A Symptom, Not A Disease
Constipation is a symptom, not a disease. It is important to establish the cause of constipation in order to treat it effectively.
It is also important to understand that people have bowel movements at different intervals and a healthy range of bowel movements is from three times a day to once every three days. As long as there is no abdominal bloating and pain and there is no urge, then its possibly not time.
However, if one does not move their bowel for more than a week, it warrants investigation. This is especially so if the patient is over 50, the age at which extra vigilance is recommended for signs of colorectal cancer.
Who Suffers Most
In general, constipation affects the elderly more than the young. Not only do most of the diseases linked to constipation occur in later life, but the incidence of poor nutrition and inactivity increases in old age due to a wide range of reasons.
Causes and Concerns
In attempting to identify the underlying causes of constipation, our specialist will first exclude possible life-threatening organic conditions such as colorectal cancer. In addition, warning signs of colorectal cancer include the passage of blood or mucus during bowel movements, abdominal pain, abdominal lumps and masses, and loss of weight and appetite.
Other possible causes of constipation include metabolic and hormone-related conditions such as thyroid disorders and high calcium levels associated with chronic kidney disease. Medications can also cause constipation, including pain killers, antidepressants, blood pressure medication, iron supplements, calcium supplements, and aluminium-containing antacids, all of which can cause or worsen constipation.
Once these organic causes have been eliminated, functional causes will be considered. These relate to the disturbance in the ‘mechanics’ of bowel movement, and include reduced gut motility (slow transit of stools), muscle incoordination at the anus and rectum and prolapse of the rectum.
Fibre… Too Much Of A Good Thing Is Bad
It is well known that eating a diet rich in fibre is essential to colon health and proper bowel function. Examples include fruits, vegetables, bran, oats and wholegrain bread.
At Mark Wong Surgery, our specialist has seen numerous sufferers of constipation, which began in his previous role as Director of a Pelvic Floor Service at a large restructured hospital. In his experience, Dr Wong cites a growing local ‘epidemic’ of constipation due to an excessive intake of dietary fibre.
Dietary fibre is either soluble or insoluble. When taken in excess, it can lead to constipation with typically pellet-like stools (caused by insoluble fibre), as well as excessive bloating and flatulence (caused by soluble fibre). Conversely, taking too little can also lead to constipation. The key is every individual must take the right amount of fibre for oneself. There is no universal dietary formula or template for everyone and it has to be individualised
How Do We Treat
When constipation occurs, simple lifestyle changes can often remedy the situation. Sometimes, stepping up your exercise routine, drinking more water or eating more or less fibre-rich foods will do the trick. Probiotics and prebiotics are also helpful to promote good gut health and regular bowel movements.
If these measures fail, medications such as laxatives can be used for short-term relief while dietary misalignments are addressed. However, long-term use of laxatives is not healthy, and our specialist believes that most if not all patients can be weaned off their medications by adjusting their lifestyles, involving a combination of both regular exercise and moderating the intake of all food groups.
For those above the age of 45 years and with risk factors for colorectal cancer, a colonoscopy should also be performed to exclude such life-threatening conditions.