Constipation Treatment in Delhi, India

Constipation itself might be a symptom of gastric discomfort or a side effect of medicines taken in the recent past. However, some symptoms that indicate constipation include:

• Passing less than five bowel movements in a week.
• The stool tools are hard, dry, and lumpy.
• Feeling bloated, feeling full in the stomach, and nauseous.
• The stools are painful and difficult to pass.
• Stomach ache or cramps accompanying hard stools.
• Feeling that bowels are not fully empty.
• Loss of appetite.

Constipation can occur for multiple reasons - lifestyle, medicines, pregnancy, diet, and more. Common causes include:

• Lack of fibres in the diet
• Inadequate water intake and dehydration.
• Lack of exercise or other physical activities
• Changes in the routine, such as travelling, eating junk, or changes in bedtime.
• Increased consumption of milk and cheese
• Stress
• Resisting bowel movements or avoiding going to the toilet for a long duration.
• Strong pain medicines, like narcotics containing codeine, oxycodone and hydromorphone
• Nonsteroidal anti-inflammatory drugs
• Antidepressants
• Antacids containing calcium or aluminium
• Iron pills
• Allergy medications
• Certain blood pressure medicines, such as calcium channel blockers
• Psychiatric medications
• Anticonvulsant/seizure medications
• Antinausea medications
• Endocrine conditions, such as hypothyroidism, uremia, diabetes, and hypercalcemia
• Colorectal cancer
• Irritable bowel syndrome (IBS)
• Diverticular disease
• Outlet dysfunction constipation
• Neurologic disorders include spinal cord injury, Parkinson's disease, multiple sclerosis, and stroke.
• Lazy bowel syndrome: A condition in which the colon poorly contracts, thereby retaining stool within.
• Intestinal obstruction.
• Structural defects in the digestive tract, such as fistula, volvulus, intussusception, colonic atresia, imperforate anus or malrotation
• Multiple organ diseases, like lupus, amyloidosis, and scleroderma
• Pregnancy

Constipation can be diagnosed by its symptoms and usually requires no tests. However, to understand its cause, the following tests and procedures can be performed:

• Blood tests: Doctors advise blood tests to rule out systemic conditions such as hypothyroidism or hypercalcemia.
• X-ray: It helps diagnose blocks in the intestines and to view the presence of stool throughout the colon.
• Sigmoidoscopy: This procedure helps examine the rectum and lower portion of the colon for abnormalities.
• Colonoscopy: This diagnostic procedure helps examine the colon.
• Anorectal manometry: this procedure helps doctors measure the coordination of the muscles that move the bowels.
• Balloon expulsion test: This test is employed, along with anorectal manometry, to measure the time it takes for the patient to push out a balloon filled with water and place it in the rectum.
• Colonic transit study: The patient is asked to swallow a capsule containing a radiopaque marker or a wireless recording device. The progression of the capsule through the colon is recorded over 24 to 48 hours and studied on X-rays. Through this test, signs of intestinal muscle dysfunction are assessed, along with how well food moves through the colon.
• Defecography: This test helps diagnose prolapse or muscle function and coordination issues.
• MRI defecography: This test helps diagnose rectocele or rectal prolapse that may contribute to constipation.

Constipation can be acute or chronic. Acute constipation can often be treated by taking over-the-counter laxatives or consuming fibre-rich food.

On the other hand, chronic constipation may require in-depth analysis to diagnose its primary cause and make a treatment plan accordingly. These include making changes in diet and lifestyle, medicines, or surgery.

Diet and lifestyle changes

Some important diet and lifestyle changes to treat constipation include:

• Increasing fibre intake since it smoothens bowel movements. This should be done gradually, over weeks, to prevent bloating and gas.
• Exercising and moving regularly helps improve bowel movements.
• Avoid ignoring the urge to pass stools, allowing enough time in the bathroom to eliminate waste without distractions.

Laxatives

Laxatives are supplements that make bowel movements easier. Some over-the-counter drugs include:

• Fibre supplements
• Stimulants help contract the intestines.
• Osmotics help move the stool through the colon by increasing fluid secretion from the intestine.
• Lubricants such as mineral oil assist in moving the stool through the colon easily.
• Stool softeners moisten dry and hard stools and ease bowel movements.
• Enemas and suppositories: Tap water enemas, taken with or without soapsuds, soften stool and induce bowel movement. In addition, they provide lubrication for smoother elimination.
• If over-the-counter medications fail to provide the desired results, doctors may prescribe medicines that help treat the primary cause of constipation, such as:
• Drugs that draw water into the intestines to hasten bowel movement.
• Serotonin 5-hydroxytryptamine 4 receptors move excretory waste through the colon.
• Peripherally acting mu-opioid receptor antagonists (PAMORAs) help deal with constipation caused by opioids.
• Exercising and training the pelvic muscles induces bowel movement and is very helpful in overcoming constipation.

Surgery

Constipation for a prolonged period can give rise to complications. Some of them include the following:

• Swollen veins of the anus or haemorrhoids
• Torn anal skin, known as an anal fissure
• Faecal impaction is a condition in which the stool cannot be expelled from the body.
• Rectal prolapse: a condition in which the intestine protrudes from the anus.

Factors that may lead to constipation include:

• Older age
• Dehydration 
• Lack of fibre in the diet
• Lack of physical activity
• Taking certain medicines such as opioids, sedatives, antidepressants, and antihypertensives

The following preventive measures can be taken to avoid developing chronic constipation:

• Add adequate high-fibre foods to the diet, including whole-grain cereals, beans, vegetables, fruits, and bran.
• Reduce the intake of foods with low amounts of fibre, such as dairy, processed foods, and meat products.
• Drink enough fluids for better and smoother excretion of waste.
• Live an active lifestyle and exercise regularly.
• Manage stress with meditation, yoga, or exercise.
• Avoid holding the urge to pass stools.

Reviewed by Dr. Namrita Singh, Associate Director - Internal Medicine on 22-Mar-2023.