Constipation and its Treatment

A person is considered constipated when the number of bowel movements is less than 3 per week. This situation may be accompanied by other signs or symptoms such as hard stools and in small quantity, feeling of incomplete evacuation or obstructive sensation or clogging, which requires much effort and even digital maneuvers to complete the evacuation.

When this situation is prolonged for more than three months, we speak of chronic constipation. Most often, constipation is due to a functional colonic, rectal or pelvic floor disorder. But it can also be secondary to other metabolic diseases (diabetes, hypothyroidism), neurological diseases (Parkinson, spinal cord injuries) or be caused by organic lesions (colorectal cancer, stenosis, fissures, etc).

In other cases, constipation may be induced by certain pharmacological treatments: calcium channel blockers, opioids, anticholinergic drugs, etc. All this should be taken into account when making the clinical diagnosis.

Consequences of constipation

An important percentage of consultations for anal pathology (hemorrhoids, fissure) have their origin in chronic constipation problems. Other pathologies such as diverticular disease of the colon or rectal prolapse can be aggravated by constipation.

Getting rid of constipation

Changing lifestyle habits is the first and most essential link in the treatment of constipation: avoid a sedentary lifestyle with routine exercise or sports; increase the fiber content of the diet, based on fruits, vegetables and whole grains and increase the intake of liquids: water, juices, infusions and broths.

Treatment

There is a wide variety of pharmacological treatments including stool bulking agents (plantago ovata), stimulant drugs (bisacodyl, senna), osmotics (magnesia, lactulose), lubricating substances and even probiotics.

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Treatment differs depending on whether the constipation is due to a motor or functional problem of the colon or whether it is a defecatory disorder. In the first case, increased fiber can be supplemented with osmotic drugs and in a second stage, stimulants can be added.

Defecatory disorders respond very well to treatment with rehabilitation (biofeedback) which teaches to coordinate relaxation with the effort required for defecation. Ultimately, pharmacological treatment will be applied on a case-by-case basis.

Laxatives

Treatment with laxatives should never be considered initially on a chronic basis. The best therapeutic scenario for each patient should be continuously sought. The abuse of laxatives can lead to undesirable situations that affect the wall and function of the colon and can exacerbate constipation to the point of making it untreatable.

Therapeutic options for constipation

Surgery (colectomy) is reserved exclusively for cases that are highly resistant to medical treatment and with very specific indications. New techniques are currently emerging, such as sacral neurostimulation, which, in the absence of more extensive research, is emerging as a therapeutic option for the future. There are also new drugs whose use in this pathology is pending approval by the competent bodies.