However, only about 3-5% of people seek medical attention with this problem. Women suffer from constipation more often than men (3 times more often), and during pregnancy this problem occurs in about 44% of expectant mothers. The risk of constipation is highest in older people (about 50% of them suffer from this disease).

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Causes chronic constipation

The most common causes of chronic constipation include the following:

1. Improper diet and habits. Ignoring the urge to defecate due to inappropriate conditions or time - this contributes to the deterioration of the defecation reflex. Contributing circumstances to the problem are: being in an unfamiliar environment, bed rest, busyness during the day. Intentionally causing the act of defecation (taking laxatives) due to the expectation of more frequent or regular bowel movements than is normal for a person. A diet that is low in foods rich in plant fibers. Reduced feces due to the use of drugs that promote constipation, or due to exhaustion of the body.
2. IBS is a disorder of the motor function of the colon, as a result of which the patient experiences hard, rare stools, accompanied by mucus (this condition alternates with diarrhea), sharp, cramping pain in the abdomen. The disruption of the bowel function can be aggravated by stress.
3. Mechanical obstruction. Benign or malignant neoplasms of the sigmoid or rectum. In this case, the lumen of the intestine narrows, which causes the frequency and rhythm of bowel movements to change, abdominal pain, diarrhea and bleeding to begin. In the case of rectal cancer, a change in the appearance of the stool column is observed (it becomes like a pencil), as well as false painful urges to defecate with an almost empty intestine. Coprostasis, in which hardened feces accumulate in the rectum (sometimes the colon). As a result, the patient feels fullness in the intestine and feels pain in the abdomen. Diarrhea is also observed - a mass of liquid feces flows around the plug of hardened feces that has formed in the intestine.
4. Other diseases in which intestinal obstruction is observed are intussusception, volvulus, and diverticulitis. As a result of these pathologies, the intestinal lumen may begin to narrow (or completely close), which causes abdominal colic, stools that look like “raspberry jelly” (in the case of intussusception), since the stool contains mucus and blood, and bloating.
5. Pathologies of the anal canal that are accompanied by painful sensations. Due to pain, a spasm may occur in the external sphincter, as a result of which the defecation reflex will be suppressed. Such symptoms are observed with anal fissure, acute hemorrhoids, and also rectal fistula.
6. Use of medications that cause constipation.
7. State of depression.
8. Neurological disorders that can result in disruption of the autonomic innervation of the intestine. Such diseases include multiple sclerosis, various spinal cord injuries, and aganglionosis.

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Pathogenesis

Chronic constipation can develop due to various factors, the common link in the pathogenesis of each of which is dyskinesia of the colon. Due to the disruption of this organ, the balance between antiperistaltic and propulsive motility is destabilized. Antiperistalsis increases, and the area of influence of retrograde waves expands along the entire length of the intestine. As a result, segmental contractions become more active, due to which the fecal masses become overcompacted.

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Symptoms chronic constipation

The frequency of bowel movements varies, but normally it is once every 2-3 days. If bowel movements occur once a week or less, this indicates problems with the intestines. Another symptom of constipation is that the feces become dense, dry, similar to sheep's - dark lumps or small balls. The feces may also have a ribbon-like, bean-like, or cord-like appearance.

Sometimes constipation diarrhea may be observed - in this case, due to a prolonged delay in emptying, mucus, which occurs as a result of irritation of the intestinal walls, begins to dilute the feces.

Symptoms of constipation may also include distension and pain in the abdomen. The patient feels relief after passing gas or defecating.

Another unpleasant manifestation of constipation is flatulence, which occurs due to the slow movement of feces through the large intestine, as well as the fact that the activity of intestinal bacteria leads to increased gas formation. In addition to these symptoms, bloating can also be accompanied by involuntary reactions of other organs - increased heartbeat, pain in the heart, etc.

Constipation causes the patient's appetite to deteriorate, an unpleasant taste in the mouth, and belching. Muscle and headache pain, decreased ability to work, bad mood, nervousness, and sleep disorders may also be observed.

With persistent constipation, the appearance of the skin may change - it becomes pale, has a yellow tint. The skin loses elasticity and becomes flabby.

Chronic constipation syndrome

Chronic constipation syndrome is a very common pathology that significantly worsens a person's quality of life. Chronic constipation is a heterogeneous disease that is observed in each group of the population. The frequency of its occurrence increases with age.

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Chronic idiopathic constipation

Chronic idiopathic constipation or inert colon is a disorder of the motor activity of the colon, which occurs due to a slowdown in the rate of movement of feces in the intestine (without any anatomical abnormalities). The etiological factors of this disease are mechanical, structural, metabolic, and cortico-visceral effects on the colon.

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Chronic atonic constipation

If atonic constipation is not treated, it can become chronic, with rather life-threatening consequences:

1. An anal fissure that causes severe pain because it diverges again and starts bleeding with each bowel movement. In this case, it is absolutely impossible to allow new constipation to occur, because it will cause the fissure to become more inflamed and enlarge.
2. Hemorrhoids are painful lumps that appear in the anus, sometimes bleeding when straining. Bleeding usually accompanies internal hemorrhoids. When the disease becomes severe, the patient experiences pain constantly - when walking, sitting, lying down.
3. Intoxication. Feces must leave the body in time, as they contain many toxins. If feces remain in the intestines for a long time, these toxins are absorbed into the blood, thereby poisoning the body.
4. A decrease in immune status that occurs as a result of intoxication. With decreased immunity, it becomes more difficult for the body to fight various viruses and infections.
5. Lazy bowel syndrome, which occurs as a result of the abuse of laxatives to relieve chronic constipation. Under the influence of drugs, the intestinal muscles stop functioning, as addiction occurs. It will be much more difficult to get rid of this problem than obstipation.
6. Colon cancer is one of the worst consequences of chronic constipation. Symptoms of this disease include anemia, blood in the stool, and changes in stool. A person begins to lose weight quickly and also feels that bowel movements are incomplete. But at first, the disease develops without any symptoms, so it is necessary to regularly visit a gastroenterologist for examination, especially in cases where there are reasons for concern.
7. Diverticular disease of the colon. Diverticula are protrusions of the intestinal wall that occur as a result of constipation, when the pressure in the intestine increases sharply due to delayed emptying. Diverticula can also be congenital. Symptoms of the disease include blood in the stool and abdominal pain. Feces accumulating in the diverticulum can cause inflammation, which can later lead to the development of a cancerous tumor.

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Chronic constipation of a nervous nature

Chronic constipation caused by nerves appears either as a result of an imbalance between the para- and sympathetic nervous systems, or due to the patient’s depressive state.

Constipation caused by a disorder of intestinal motility, which developed as a result of problems in the neuropsychiatric area, is also considered neurogenic. In addition, the disorder may be caused by problems with the conditioned reflex act of defecation, the involuntary influence of organs altered by pathology, as well as organic destruction of the spinal cord and brain. Thus, neurogenic constipation can be divided into several subgroups: psychogenic, conditioned reflex, dyskinetic (in which spasms or atony predominate), and organic.

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Chronic constipation in the elderly

Chronic constipation in the elderly is usually much more common than acute constipation. Nowadays, chronic constipation is already considered an independent pathology, although it is often a symptom of some other gastrointestinal diseases. Signs of chronic constipation in the elderly are the following circumstances:

• Less than 3 bowel movements occurred in a week;
• The stool is fragmentary and hard with 25% of stools;
• At least 25% of bowel movements occur only with straining;
• More than 25% of bowel movements cause a feeling of incomplete defecation;
• At least 25% of bowel movements cause a feeling of anorectal blockage;
• In 25% of cases, manual assistance is required for bowel movements;
• There are no signs that can confirm that a patient has IBS.

If at least 2 of the above manifestations are observed for at least 3 months per year, this indicates the development of chronic constipation.

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Complications and consequences

Long-term chronic constipation can result in a variety of complications, such as proctosigmoiditis (an inflammatory process in the rectum and sigmoid colon) and secondary colitis.

Prolonged stagnation of feces in the cecum can lead to the contents being thrown back into the small intestine, resulting in enteritis. Complications accompanying constipation also include hepatitis and bile duct pathologies.

Chronic constipation can cause various diseases of the rectum. Mainly, these are hemorrhoids, but anal fissures with paraproctitis also often appear.

In some cases, constipation leads to the lengthening and expansion of the large intestine, which makes the disease even more persistent.

The worst consequence of chronic constipation is the development of cancer.

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Diagnostics chronic constipation

Chronic constipation is diagnosed in the following cases:

• Bowel movements occur less than 3 times a week;
• When defecating, the patient has to strain;
• The stool has a lumpy or firm consistency;
• The appearance of a feeling of incompleteness of the act of defecation.

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Tests

To confirm the diagnosis, the following tests may be taken:

• stool culture for intestinal microflora;
• examination (histochemical and histological) of intestinal mucosa biopsies.

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Instrumental diagnostics

Instrumental diagnostic methods can also be used to identify symptoms of chronic constipation:

• irrigoscopy (X-ray of the colon);
• colonoscopy;
• study of the motor activity of the large intestine;
• functional study of the locking muscular system of the rectum.

Differential diagnosis

In the case of chronic constipation, especially in people over 45 years of age, which has appeared recently and has increasingly severe symptoms (anemia, sudden weight loss), the possibility of a cancerous tumor should be ruled out first.

The following diseases also need to be ruled out:

• Intestinal stenosis of various origins (inflammation of the colon, stenosis of radiation or ischemic origin, diverticulosis);
• Parasitic infestation or chronic intestinal infections;
• Neurological diseases (shaking palsy, autonomic dysfunction, multiple sclerosis);
• Diabetes mellitus, aganglionosis, hypothyroidism;
• Scleroderma;
• Cholestatic pathologies;
• Chronic constipation caused by medication;
• Endometriosis;
• Ulcer.

Treatment chronic constipation

Treatment of chronic constipation involves more than just taking laxatives. In addition to symptomatic treatment, there should also be therapy aimed at the irritant that caused the constipation.

Self-medication in this case is not recommended, since prolonged regular constipation may be a sign of a serious pathology or contribute to the development of life-threatening complications.

It should also be understood that the independent use of laxatives, which does not take into account the characteristics of the drugs, their effect on the body, as well as side effects, often leads to even more serious problems with the act of defecation, since intestinal motility decreases. In addition, in this case, the dose of the drug becomes larger each time, as a result of which over time it generally loses its effectiveness and does not affect the body.

Having determined the cause of chronic constipation, the doctor determines what treatment to prescribe to the patient. In this case, all pathogenetic factors are taken into account, due to which the drugs affect the body more effectively, without causing side effects that can aggravate the disorder of intestinal functioning.

Enema for chronic constipation

In case of chronic constipation, enemas should be used once a week. Patients should alternate the use of water-oil enemas (every day in the morning, maximum 200 ml) and cleansing enemas. This procedure is carried out in order to restore the reflex lost by the intestines.

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Laxatives for chronic constipation

Chronic constipation is most effectively eliminated by laxatives from the prebiotic group: they help stabilize intestinal microflora and stimulate intestinal motility. Thanks to this, the effect of the drug will be long-lasting and stable.

Prelax is taken in a daily dosage of 2-6 tablespoons during meals. The duration of the treatment course can be at least 2 weeks, and a maximum of 3 months. Contraindicated in case of high individual sensitivity to the elements of the drug.

The daily dosage of Lactusan syrup for adults is 20 ml (divided into 2 doses); children are prescribed 10 ml under the same conditions. The drug should be taken during meals. In tablets, the dosage for adults is 8-10 pcs./day, and for children over 5 years old - 3 pcs./day. The treatment course lasts 1-2 weeks. If the form of the disease is neglected, the treatment can be extended to 1 month. Side effects: at the beginning of the treatment course, bloating may be observed, which disappears after a few days. Due to lactulose, the laxative effect may be too strong and provoke the development of diarrhea. Lactusan is contraindicated in case of high sensitivity to additive elements and other components of the drug, lactase deficiency, and galactosemia.

Dufalac is taken in the morning during meals. Dosages are set for each patient individually. For constipation or to soften stool, the following dosages are used:

• Adults – 15-45 ml initial dose and 10-25 ml maintenance dose;
• At the age of 7-14 years – 15 ml initial, 10 ml maintenance;
• At the age of 3-6 years – 5-10 ml, both initial and maintenance;
• For children under 3 years old – 5 ml initial and maintenance.

Usually the dose is reduced after 2 days of use according to the patient's needs. The effect of the drug is manifested 2 days after the first dose, since this is the property of lactulose. The dosage or frequency of use can be increased if the patient's condition has not improved after 2 days of taking the drug.

Side effects of Dufalac: gastrointestinal disorders (nausea, bloating, vomiting); overdose may cause diarrhea. Contraindicated in intestinal obstruction, high sensitivity to galactose, fructose, lactose, or the active substance of the drug, as well as galactosemia. It is prescribed with caution in diabetes mellitus.

Physiotherapy treatment

Physiotherapy will be more effective in combination with diet. If constipation is of an alimentary nature, bowel irrigation is suitable as a treatment method, for which mineral waters with a laxative effect are used. Mineral sulfate waters should be drunk on an empty stomach in the morning and in the evening for about 2 weeks. If constipation also causes abdominal cramps, the water should be drunk warm.

If constipation is caused by atony of the colon, it is necessary to massage the abdomen, perform mechanotherapy and therapeutic gymnastics, take a circular shower and subaquatic baths. Thanks to massage, intestinal motility improves. If the patient feels spasms, it is necessary to use thermal procedures - apply paraffin to the abdomen, take pine baths.

Folk remedies

There are also folk methods of treating chronic constipation.

Pour 1 cup of boiling water over 2 tablespoons of bran and leave to cool, then drain the liquid and eat the resulting bran mixture on an empty stomach. When used correctly, this folk laxative improves the digestive system after just 5 days of use, and stool stabilization occurs on the 10th day. This remedy will be even more effective when combined with enemas.

Tea made from buckthorn bark is no less effective for constipation.

Another recipe: take lemon peel, rhubarb (0.5 kg), and sugar (200 g). Dissolve sugar in water (0.25 ml), peel and chop rhubarb. Pour the ingredients into a saucepan and cook until the mixture is ready. The medicine should be taken daily until the condition improves.

Tea from oregano leaves – pour 30 g of the ingredient into 1 liter of boiling water, let it brew and drink 0.5 cups 3 times a day.

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Herbal treatment

Celandine is very effective in combating chronic constipation. To make a laxative from this herb, you need to cut it and mix it with sugar (take 250 g of both ingredients). Put the mixture on gauze, twist it into a tourniquet, and then put it in a jar filled with whey. Close it with a lid and wrap it in a thick cloth. Put the container in a dark place and leave it to infuse for 2 weeks. Strain the resulting tincture and drink 0.5 cups before meals (20 minutes). In treatment, adhere to the following regimen - take the medicine daily for 2 weeks, then take a break for 2 days, and then resume taking it.

Senna has a high-quality laxative effect on the body. To make a medicine from it, mix 2 teaspoons of this herb leaves with prunes (100 g) and pour 3 cups of boiling water over the mixture. Infuse the medicine for 3 hours, then strain. Drink the finished tincture every hour, 5 tablespoons until the bowel activity is completely restored.

Homeopathy

Among homeopathic remedies that help with constipation are the following: Sulfuris eliminates disorders by stabilizing portal circulation in cases where, together with constipation, the patient experiences itching in the anal area, as well as hemorrhoids. With similar symptoms, but with more severe hemorrhoids, the drug Aesculus hippocastanum should be taken.

Nux vomica is used when the functions of the intestines are reversed - when there is an urge to defecate, the sphincter does not relax, but on the contrary contracts, preventing feces from coming out.

Diet for chronic constipation

Features of a diet for chronic constipation: the basis of the diet should be products and dishes made from them that improve intestinal peristalsis. At the same time, food that can cause rotting or fermentation in the intestines and stomach should be completely excluded from it.

To normalize the functional activity of the intestines, it is necessary to remove products made from puff pastry and yeast dough, fast food, soups infused with the first broth, kvass, sweet carbonated water, legumes, and pasta products from the diet. In addition, you cannot eat mushrooms. It is forbidden to drink cocoa, very strong tea, jelly, and coffee. Of the sweets, you cannot eat cakes containing custard, as well as chocolate; of berries and fruits - blueberries, bananas, and dogwood.

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Menu for chronic constipation

Sample daily menu for chronic constipation.

The diet should be fractional - you need to eat small portions 5-6 times a day. The menu can have approximately the following sequence:

• For breakfast: salad (tuna and fresh vegetables), cottage cheese with jam or honey, and weak tea;
• The 2nd breakfast includes fruit salad (it is recommended to make it from pears, apples, cherries, as well as oranges, pineapples, plums, etc.);
• For lunch, eat seafood soup, an omelette with added vegetables, and a compote made from dried fruits;
• Afternoon snack should consist of weak tea with some kind of dessert (for example, marshmallows or pastilles);
• For dinner, prepare a side dish that includes crumbly buckwheat with butter and fish cutlets (baked);
• Drink low-fat kefir (1 glass) 3 hours before bed.

Exercises for Chronic Constipation

In case of chronic constipation, it is best to do the exercises in the morning, and later again after lunch. Keep in mind that the procedures can be performed no earlier than 1.5-2 hours after eating.

Lie on your back, spreading your arms to the sides, bend over as you inhale and simultaneously draw in your anus, then return to the previous position as you exhale. Perform this procedure 2-3 times.

Having assumed a lying position, bend/unbend, and also bring together/spread your legs, in addition to this rotating your feet (all movements 4-5 times).

In a lying position, place your arms along your body. Turn your palms up, stretch your arms and bend them at the elbows, then return them to the previous position and turn your palms down. Repeat the procedure 5-6 times.

In a lying position with arms along the body. As you exhale, turn to the right, reach the edge of the bed with your left hand, and as you inhale, return to the previous position. Repeat the movement with your right hand. Do this exercise 3-5 times.

In a lying position, grab the back of the bed with your hands and perform cycling movements with your legs – make 8-20 turns with each leg.

In a lying position, bend your legs at the knees, then bring them together/spread them apart – repeat 4-5 times.

Lie on your back, placing your hands under your head. Perform torso lifts, using your hands, the back of your head and your heels as support points. When lifting, draw in your anus. Repeat the procedure 4-5 times. After completing the above exercise, place your hands on your chest and stomach, then inhale deeply twice with your chest and then with your stomach.

Take the “elbows-knees” position and alternately stretch your legs back (repeat 4-5 times).

In the knee-elbow position, lift the pelvis by straightening the knees. Repeat the procedure 3-4 times. If possible, after this procedure, try to stand on your hands in 3-4 short stands, while resting your feet against the wall. While doing the stands, perform movements with your feet.

Take a standing position with your legs together. Perform stretching while simultaneously drawing in your anus. Perform the procedure 2-3 times.

Take a standing position with your legs crossed. Stretch, drawing in your anus – repeat the procedure 2-3 times.

Bring your legs together while standing, and spread your arms to the sides and stretch while inhaling, drawing in your anus. Perform the procedure 3-4 times.

Stand up straight and bring your legs together. Swing your legs to the side, as well as back and forth. Repeat the exercise 3-4 times.

Walk at a normal pace first, then lift your knees high, then return to normal again. The procedure lasts 1-2 minutes.

Take a standing position and bring your legs together, place your hands on your waist, then inhale and move your elbows back, thereby pushing your chest forward. Draw in your anus with this movement. Exhale and take the starting position. Perform the procedure 2-3 times.

Stand up, put your legs together, place your arms along your body. Calmly and deeply inhale/exhale 2-3 times.

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Prevention

Prevention of constipation is the timely detection and treatment of diseases of the digestive system, as well as other pathologies that result in constipation. In addition, you should eat right and include foods rich in organic fiber in your diet. Drink enough fluids, move a lot, follow a daily diet, and empty your bowels on time.

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Forecast

Chronic constipation often has a favorable prognosis. But it should be taken into account that this pathology can have complications - the formation of fecal impaction, the development of fecal peritonitis or intestinal obstruction. These problems are especially related to paralyzed people, as well as elderly people.

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