Frequent bowel movements – Mayo Clinic

There’s not a generally accepted clinical definition for frequent bowel movements. Most people consider several bowel movements a day to at least be unusual, particularly if this pattern is a change from what’s normal.

If the only change from your usual bowel pattern is the frequency of your bowel movements, an illness is unlikely to be the cause. If you don’t have loose, watery stools, abdominal cramping or bloody stool (diarrhea), frequent bowel movements are usually related to your lifestyle.

Nov. 14, 2020

Show references

1. Wilkinson JM (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 9, 2017.
2. Fiber. Academy of Nutrition and Dietetics. https://www.eatright.org/food/vitamins-and-supplements/nutrient-rich-foods/fiber. Accessed Oct. 22, 2020.
3. Evaluation of the gatrointestinal patient. Merck Manual Professional Version. https://www.merckmanuals.com/professional/gastrointestinal-disorders/approach-to-the-gastrointestinal-patient/evaluation-of-the-gastrointestinal-patient?query=Evaluation of the GI patient. Accessed Oct. 22, 2020.
4. Celiac disease. National Institute of Diabetes and Digestive and Kidney Diseases. Understanding celiac disease. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease. Accessed Oct. 22, 2020.
5. What is inflammatory bowel disease (IBD)? Centers for Disease Control and Prevention. https://www.cdc.gov/ibd/what-is-IBD.htm. Accessed Oct. 22, 2020.
6. Hyperthyroidism (overactive thyroid). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/endocrine-diseases/hyperthyroidism. Accessed Oct. 22, 2020.
7. Irritable bowel syndrome (IBS). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome. Accessed Oct. 22, 2020.
8. Diarrhea. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea/all-content. Accessed Oct. 22, 2020.
9. What is IBS? American Gastroenterological Association. https://gastro.org/practice-guidance/gi-patient-center/topic/irritable-bowel-syndrome-ibs/?hilite=%27stool%27%2C%27frequency%27. Accessed Oct. 23, 2020.

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What Your Poop Says About Your Health

Most people are at least moderately intrigued by their poop – and the vast majority of us peer into the toilet after a bowel movement to view what our bodies produced. As embarrassing as the subject can be, looking is the right thing to do.

Paying attention to the color, size, shape and smell of your poop can tell you a lot about your health. When it comes to poop, “normal” is a relative term.

“Instead of focusing on achieving a certain ideal, you should tune in to changes in what has always been normal for you,” says Radhika Aggarwal, M.D., a gastroenterologist at Henry Ford Health System. There are ranges of normal in terms of frequency, color, size, shape and consistency that could offer clues about how your body is functioning.

Answering the Embarrassing Questions

Here, we ask Dr. Aggarwal to answer your most pressing questions about poop:

Q: What factors affect your poop?

A: What you eat is the main factor in the consistency and frequency of your stool. The amount of fiber and water in your diet, as well as whether you’re eating greasy or fried foods, can dramatically affect how often you visit the toilet. Travel, hormonal shifts, medications and multivitamins, and your activity level also affect your bowel habits. The appearance and experience of your bowel movements can vary from day to day and also change as you age.

Q: What is the “normal range” for frequency?

A: The idea that good bowel health requires a daily poop is a myth. Anywhere from three times a day to once every three days is within the normal range. If you’re going more or less than those benchmarks, your bowel habits are probably in the abnormal range. But that doesn’t mean it’s harmful. If you go three times a day without abdominal pain or discomfort, that’s probably normal for you. If, on the other hand, you have a daily bowel movement but suffer from abdominal pain, you may want to discuss it with your health care provider.

Q: Which poop colors are concerning?

A: People are often very concerned about color, but the color of your poop is really based on what you’re eating and the amount of bile in your stool. Anything from light yellow to dark brown is normal. Abnormal colors that can be concerning include:

• Bright red could be a sign of gastrointestinal bleeding (unless you’ve ingested a lot of cherries, beets or red food coloring).
• Black indicates digested blood, unless you’re taking an iron supplement, or have recently taken Pepto Bismol, which may turn stool black.
• Gray or clay-colored may indicate a blockage in the bile duct.

Q: What is normal in terms of consistency?

A: Something called the Bristol Stool Scale can help you determine whether the consistency of your poop is “normal.” Types 1 and 2 are constipated, type 3 and 4 are in the normal range, and types 5 through 7 are leaning toward diarrhea. If you fall in the constipated range, eating more fiber and drinking more water can help. If you’re on the other end of the spectrum, eating more fiber can also help since it bulks up your stool. Your goal: soft, fully formed stools that are easy to pass without straining.

Q: How do you know if your stool is concerning?

A: An abrupt change in your bowel habits can indicate something happening in your body. Constipation may be an indication that you’re not getting as much water, fiber or exercise. It could also arise from a multivitamin or medication you’re taking. Loose stools can be a sign that you’re suffering from a food intolerance, reaction to medication or inflammation in the colon. Changes can also be a sign of a more serious health concern like a blockage caused by cancer or a mass or something slightly more benign like a hormonal dysfunction such as thyroid disease. In any case, if you notice a big change from your norm that lasts more than a few days, seek advice from your doctor.

When it comes to analyzing your poop, paying attention to change is the best thing you can do.

“If your stool has always been a certain way, it usually doesn’t indicate something wrong is going on with your body,” says Dr. Aggarwal. “Instead, look for things like a change in your bowel habits especially if associated with abdominal pain, blood in the stool or changes in appetite or weight loss, which could be signs of something more serious.”

Most important, stay on top of your colon health. If you’re age 50 (or older), get a colonoscopy. If you’re under 50 and have a family history of colon cancer, talk to your doctor about the right time to start screening. And no matter what, consult with your primary care provider if you notice any change in your normal bowel habits.

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To find a Henry Ford doctor or schedule an appointment, visit henryford.com or call 1-800-HENRYFORD (436-7936).

For more health and wellness advice, subscribe today to receive weekly emails of our latest articles.

Dr. Radhika Aggarwal is a gastroenterologist, specializing in digestive disorders and seeing patients at Henry Ford Hospital in Detroit and Henry Ford Medical Center – Fairlane in Dearborn.

Understanding Irritable Bowel Syndrome with Diarrhea (also known as IBS-D)

What is Irritable Bowel Syndrome with Diarrhea (IBS-D)?

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder affecting 7-21% of the general population. It is associated with abdominal pain or discomfort, bloating, and changing stool frequency and/or form. IBS-D is a type of IBS in which abdominal pain or bloating symptoms happen along with stools that are often loose or more frequent than usual.

Who gets IBS-D?

IBS-D can affect any gender and any age group, but young females are more commonly affected than males or older people.

What causes IBS-D?

The cause of IBS-D is not known. There likely are multiple factors. Some of the different possibilities are discussed here.

In some patients, rapid contractions of the intestine can cause both pain and faster movement of stool. This gives the intestine less time to absorb water from the digested matter, which leads to loose or watery stools.  

For unclear reasons, some patients develop IBS-D from a prior infection in the gut. When this occurs, it is called post-infectious IBS. It can last for weeks, months, or even years following a gut infection.

It is also possible that sensitivity or allergy to certain foods may play a role for some people with IBS-D. Many patients have symptoms after eating certain food ingredients, such as gluten or lactose. In these cases, avoiding foods containing those ingredients can improve symptoms. Unfortunately, routine allergy testing is not a reliable way to tell if particular foods are causing IBS symptoms.

Some IBS patients have a more sensitive gut, and they feel pain or discomfort from gas or intestinal contractions more than most people do.  

Recent research has suggested that changes in the type or number of normal bacteria living in the gut may contribute to IBS-D symptoms.

Lastly, while stress and anxiety are not thought to cause IBS-D, they can play an important role in making the symptoms worse.

What are the symptoms of IBS-D?

Frequent abdominal pain or discomfort along with changed bowel habits are typical in IBS. People with IBS often report that these symptoms have been present, to some degree, for many months or years. The pain is usually described as abdominal cramps that come and go, which often improve after having a bowel movement. In IBS-D, stools are usually loose and frequent, sometimes include mucus, and happen during the day while the patient is awake.

Diarrhea that frequently awakens a person from sleep is not typical for IBS-D and should be mentioned to your doctor.  

Abdominal bloating also is common in people with IBS-D. Symptoms unrelated to the gut can also occur as part of this syndrome, such as difficulty with sexual function, irregular menstrual periods, increased or more urgent need to pass urine, or pain in other parts of the body.  

Triggers for pain and diarrhea vary from patient to patient, and may include eating or stress.

How do doctors diagnose IBS-D?

The diagnosis is based on a thorough medical history and physical exam. Doctors use a tool called the Rome criteria, a list of specific symptoms and factors that can help determine if someone has IBS-D. The most important of these criteria include the presence of abdominal pain or discomfort and change in bowel habits. There are no lab tests or imaging studies that can confirm a diagnosis of IBS-D. But  limited testing (such as blood work or imaging studies) may be necessary to be sure the symptoms are not being caused by some other condition.  

What is the treatment for IBS-D?

IBS-D is not life-threatening. It can, however, affect a person’s quality of life. There is no cure, so the goal of treatment is to reduce symptoms as much as possible. Some treatments may be aimed at improving the uncomfortable symptoms of IBS-D – such as abdominal pain, discomfort or bloating. Other treatments may focus on improving bowel function. Treatments include lifestyle modifications, dietary changes, psychosocial therapy, and medications.   

Dietary therapy:  In some patients with mild IBS-D, lifestyle and dietary changes can control symptoms completely. Specific foods that cause symptoms vary widely from patient to patient. There are no reliable tests to identify which foods may trigger symptoms, but some foods containing lactose or gluten are common problem foods for people with IBS-D. For those people, avoiding these foods can improve symptoms.

For other people, it is not easy to figure out what foods may be “triggering” their symptoms.  In these cases, symptoms may improve with a diet low in FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols) or foods low in a type of sugar called fructose (which is found in many types of fruit). Avoiding foods that are known to cause increased gas production, such as onions, celery, carrots, beans, prunes, wheat, alcohol or caffeine, can help.

These diets are not easy to follow. When attempting diets that exclude entire types or groups of food, it is often helpful to work with a dietitian to be sure the restricted diet is both safe and nutritious.

Medical therapy:  If a person’s symptoms do not improve despite dietary changes, there are several kinds of medication that can help.

Medications for abdominal discomfort:

Antispasmodics are a group of medicines thought to relax smooth muscle in the intestine. They are commonly used to treat IBS. These medications may reduce pain, bloating and the urgent need to go to the bathroom. Commonly prescribed anti-spasmodics include dicyclomine and hyoscyamine. Over-the-counter preparations of peppermint oil also have been found to have similar benefits.

Medications to improve bowel function:

For people whose main symptom is diarrhea, fiber supplements often are the first treatment recommended. Fiber can add form to stool and make it less loose or watery.  Anti-diarrheal products, such as loperamide, also work to decrease diarrhea. These medications slow down the contractions of the gut, giving the intestine more time to absorb water from the digested food. This lessens the stool volume and frequency and makes the stool more solid.

Bile, a substance produced by the liver, enters the upper part of the small intestine. Most of the bile is reabsorbed as it moves further down in the small intestine. If not enough bile gets reabsorbed before it reaches the large intestine (colon), it can cause diarrhea. In some IBS-D patients, a medication that binds the extra bile can be used to reduce diarrhea.

For people with IBS-D whose keep having symptoms despite trying some of the above-mentioned treatments, there are other medical options, including antibiotics and a medication to block pain specifically in the intestine.

Probiotics

Bacteria are naturally present in the intestines or “gut” of humans, and they play an important role in normal bowel health and function. “Probiotic” products are foods or pills that contain live bacteria that may promote gut health. They are sometimes recommended with the goal of changing of the types of gut bacteria in the intestine. This can sometimes reduce abdominal discomfort, bloating and gas from IBS-D. Experts are not sure of the overall benefit of probiotics for people with IBS; the most beneficial types and amounts of probiotic foods or supplements also is not known.

Antibiotics are another way to change the population of bacteria in the gut. While antibiotics sometimes provide relief of IBS symptoms, there are potential risks associated with frequent use. If antibiotics are used too often, they can become less effective, and the risk for developing serious infections increases. These risks are reduced when a non-absorbable antibiotic such as rifaximin is used, which has shown some benefit in the treatment of IBS-D.   

Lastly, stress and anxiety play a major role in some cases of IBS-D. If these are a known trigger of symptoms, it is best to discuss these openly with your healthcare provider and other caregivers to find ways to reduce stress and anxiety. Doctors might also suggest antidepressant medications to lessen symptoms.

When Should I See a Doctor?

If you have chronic symptoms of diarrhea and discomfort, see your doctor for a diagnosis and treatment plan to help reduce and manage symptoms, improve bowel function and increase comfort. Such a plan can improve your quality of life.

In addition, if you use over-the-counter medications regularly to reduce symptoms, you should consult a doctor to determine the best course of treatment.

Also report abdominal discomfort or symptoms that come with weight loss, bleeding, iron deficiency (low levels of iron based on blood tests) or symptoms that start after age 50. Tell your doctor about any personal or family history of gastrointestinal diseases such as cancer or inflammatory bowel disease or celiac disease.

To find a doctor near you who is a member of the American Society for Gastrointestinal Endoscopy, use the ASGE Find a Doctor tool.

ASGE – The Source for Colonoscopy and Endoscopy

IMPORTANT REMINDER: The preceding information is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition.

Constipation | Gastrointestinal Society

Click here to download a PDF of this information.

It is normal to have a bowel movement (defecate) anywhere from three times a day to three times a week, as long as the stool (fecal matter) is soft and comfortable to pass. A person experiencing constipation has hard or lumpy stool, which is difficult to pass. Chronic constipation affects 15-30% of Canadians and is commonly found in young children and the elderly, occurring more frequently in females than in males.

Transit time is the duration between when food enters the mouth and when leftover waste finally passes out as stool. A meal could take anywhere from 12-72 hours to travel through the digestive tract. Each person is unique; a normal bowel movement pattern for one person may be very different from those of family members or friends. Some individuals have an irregular pattern, never knowing what to expect. Usually, before food enters the colon, most of the nutrients have been absorbed into the body and the colon’s role is to remove water. If someone has a long transit time, meaning food passes slowly through the colon, then too much water is absorbed, hardening the stool.

Factors that can contribute to constipation, often by altering transit time, include:

• medication side effects (e.g., some narcotics, antidepressants, codeine, calcium or iron supplements, and medications that affect the nervous system),
• diseases in which there is a physiological change to some tissue or organ of the body (e.g., radiation therapy, inflammatory bowel disease, colon cancer, diabetes, stroke, hypothyroidism, or Parkinson’s disease),
• functional disorders, such as irritable bowel syndrome, intestinal obstructions or strictures resulting from surgery, and
• diet and lifestyle choices, such as consuming a diet too low in fibre and fluid, insufficient physical activity, and chronic use of laxatives, suppositories, or enemas.

Constipation Symptoms

The increased length of time during which stool remains in the colon causes increased pressure on the bowel, leading to abdominal cramping and bloating. Bowel movements may occur infrequently, resulting in hard, lumpy, dry stool that resembles either many small pellets or one solid, hard, sausage-shaped piece. Rectal pressure or fullness, bloating, abdominal pain, and a sensation of incomplete evacuation are common symptoms of constipation. The slowdown in the digestive tract may also cause poor appetite, back pain, and general malaise.

Most complications result from the intense straining needed to pass stool. These include hemorrhoids, anal fissures, diverticular disease, bright red streaks on the stool (rectal bleeding), and a condition in which the rectal wall pushes out through the anus (rectal prolapse).

Diagnosing Constipation

A panel of experts developed the main diagnostic criteria for functional constipation, and update them regularly. Below are the current Rome IV diagnostic criteria*.

1. must include two or more of the following:

• straining during more than one-fourth (25%) of defecations
• lumpy or hard stools (Bristol stool form scale 1 or 2) more than one-fourth (25%) of defecations
• sensation of incomplete evacuation more than one-fourth (25%) of defecations
• sensation of anorectal obstruction/blockage more than one-fourth (25%) of defecations
• manual manoeuvres to facilitate more than one-fourth (25%) of defecations (such as digital evacuation, or support of the pelvic floor)

2. fewer than 3 spontaneous bowel movements per week. Loose stools are rarely present without the use of laxatives
3. insufficient criteria for irritable bowel syndrome (IBS)

*Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis.

A physician may order a number of tests, including blood analysis, to check for abnormal levels of thyroid hormone, electrolytes, or glucose, and a stool sample to examine for hidden (occult) blood. Other tests include a sigmoidoscopy or colonoscopy, which are examinations involving an instrument that allows a physician to see the inside of the rectum and colon. Colorectal screening is recommended in persons older than 50 years of age.

It is important to differentiate between temporary (acute) constipation and chronic constipation, as the treatments and recommendations may differ.

Constipation Management

Always check with your healthcare provider before making major changes to your treatment plan and be sure these actions won’t interfere with other conditions you might have.

Dietary and Lifestyle Modifications

Diet: Eating regular well-balanced meals and snacks with high-fibre content, as outlined in Canada’s Food Guide, available on the Health Canada website, and maintaining an adequate fluid intake, is the recommended approach to prevent and manage constipation.

Exercise: Exercise helps move food through the colon more quickly. Aerobic exercise, such as brisk walking, accelerates your heart and breathing rates, and helps to stimulate the natural contractions of intestinal muscles.

Physiotherapy: Pelvic dysfunction physiotherapy may include bowel retraining, electrical stimulation, and posture correction.

Medication Therapy

If constipation does not improve with diet and lifestyle changes, then there are supplements and medications available.

Bulk Forming Agents: These are made of indigestible fibre, which absorbs and retains fluid and helps to form a soft, bulky stool (e.g., Metamucil®, Prodiem®). While not quick-acting, they are safe for long-term use. Add these to your diet gradually and increase your fluid intake at the same time.

Enemas: An enema involves insertion of a liquid, usually water, into the rectum via the anus. Typically, after holding the liquid in place for a few minutes, there is an intense urgency to move the bowels.

Stool Softeners: These products work by holding water in the stool (e.g., Colace®). They are safe for long-term use and for pregnant women and the elderly.

Lubricants: Lubricant laxatives coat the colon and stool in a waterproof film, allowing it to remain soft and slip easily through the intestine, usually within 6-8 hours. Don’t use these products for longer than a week, as some have been shown to cause vitamin deficiencies and medication interactions. An example of a lubricant laxative is mineral oil. Mineral oil is not recommended for pregnant women or for persons who have difficulty swallowing.

Stimulants: These laxatives increase muscle contractions to move food along the digestive tract more quickly (e.g., Ex-lax®, Dulcolax®, castor oil, senna tea, and Senokot®). While helpful for constipation, they can come with abdominal cramping, pain, or discomfort, diarrhea, electrolyte abnormalities, including low potassium (hypokalemia), and nausea. Therefore, stimulants are typically recommended for short-term use. However, in some individuals, constipation does not resolve with dietary adjustments, exercise, or short-term laxative use. For those with persistent or difficult constipation, physicians might suggest long-term laxative use, so it is important to check with your doctor if you need ongoing stimulant assistance for a bowel movement.  These are not recommended for pregnant women.

Hyperosmotics: Osmotic laxatives encourage bowel movements by drawing water into the bowel from nearby tissue (intestinal lumen), thereby softening stool. Some of these laxatives can cause electrolyte imbalances if they draw out too many nutrients and other substances with the water. They can increase thirst and dehydration. There are four main types of hyperosmotics:

• Saline laxatives are salts dissolved in liquid; they rapidly empty all contents of the bowel, usually working within 30 minutes to 3 hours. Examples of saline laxatives are citrate salts (e.g., Royvac®), magnesium preparations (e.g., Phillips’® Milk of Magnesia), sulfate salts, and sodium phosphate. They are not intended for long-term use or for pregnant women.
• Lactulose laxatives are sugar-like agents that work similarly to saline laxatives but at a much slower rate, and are sometimes used to treat chronic constipation. They take 6 hours to 2 days to produce results.
• Polymer laxatives consist of large molecules that cause the stool to hold and retain water. They are usually non-gritty, tasteless, and are well tolerated for occasional constipation. Results can be expected within 6 hours, but it can take longer depending on the dose. An example of a polymer laxative is polyethylene glycol (e.g., PegaLAX®).
• Glycerine is available as a suppository and mainly has a hyperosmotic effect, but it may also have a stimulant effect from the sodium stearate used in the preparation. Glycerine is available through several manufacturers.

Enterokinetic: Prucalopride succinate (Resotran®) works by targeting the serotonin (5-HT4) receptors in the digestive tract to stimulate motility (muscle movement). It has Health Canada approval for the treatment of chronic idiopathic constipation in women for whom laxative treatment has failed to provide relief. Resotran® usually produces a bowel movement within 2-3 hours and then spontaneous complete bowel movements typically begin occurring within 4-5 days of starting treatment. Side effects may include nausea, diarrhea, abdominal pain, and headache, mostly following the initial dose and then subsiding with ongoing treatment.

Guanylate cyclase-C agonist: Linaclotide (Constella®) works by increasing intestinal fluid secretion, which helps ease the passage of stool through the digestive tract, relieving associated symptoms and has Health Canada approval for the treatment of chronic idiopathic constipation in men and women. In clinical trials, Constella® showed a statistically significant improvement compared with placebo for complete spontaneous bowel movements. The results occurred within the first week, often on the first day, of dosing and were sustained over the 12-week treatment period. Diarrhea is the most commonly noted side effect.

Constipation Outlook

Constipation can occur for many reasons, so treatment often requires trial and error. An individual may experience a short bout of constipation and return to a normal routine, or it may be an ongoing health issue. With diet and lifestyle changes, and the proper use of supplements and medications, most forms of constipation are manageable. If your bowel habits change drastically for no apparent reason, be sure to consult your physician.

Want to learn more about constipation?

We have several related articles that may be helpful:

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Gastrointestinal Complications | MHealth.org

Source:
National Cancer Institute Research, www.cancer.gov

Gastrointestinal Complications

General Information

The gastrointestinal (GI) tract is part of the digestive system, which processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) in foods that are eaten and helps pass waste material out of the body. The GI tract includes the stomach and intestines (bowels). The stomach is a J-shaped organ in the upper abdomen. Food moves from the throat to the stomach through a hollow, muscular tube called the esophagus. After leaving the stomach, partly-digested food passes into the small intestine and then into the large intestine.

The colon (large bowel) is the first part of the large intestine and is about 5 feet long. Together, the rectum and anal canal make up the last part of the large intestine and are 6-8 inches long. The anal canal ends at the anus (the opening of the large intestine to the outside of the body).

Anatomy of the lower digestive system, showing the colon and other organs.

Anatomy of the lower digestive system, showing the colon and other organs.

GI complications are common in cancer patients. Complications are medical problems that occur during a disease, or after a procedure or treatment. They may be caused by the disease, procedure, or treatment, or may have other causes. This summary describes the following GI complications and their causes and treatments:

• Constipation.
• Fecal impaction.
• Bowelobstruction.
• Diarrhea.
• Radiation enteritis.

This summary is about GI complications in adults with cancer. Treatment of GI complications in children is different than treatment for adults.

Constipation

With constipation, bowel movements are difficult or don’t happen as often as usual.

Constipation is the slow movement of stool through the large intestine. The longer it takes for the stool to move through the large intestine, the more it loses fluid and the drier and harder it becomes. The patient may be unable to have a bowel movement, have to push harder to have a bowel movement, or have fewer than their usual number of bowel movements.

Certain medicines, changes in diet, not drinking enough fluids, and being less active are common causes of constipation.

Constipation is a common problem for cancer patients. Cancer patients may become constipated by any of the usual factors that cause constipation in healthy people. These include older age, changes in diet and fluid intake, and not getting enough exercise. In addition to these common causes of constipation, there are other causes in cancer patients.

Other causes of constipation include:

• Medicines
  • Opioids and other pain medicines. This is one of the main causes of constipation in cancer patients.
  • Chemotherapy.
  • Medicines for anxiety and depression.
  • Antacids.
  • Diuretics (drugs that increase the amount of urine made by the body).
  • Supplements such as iron and calcium.
  • Sleep medicines.
  • Drugs used for anesthesia (to cause loss of feeling for surgery or other procedures).
• Diet
  • Not drinking enough water or other fluids. This is a common problem for cancer patients.
  • Not eating enough food, especially high-fiber food.
• Bowel movement habits
  • Not going to the bathroom when the need for a bowel movement is felt.
  • Using laxatives and/or enemas too often.
• Conditions that prevent activity and exercise
  • Spinal cord injury or pressure on the spinal cord from a tumor or other cause.
  • Broken bones.
  • Fatigue.
  • Weakness.
  • Long periods of bed rest or not being active.
  • Heart problems.
  • Breathing problems.
  • Anxiety.
  • Depression.
• Intestinal disorders
  • Irritable colon.
  • Diverticulitis (inflammation of small pouches in the colon called diverticula).
  • Tumor in the intestine.
• Muscle and nerve disorders
  • Brain tumors.
  • Spinal cord injury or pressure on the spinal cord from a tumor or other cause.
  • Paralysis (loss of ability to move) of both legs.
  • Stroke or other disorders that cause paralysis of part of the body.
  • Peripheral neuropathy (pain, numbness, tingling) of feet.
  • Weakness of the diaphragm (the breathing muscle below the lungs) or abdominal muscles. This makes it hard to push to have a bowel movement.
• Changes in body metabolism
  • Having a low level of thyroid hormone, potassium, or sodium in the blood.
  • Having too much nitrogen or calcium in the blood.
• Environment
  • Having to go farther to get to a bathroom.
  • Needing help to go to the bathroom.
  • Being in unfamiliar places.
  • Having little or no privacy.
  • Feeling rushed.
  • Living in extreme heat that causes dehydration.
  • Needing to use a bedpan or bedside commode.
• Narrow colon
  • Scars from radiation therapy or surgery.
  • Pressure from a growing tumor.

• Opioids and other pain medicines. This is one of the main causes of constipation in cancer patients.
• Chemotherapy.
• Medicines for anxiety and depression.
• Antacids.
• Diuretics (drugs that increase the amount of urine made by the body).
• Supplements such as iron and calcium.
• Sleep medicines.
• Drugs used for anesthesia (to cause loss of feeling for surgery or other procedures).

• Not drinking enough water or other fluids. This is a common problem for cancer patients.
• Not eating enough food, especially high-fiber food.

• Not going to the bathroom when the need for a bowel movement is felt.
• Using laxatives and/or enemas too often.

• Spinal cord injury or pressure on the spinal cord from a tumor or other cause.
• Broken bones.
• Fatigue.
• Weakness.
• Long periods of bed rest or not being active.
• Heart problems.
• Breathing problems.
• Anxiety.
• Depression.

• Irritable colon.
• Diverticulitis (inflammation of small pouches in the colon called diverticula).
• Tumor in the intestine.

• Brain tumors.
• Spinal cord injury or pressure on the spinal cord from a tumor or other cause.
• Paralysis (loss of ability to move) of both legs.
• Stroke or other disorders that cause paralysis of part of the body.
• Peripheral neuropathy (pain, numbness, tingling) of feet.
• Weakness of the diaphragm (the breathing muscle below the lungs) or abdominal muscles. This makes it hard to push to have a bowel movement.

• Having a low level of thyroid hormone, potassium, or sodium in the blood.
• Having too much nitrogen or calcium in the blood.

• Having to go farther to get to a bathroom.
• Needing help to go to the bathroom.
• Being in unfamiliar places.
• Having little or no privacy.
• Feeling rushed.
• Living in extreme heat that causes dehydration.
• Needing to use a bedpan or bedside commode.

• Scars from radiation therapy or surgery.
• Pressure from a growing tumor.

An assessment is done to help plan treatment.

The assessment includes a physical exam and questions about the patient’s usual bowel movements and how they have changed.

The following tests and procedures may be done to help find the cause of the constipation:

• Physical exam: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. The doctor will check for bowel sounds and swollen, painful abdomen.
• Digital rectal exam (DRE): An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual. In women, the vagina may also be examined.
• Fecal occult blood test: A test to check stool for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.
  Fecal Occult Blood Test (FOBT) kit to check for blood in stool.
• Proctoscopy: An exam of the rectum using a proctoscope, inserted into the rectum. A proctoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.
• Colonoscopy: A procedure to look inside the rectum and colon for polyps, abnormal areas, or cancer. A colonoscope is inserted through the rectum into the colon. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.
  
• Abdominal x-ray: An x-ray of the organs inside the abdomen. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Fecal Occult Blood Test (FOBT) kit to check for blood in stool.

There is no “normal” number of bowel movements for a cancer patient. Each person is different. You will be asked about bowel routines, food, and
medicines:

• How often do you have a bowel movement? When and how much?
• When was your last bowel movement? What was it like (how much, hard or soft, color)?
• Was there any blood in your stool?
• Has your stomach hurt or have you had any cramps, nausea, vomiting, gas, or feeling of fullness near the rectum?
• Do you use laxatives or enemas regularly?
• What do you usually do to relieve constipation? Does this usually work?
• What kind of food do you eat?
• How much and what type of fluids do you drink each day?
• What medicines are you taking? How much and how often?
• Is this constipation a recent change in your normal habits?
• How many times a day do you pass gas?

For patients who have colostomies, care of the colostomy will be discussed.

Treating constipation is important to make the patient comfortable and to prevent more serious problems.

It’s easier to prevent constipation than to relieve it. The health care team will work with the patient to prevent constipation. Patients who take opioids may need to start taking laxatives right away to prevent constipation.

Constipation can be very uncomfortable and cause distress. If left untreated, constipation may lead to fecal impaction. This is a serious condition in which stool will not pass out of the colon or rectum.

It’s important to treat constipation to prevent fecal impaction.

Prevention and treatment are not the same for every patient. Do the following to prevent and treat constipation:

• Keep a record of all bowel movements.
• Drink eight 8-ounce glasses of fluid each day. Patients who have certain conditions, such as kidney or heart disease, may need to drink less.
• Get regular exercise. Patients who cannot walk may do abdominal exercises in bed or move from the bed to a chair.
• Increase the amount of fiber in the diet by eating more of the following:
  • Fruits, such as raisins, prunes, peaches, and apples.
  • Vegetables, such as squash, broccoli, carrots, and celery.
  • Whole grain cereals, whole grain breads, and bran.

  It’s important to drink more fluids when eating more high-fiber foods, to avoid making constipation worse. (See the Constipation section of the PDQ summary on Nutrition in Cancer Care for more information.) Patients who have had a small or large intestinal obstruction or have had intestinal surgery (for example, a colostomy) should not eat a high-fiber diet.

• Drink a warm or hot drink about one half-hour before the usual time for a bowel movement.
• Find privacy and quiet when it is time for a bowel movement.
• Use the toilet or a bedside commode instead of a bedpan.
• Take only medicines that are prescribed by the doctor.

  Medicines for constipation may include bulking agents, laxatives, stool softeners, and drugs that cause the intestine to empty.

• Use suppositories or enemas only if ordered by the doctor. In some cancer patients, these treatments may lead to bleeding, infection, or other harmful side effects.

• Fruits, such as raisins, prunes, peaches, and apples.
• Vegetables, such as squash, broccoli, carrots, and celery.
• Whole grain cereals, whole grain breads, and bran.

When constipation is caused by opioids, treatment may be drugs that stop the effects of the opioids or other medicines, stool softeners, enemas, and/or manual removal of stool.

Fecal Impaction

Fecal impaction is a mass of dry, hard stool that will not pass out of the colon or rectum.

Fecal impaction is dry stool that cannot pass out of the body. Patients with fecal impaction may not have gastrointestinal (GI) symptoms. Instead, they may have problems with circulation, the heart, or breathing. If fecal impaction is not treated, it can get worse and cause death.

A common cause of fecal impaction is using laxatives too often.

Repeated use of laxatives in higher and higher doses makes the colon less able to respond naturally to the need to have a bowel movement. This is a common reason for fecal impaction. Other causes include:

• Opioid pain medicines.
• Little or no activity over a long period.
• Diet changes.
• Constipation that is not treated. See the section above on causes of constipation.

Certain types of mental illness may lead to fecal impaction.

Symptoms of fecal impaction include being unable to have a bowel movement and pain in the abdomen or back.

The following may be symptoms of fecal impaction:

• Being unable to have a bowel movement.
• Having to push harder to have a bowel movement of small amounts of hard, dry stool.
• Having fewer than the usual number of bowel movements.
• Having pain in the back or abdomen.
• Urinating more or less often than usual, or being unable to urinate.
• Breathing problems, rapid heartbeat, dizziness, low blood pressure, and swollen abdomen.
• Having sudden, explosive diarrhea (as stool moves around the impaction).
• Leaking stool when coughing.
• Nausea and vomiting.
• Dehydration.
• Being confused and losing a sense of time and place, with rapid heartbeat, sweating, fever, and high or low blood pressure.

These symptoms should be reported to the health care provider.

Assessment includes a physical exam and questions like those asked in the assessment of constipation.

The doctor will ask questions similar to those for the assessment of constipation:

• How often do you have a bowel movement? When and how much?
• When was your last bowel movement? What was it like (how much, hard or soft, color)?
• Was there any blood in your stool?
• Has your stomach hurt or have you had any cramps, nausea, vomiting, gas, or feeling of fullness near the rectum?
• Do you use laxatives or enemas regularly?
• What do you usually do to relieve constipation? Does this usually work?
• What kind of food do you eat?
• How much and what type of fluids do you drink each day?
• What medicines are you taking? How much and how often?
• Is this constipation a recent change in your normal habits?
• How many times a day do you pass gas?

The doctor will do a physical exam to find out if the patient has a fecal impaction. The following tests and procedures may be done:

• Physical exam: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual.
• X-rays: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

  To check for fecal impaction, x-rays of the abdomen or chest may be done.

• Digital rectal exam (DRE): An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for a fecal impaction, lumps, or anything else that seems unusual.
• Sigmoidoscopy: A procedure to look inside the rectum and sigmoid (lower) colon for a fecal impaction, polyps, abnormal areas, or cancer. A sigmoidoscope is inserted through the rectum into the sigmoid colon. A sigmoidoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.
  Sigmoidoscopy. A thin, lighted tube is inserted through the anus and rectum and into the lower part of the colon to look for abnormal areas.
• Blood tests: Tests done on a sample of blood to measure the amount of certain substances in the blood or to count different types of blood cells. Blood tests may be done to look for signs of disease or agents that cause disease, to check for antibodies or tumor markers, or to see how well treatments are working.
• Electrocardiogram (EKG): A test that shows the activity of the heart. Small electrodes are placed on the skin of the chest, wrists, and ankles and are attached to an electrocardiograph. The electrocardiograph makes a line graph that shows changes in the electrical activity of the heart over time. The graph can show abnormal conditions, such as blocked arteries, changes in electrolytes (particles with electrical charges), and changes in the way electrical currents pass through the heart tissue.

Sigmoidoscopy. A thin, lighted tube is inserted through the anus and rectum and into the lower part of the colon to look for abnormal areas.

A fecal impaction is usually treated with an enema.

The main treatment for impaction is to moisten and soften the stool so it can be removed or passed out of the body. This is usually done with an enema. Enemas are given only as prescribed by the doctor since too many enemas can damage the intestine. Stool softeners or glycerin suppositories may be given to make the stool softer and easier to pass. Some patients may need to have stool manually removed from the rectum after it is softened.

Laxatives that cause the stool to move are not used because they can also damage the intestine.

Bowel Obstruction

A bowel obstruction is a blockage of the small or large intestine by something other than fecal impaction.

Bowelobstructions (blockages) keep the stool from moving through the small or large intestines. They may be caused by a physical change or by conditions that stop the intestinal muscles from moving normally. The intestine may be partly or completely blocked. Most obstructions occur in the small intestine.

Physical changes

• The intestine may become twisted or form a loop, closing it off and trapping stool.
• Inflammation, scar tissue from surgery, and hernias can make the intestine too narrow.
• Tumors growing inside or outside the intestine can cause it to be partly or completely blocked.

If the intestine is blocked by physical causes, it may decrease blood flow to blocked parts. Blood flow needs to be corrected or the affected tissue may die.

Conditions that affect the intestinal muscle

• Paralysis (loss of ability to move).
• Blocked blood vessels going to the intestine.
• Too little potassium in the blood.

The most common cancers that cause bowel obstructions are cancers of the colon, stomach, and ovary.

Other cancers, such as lung and breast cancers and melanoma, can spread to the abdomen and cause bowel obstruction. Patients who have had surgery on the abdomen or radiation therapy to the abdomen have a higher risk of a bowel obstruction. Bowel obstructions are most common during the advanced stages of cancer.

Assessment includes a physical exam and imaging tests.

The following tests and procedures may be done to diagnose a bowel obstruction:

• Physical exam: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. The doctor will check to see if the patient has abdominal pain, vomiting, or any movement of gas or stool in the bowel.
• Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
  • The number of red blood cells, white blood cells, and platelets.
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
  • The portion of the blood sample made up of red blood cells.
• Electrolyte panel: A blood test that measures the levels of electrolytes, such as sodium, potassium, and chloride.
• Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
• Abdominal x-ray: An x-ray of the organs inside the abdomen. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• Barium enema: A series of x-rays of the lower gastrointestinal tract. A liquid that contains barium (a silver-white metalliccompound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series. This test may show what part of the intestine is blocked.
  Barium enema procedure. The patient lies on an x-ray table. Barium liquid is put into the rectum and flows through the colon. X-rays are taken to look for abnormal areas.

• The number of red blood cells, white blood cells, and platelets.
• The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
• The portion of the blood sample made up of red blood cells.

Barium enema procedure. The patient lies on an x-ray table. Barium liquid is put into the rectum and flows through the colon. X-rays are taken to look for abnormal areas.

Treatment is different for acute and chronic bowel obstructions.

Acute bowel obstruction

Acute bowel obstructions occur suddenly, may have not occurred before, and are not long-lasting. Treatment may include the following:

• Fluid replacement therapy: A treatment to get the fluids in the body back to normal amounts. Intravenous (IV) fluids may be given and medicines may be prescribed.
• Electrolyte correction: A treatment to get the right amounts of chemicals in the blood, such as sodium, potassium, and chloride. Fluids with electrolytes may be given by infusion.
• Blood transfusion: A procedure in which a person is given an infusion of whole blood or parts of blood.
• Nasogastric or colorectal tube: A nasogastric tube is inserted through the nose and esophagus into the stomach. A colorectal tube is inserted through the rectum into the colon. This is done to decrease swelling, remove fluid and gas buildup, and relieve pressure.
• Surgery: Surgery to relieve the obstruction may be done if it causes serious symptoms that are not relieved by other treatments.

Patients with symptoms that keep getting worse will have follow-up exams to check for signs and symptoms of shock and to make sure the obstruction isn’t getting worse.

Chronic, malignant bowel obstruction

Chronic bowel obstructions keep getting worse over time. Patients who have advanced cancer may have chronic bowel obstructions that cannot be removed with surgery. The intestine may be blocked or narrowed in more than one place or the tumor may be too large to remove completely. Treatments include the following:

• Surgery: The obstruction is removed to relieve pain and improve the patient’s quality of life.
• Stent: A metal tube inserted into the intestine to open the area that is blocked.
• Gastrostomy tube: A tube inserted through the wall of the abdomen directly into the stomach. The gastrostomy tube can relieve fluid and air build-up in the stomach and allow medications and liquids to be given directly into the stomach by pouring them down the tube. A drainage bag with a valve may also be attached to the gastrostomy tube. When the valve is open, the patient may be able to eat or drink by mouth and the food drains directly into the bag. This gives the patient the experience of tasting the food and keeping the mouth moist. Solid food is avoided because it may block the tubing to the drainage bag.
• Medicines: Injections or infusions of medicines for pain, nausea and vomiting, and/or to make the intestines empty. This may be prescribed for patients who cannot be helped with a stent or gastrostomy tube.

Diarrhea

Diarrhea is frequent, loose, and watery bowel movements.

Diarrhea is frequent, loose, and watery bowel movements. Acute diarrhea lasts more than 4 days but less than 2 weeks. Symptoms of acute diarrhea may be loose stools and passing more than 3 unformed stools in one day. Diarrhea is chronic (long-term) when it goes on for longer than 2 months.

Diarrhea can occur at any time during cancer treatment. It can be physically and emotionally stressful for patients who have cancer.

In cancer patients, the most common cause of diarrhea is cancer treatment.

Causes of diarrhea in cancer patients include the following:

• Cancer treatments, such as chemotherapy, radiation therapy, bone marrow transplant, and surgery.
  • Some chemotherapy drugs cause diarrhea by changing how nutrients are broken down and absorbed in the small intestine. More than half of patients who receive chemotherapy have diarrhea that needs to be treated.
  • Radiation therapy to the abdomen and pelvis can cause inflammation of the bowel. Patients may have problems digesting food, and have gas, bloating, cramps, and diarrhea. These symptoms may last up to 8 to 12 weeks after treatment or may not happen for months or years. Treatment may include diet changes, medicines, or surgery.
  • Patients who are having radiation therapy and chemotherapy often have severe diarrhea. Hospital treatment may not be needed. Treatment may be given at an outpatient clinic or with home care. Intravenous (IV) fluids may be given or medicines may be prescribed.
  • Patients who have a donor bone marrow transplant may develop graft-versus-host disease (GVHD). Stomach and intestinal symptoms of GVHD include nausea and vomiting, severe abdominal pain and cramps, and watery, green diarrhea. Symptoms may show up 1 week to 3 months after the transplant.
  • Surgery on the stomach or intestines.
• The cancer itself.
• Stress and anxiety from being diagnosed with cancer and having cancer treatment.
• Medical conditions and diseases other than cancer.
• Infections.
• Antibiotic therapy for certain infections. Antibiotic therapy can irritate the lining of the bowel and cause diarrhea that often does not get better with treatment.
• Laxatives.
• Fecal impaction in which the stool leaks around the blockage.
• Certain foods that are high in fiber or fat.

• Some chemotherapy drugs cause diarrhea by changing how nutrients are broken down and absorbed in the small intestine. More than half of patients who receive chemotherapy have diarrhea that needs to be treated.
• Radiation therapy to the abdomen and pelvis can cause inflammation of the bowel. Patients may have problems digesting food, and have gas, bloating, cramps, and diarrhea. These symptoms may last up to 8 to 12 weeks after treatment or may not happen for months or years. Treatment may include diet changes, medicines, or surgery.
• Patients who are having radiation therapy and chemotherapy often have severe diarrhea. Hospital treatment may not be needed. Treatment may be given at an outpatient clinic or with home care. Intravenous (IV) fluids may be given or medicines may be prescribed.
• Patients who have a donor bone marrow transplant may develop graft-versus-host disease (GVHD). Stomach and intestinal symptoms of GVHD include nausea and vomiting, severe abdominal pain and cramps, and watery, green diarrhea. Symptoms may show up 1 week to 3 months after the transplant.
• Surgery on the stomach or intestines.

Assessment includes a physical exam, lab tests, and questions about diet and bowel movements.

Because diarrhea can be life-threatening, it is important to find out the cause so treatment can begin as soon as possible. The doctor may ask the following questions to help plan treatment:

• How often have you had bowel movements in the past 24 hours?
• When was your last bowel movement? What was it like (how much, how hard or soft, what color)? Was there any blood?
• Was there any blood in your stool or any rectal bleeding?
• Have you been dizzy, very drowsy, or had any cramps, pain, nausea, vomiting, or fever?
• What have you eaten? What and how much have you had to drink in the past 24 hours?
• Have you lost weight recently? How much?
• How often have you urinated in the past 24 hours?
• What medicines are you taking? How much and how often?
• Have you traveled recently?

Tests and procedures may include the following:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

  The exam will include checking blood pressure, pulse, and breathing; checking for dryness of the skin and tissue lining the inside of the mouth; and checking for abdominal pain and bowel sounds.

• Digital rectal exam (DRE): An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual. The exam will check for signs of fecal impaction. Stool may be collected for laboratory tests.
• Fecal occult blood test: A test to check stool for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.
• Stool tests: Laboratory tests to check the water and sodium levels in stool, and to find substances that may be causing diarrhea. Stool is also checked for bacterial, fungal, or viral infections.
• Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
  • The number of red blood cells, white blood cells, and platelets.
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
  • The portion of the blood sample made up of red blood cells.
• Electrolyte panel: A blood test that measures the levels of electrolytes, such as sodium, potassium, and chloride.
• Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
• Abdominal x-ray: An x-ray of the organs inside the abdomen. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. Abdominal x-rays may also be done to look for a bowel obstruction or other problems.

• The number of red blood cells, white blood cells, and platelets.
• The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
• The portion of the blood sample made up of red blood cells.

Treatment of diarrhea depends on what is causing it.

Treatment depends on the cause of the diarrhea. The doctor may make changes in medicines, diet, and/or fluids.

• A change in the use of laxatives may be needed.
• Medicine to treat diarrhea may be prescribed to slow down the intestines, decrease fluid secreted by the intestines, and help nutrients be absorbed.
• Diarrhea caused by cancer treatment may be treated by changes in diet. Eat small frequent meals and avoid the following foods:
  • Milk and dairy products.
  • Spicy foods.
  • Alcohol.
  • Foods and drinks that have caffeine.
  • Certain fruit juices.
  • Foods and drinks that cause gas.
  • Foods high in fiber or fat.
• A diet of bananas, rice, apples, and toast (the BRAT diet) may help mild diarrhea.

• Drinking more clear liquids may help decrease diarrhea. It is best to drink up to 3 quarts of clear fluids a day. These include water, sports drinks, broth, weak decaffeinated tea, caffeine-free soft drinks, clear juices, and gelatin. For severe diarrhea, the patient may need intravenous (IV) fluids or other forms of IV nutrition. (See the Diarrhea section in the PDQ summary on Nutrition in Cancer Care for more information.)

• Diarrhea caused by graft-versus-host-disease (GVHD) is often treated with a special diet. Some patients may need long-term treatment and diet management.
• Probiotics may be recommended. Probiotics are live microorganisms used as a dietary supplement to help with digestion and normal bowel function. A bacterium found in yogurt called Lactobacillus acidophilus, is the most common probiotic.
• Patients who have diarrhea with other symptoms may need fluids and medicine given by IV.

• Milk and dairy products.
• Spicy foods.
• Alcohol.
• Foods and drinks that have caffeine.
• Certain fruit juices.
• Foods and drinks that cause gas.
• Foods high in fiber or fat.

Radiation Enteritis

Radiation enteritis is inflammation of the intestine caused by radiation therapy.

Radiation enteritis is a condition in which the lining of the intestine becomes swollen and inflamed during or after radiation therapy to the abdomen, pelvis, or rectum. The small and large intestine are very sensitive to radiation. The larger the dose of radiation, the more damage may be done to normal tissue. Most tumors in the abdomen and pelvis need large doses of radiation. Almost all patients receiving radiation to the abdomen, pelvis, or rectum will have enteritis.

Radiation therapy to kill cancercells in the abdomen and pelvis affects normal cells in the lining of the intestines. Radiation therapy stops the growth of cancer cells and other fast-growing cells. Since normal cells in the lining of the intestines grow quickly, radiation treatment to that area can stop those cells from growing. This makes it hard for tissue to repair itself. As cells die and are not replaced, gastrointestinal problems occur over the next few days and weeks.

Doctors are studying whether the order that radiation therapy, chemotherapy, and surgery are given affects how severe the enteritis will be.

Symptoms may begin during radiation therapy or months to years later.

Radiation enteritis may be acute or chronic:

• Acute radiation enteritis occurs during radiation therapy and may last up to 8 to 12 weeks after treatment stops.
• Chronic radiation enteritis may appear months to years after radiation therapy ends, or it may begin as acute enteritis and keep coming back.

The total dose of radiation and other factors affect the risk of radiation enteritis.

Only 5% to 15% of patients treated with radiation to the abdomen will have chronic problems. The amount of time the enteritis lasts and how severe it is depend on the following:

• The total dose of radiation received.
• The amount of normal intestine treated.
• The tumor size and how much it has spread.
• If chemotherapy was given at the same time as the radiation therapy.
• If radiation implants were used.
• If the patient has high blood pressure, diabetes, pelvic inflammatory disease, or poor nutrition.
• If the patient has had surgery to the abdomen or pelvis.

Acute and chronic enteritis have symptoms that are a lot alike.

Patients with acute enteritis may have the following symptoms:

• Nausea.
• Vomiting.
• Abdominal cramps.
• Frequent urges to have a bowel movement.
• Rectal pain, bleeding, or mucus in the stool.
• Watery diarrhea.
• Feeling very tired.

Symptoms of acute enteritis usually go away 2 to 3 weeks after treatment ends.

Symptoms of chronic enteritis usually appear 6 to 18 months after radiation therapy ends. It can be hard to diagnose. The doctor will first check to see if the symptoms are being caused by a recurrent tumor in the small intestine. The doctor will also need to know the patient’s full history of radiation treatments.

Patients with chronic enteritis may have the following signs and symptoms:

• Abdominal cramps.
• Bloody diarrhea.
• Frequent urges to have a bowel movement.
• Greasy and fatty stools.
• Weight loss.
• Nausea.

Assessment of radiation enteritis includes a physical exam and questions for the patient.

Patients will be given a physical exam and be asked questions about the following:

• Usual pattern of bowel movements.
• Pattern of diarrhea:
  • When it started.
  • How long it has lasted.
  • How often it occurs.
  • Amount and type of stools.
  • Other symptoms with the diarrhea (such as gas, cramping, bloating, urgency, bleeding, and rectal soreness).
• Nutrition health:
  • Height and weight.
  • Usual eating habits.
  • Changes in eating habits.
  • Amount of fiber in the diet.
  • Signs of dehydration (such as poor skin tone, increased weakness, or feeling very tired).
• Stress levels and ability to cope.
• Changes in lifestyle caused by the enteritis.

• When it started.
• How long it has lasted.
• How often it occurs.
• Amount and type of stools.
• Other symptoms with the diarrhea (such as gas, cramping, bloating, urgency, bleeding, and rectal soreness).

• Height and weight.
• Usual eating habits.
• Changes in eating habits.
• Amount of fiber in the diet.
• Signs of dehydration (such as poor skin tone, increased weakness, or feeling very tired).

Treatment depends on whether the radiation enteritis is acute or chronic.

Acute radiation enteritis

Treatment of acute enteritis includes treating the symptoms. The symptoms usually get better with treatment, but if symptoms get worse, then cancer treatment may have to be stopped for a while.

Treatment of acute radiation enteritis may include the following:

• Medicines to stop diarrhea.
• Opioids to relieve pain.
• Steroid foams to relieve rectal inflammation.
• Pancreatic enzyme replacement for patients who have pancreatic cancer. A decrease in pancreatic enzymes can cause diarrhea.
• Diet changes. Intestines damaged by radiation therapy may not make enough of certain enzymes needed for digestion, especially lactase. Lactase is needed to digest lactose, which is found in milk and milk products. A lactose-free, low-fat, and low-fiber diet may help to control symptoms of acute enteritis.
  • Foods to avoid:
    • Milk and milk products, except buttermilk, yogurt, and lactose-free milkshake supplements, such as Ensure.
    • Whole-bran bread and cereal.
    • Nuts, seeds, and coconut.
    • Fried, greasy, or fatty foods.
    • Fresh and dried fruit and some fruit juices (such as prune juice).
    • Raw vegetables.
    • Rich pastries.
    • Popcorn, potato chips, and pretzels.
    • Strong spices and herbs.
    • Chocolate, coffee, tea, and soft drinks with caffeine.
    • Alcohol and tobacco.
  • Foods to choose:
    • Fish, poultry, and meat that are broiled or roasted.
    • Bananas.
    • Applesauce and peeled apples.
    • Apple and grape juices.
    • White bread and toast.
    • Macaroni and noodles.
    • Baked, boiled, or mashed potatoes.
    • Cooked vegetables that are mild, such as asparagus tips, green and waxed beans, carrots, spinach, and squash.
    • Mild processed cheese. Processed cheese may not cause problems because the lactose is removed when it is made.
    • Buttermilk, yogurt, and lactose-free milkshake supplements, such as Ensure.
    • Eggs.
    • Smooth peanut butter.
  • Helpful hints:
    • Eat food at room temperature.
    • Drink about 12 eight-ounce glasses of fluid a day.
    • Let sodas lose their fizz before drinking them.
    • Add nutmeg to food. This helps slow down movement of digested food in the intestines.
    • Start a low-fiber diet on the first day of radiation therapy.

• Foods to avoid:
  • Milk and milk products, except buttermilk, yogurt, and lactose-free milkshake supplements, such as Ensure.
  • Whole-bran bread and cereal.
  • Nuts, seeds, and coconut.
  • Fried, greasy, or fatty foods.
  • Fresh and dried fruit and some fruit juices (such as prune juice).
  • Raw vegetables.
  • Rich pastries.
  • Popcorn, potato chips, and pretzels.
  • Strong spices and herbs.
  • Chocolate, coffee, tea, and soft drinks with caffeine.
  • Alcohol and tobacco.
• Foods to choose:
  • Fish, poultry, and meat that are broiled or roasted.
  • Bananas.
  • Applesauce and peeled apples.
  • Apple and grape juices.
  • White bread and toast.
  • Macaroni and noodles.
  • Baked, boiled, or mashed potatoes.
  • Cooked vegetables that are mild, such as asparagus tips, green and waxed beans, carrots, spinach, and squash.
  • Mild processed cheese. Processed cheese may not cause problems because the lactose is removed when it is made.
  • Buttermilk, yogurt, and lactose-free milkshake supplements, such as Ensure.
  • Eggs.
  • Smooth peanut butter.
• Helpful hints:
  • Eat food at room temperature.
  • Drink about 12 eight-ounce glasses of fluid a day.
  • Let sodas lose their fizz before drinking them.
  • Add nutmeg to food. This helps slow down movement of digested food in the intestines.
  • Start a low-fiber diet on the first day of radiation therapy.

• Milk and milk products, except buttermilk, yogurt, and lactose-free milkshake supplements, such as Ensure.
• Whole-bran bread and cereal.
• Nuts, seeds, and coconut.
• Fried, greasy, or fatty foods.
• Fresh and dried fruit and some fruit juices (such as prune juice).
• Raw vegetables.
• Rich pastries.
• Popcorn, potato chips, and pretzels.
• Strong spices and herbs.
• Chocolate, coffee, tea, and soft drinks with caffeine.
• Alcohol and tobacco.

• Fish, poultry, and meat that are broiled or roasted.
• Bananas.
• Applesauce and peeled apples.
• Apple and grape juices.
• White bread and toast.
• Macaroni and noodles.
• Baked, boiled, or mashed potatoes.
• Cooked vegetables that are mild, such as asparagus tips, green and waxed beans, carrots, spinach, and squash.
• Mild processed cheese. Processed cheese may not cause problems because the lactose is removed when it is made.
• Buttermilk, yogurt, and lactose-free milkshake supplements, such as Ensure.
• Eggs.
• Smooth peanut butter.

• Eat food at room temperature.
• Drink about 12 eight-ounce glasses of fluid a day.
• Let sodas lose their fizz before drinking them.
• Add nutmeg to food. This helps slow down movement of digested food in the intestines.
• Start a low-fiber diet on the first day of radiation therapy.

Chronic radiation enteritis

Treatment of chronic radiation enteritis may include the following:

• Same treatments as for acute radiation enteritis symptoms.
• Surgery. Few patients need surgery to control their symptoms.

  Two types of surgery may be used:

  • Intestinalbypass: A procedure in which the doctor creates a new pathway for the flow of intestinal contents around the damaged tissue.
  • Total intestinal resection: Surgery to completely remove the intestines.

  Doctors look at the patient’s general health and the amount of damaged tissue before deciding if surgery will be needed. Healing after surgery is often slow and long-term tubefeeding may be needed. Even after surgery, many patients still have symptoms.

• Intestinalbypass: A procedure in which the doctor creates a new pathway for the flow of intestinal contents around the damaged tissue.
• Total intestinal resection: Surgery to completely remove the intestines.

Current Clinical Trials

Check NCI’s list of cancer clinical trials for U.S. supportive and palliative care trials about constipation, impaction, and bowel obstruction and diarrhea that are now accepting participants. The list of trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

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Irritable Bowel Syndrome (IBS) – Digestive Disorders

• A doctor’s evaluation based on the Rome criteria

• Laboratory and imaging tests to look for other disorders

Most people with IBS appear healthy. Doctors base the diagnosis of irritable bowel syndrome on the characteristics of the person’s symptoms. Doctors also use standardized symptom-based criteria for diagnosing IBS called the Rome criteria. They may also do tests to diagnose common illnesses that can cause similar symptoms, particularly when people are over 40 or have warning signs such as fever, weight loss, rectal bleeding, or vomiting.

Doctors use the Rome criteria to diagnose IBS in people who have had abdominal pain for at least 1 day a week in the last 3 months along with 2 or more of the following:

• Pain that is related to defecation.

• Pain is associated with a change in stool frequency (constipation or diarrhea).

• Pain is associated with a change in the consistency of stool.

A physical examination generally does not reveal anything unusual except sometimes tenderness over the large intestine. Doctors do a digital rectal examination, in which a gloved finger is inserted in the person’s rectum. Women also undergo a pelvic examination.

Doctors usually do some tests—for example, blood tests, stool tests—to differentiate IBS from Crohn disease, ulcerative colitis, cancer (mainly in people over age 40), collagenous colitis, lymphocytic colitis, celiac disease, and the many other diseases and infections that can cause abdominal pain and changes in bowel habits. People who have chronic diarrhea also have their stool tested for the parasite Giardia. These test results are usually normal in people with IBS.

Doctors usually do more tests, such as ultrasonography of the abdomen, x-rays of the intestines, or a colonoscopy, in older people and in people who have symptoms that are unusual for IBS, such as fever, bloody stools, weight loss, and vomiting. Doctors may do a test to rule out lactose intolerance or bacterial overgrowth and also ask questions to rule out laxative abuse.

Other digestive tract disorders (such as appendicitis, gallbladder disease, ulcers, and cancer) may develop in a person with IBS, particularly after age 40. Thus, if a person’s symptoms change significantly, if new symptoms develop, or if symptoms are unusual for IBS, further testing may be needed.

Because IBS symptoms can be triggered by stress and emotional conflicts, doctors ask questions to help identify stress, anxiety, or mood disorders.

Constipation: every parent’s favorite topic

It’s amazing how once you become a parent you begin to realize that talking about poop is just part of everyday conversation. Has your child pooped today? What was the consistency? What was the color? (I know! Your high school self would not believe this is what you now talk about with your significant other!) But what happens when you child can’t, or isn’t, pooping? 

Constipation is a very common problem for many children. Between 12-14% of kids have chronic issues with constipation, which is defined as a decrease in the frequency of bowel movements (poop) or the passage of painful bowel movements.  

We asked Kacie Kaufman, APRN, and director of the BRICK (Bowel Retraining in Constipated Kids) Clinic, about the common myths and facts of constipation.

Constipation is almost always caused by a medical condition.

False: Most constipation is functional in nature, meaning there is no identifiable medical cause. Often kids begin withholding poop because of pain or for social reasons such as school. It is very uncommon for there to be an organic cause of a child’s constipation such as colon disease or a neurological problem. In children, constipation can begin when there is a change in the diet, during toilet training or following an illness. Often kids don’t like using toilets outside of home, so they withhold till they get back home. Holding poop is a very common trigger for constipation. A diet low in fiber and fluids and some medications can also contribute to constipation.

Chronic constipation only happens to toddlers.

False: Constipation can occur at any age. It is especially common in preschool aged children who are being toilet trained and in school-aged children. Children at these ages are more prone to hold their poop due to avoidance of the toilet leading to painful poop. 

There are several symptoms parents should be aware of.

True: There are a variety of symptoms associated with constipation.  People think constipation means that a person goes days without pooping, but there are also other symptoms that parents need to be aware of. Symptoms such as a history of passing large sized poop that may or may not clog the toilet, fecal soiling (the leakage of stool that a child cannot control), abdominal pain and withholding behaviors such as stiffening legs or hiding in the corner can be associated with constipation. 

Older aged children are typically more private about their bathroom habits, so these kids often don’t get diagnosed until these other symptoms occur.

A child can be constipated even if they’re going poop every day.

True: Yes, this is definitely true. Constipation is not only determined by how often the child poops, but also by the volume or amount and the consistency of it.  If the child only passes a pea size poop once a day, then he or she is constipated.

Parents should do their best to monitor a child’s bathroom habits to find out if the child is having any trouble going poop, especially when they reach school age and older. Keeping a poop journal can be a helpful way of tracking.

Over-the-counter laxatives are safe to use.

True:  Over-the-counter laxatives are safe to give children. MiraLAX is commonly the first line treatment many health care providers recommend because it is a powder that is easy to administer in a drink of choice. It is colorless, tasteless and is well-tolerated for long periods of time without children becoming dependent on it. MiraLAX and other stool softeners work by pulling water into the stool to keep it soft and easy to pass. 

Constipated kids will find relief after going poop once.

False: Treatment of constipation is often a process and takes several months or more to improve. The first step in treatment is to do a bowel clean out and remove as much poop as possible from the colon.  A clean out should create lots of loose stool. After clean out, a daily maintenance dose of a stool softener/laxative is given to prevent build-up again. The goal with daily medication is to help the child pass soft daily stools and decrease withholding behaviors. It takes times for the colon to return to its normal shape and muscle tone.   

Bowel retraining is an important part of treating constipation.

True: Overtime the rectum gets stretched out from retained stool and there is loss of sensation and lack of communication from the gut to the brain. The normal urge to poop is lost, so kids can go several days without passing a poop. Scheduled bathroom breaks after meals are a good way to retrain the bowel.  Children should sit on the toilet for about five minutes and relax to see if they can go. Using a foot stool can be very helpful when sitting on the toilet as well. By getting kids on the toilet daily and treating their constipation effectively, kids will regain the urge to poop.   

Positive reinforcement and rewards can be very helpful with bowel training.  Offer kids a small reward or treat such as a piece of candy or electronic time immediately after completing a toilet sit. 

Constipation is fixable.

True: Constipation is definitely fixable, but it takes a commitment from both the child and parents. Often kids are taking medication daily for many months or longer to keep stools soft and regular.   

I recommend kids visit their pediatrician and try over-the-counter remedies first for constipation. The child may need to try a couple of different medications before they find relief. If symptoms persist, than a referral to a GI clinic can be made.  

Constipation (constipation)

Tel. +7 (4152) 303 777 , +7 (914) 781 82 04 | Karl Marx Ave, 35 | 8: 30-21: 00

What is constipation?

Constipation (in common people – constipation) usually has different meanings for different people. Most often, this is understood as the appearance of difficulties with bowel movement, but this term can also describe a decrease in stool volume and mass, or the need to push when performing a bowel movement.

Normal, average frequency of bowel movements is considered from 3 times a week to 3 times a day. Some people can abstain from bowel movements for up to 2 weeks without experiencing any need or acute discomfort. The need for bowel movements and the intervals between them directly depend on nutrition. With the modern rhythm of life, a person on average eats only 15 grams of fiber per day, while the rate of fiber intake for the normal functioning of the intestine contains at least 25 grams.Do not forget about physical activity, which also significantly affects the functioning of the intestines.

Fiber-rich bran and whole grain breads should be included in the daily diet to replenish the daily intake of fiber.

Nowadays, about 80% of people suffered from constipation at least once in their life. Meanwhile, short periods of constipation are quite normal, and the diagnosis “constipation” is made only in the absence of defecation for more than 3 days in a row.The common misconception that bowel movements should occur every day, regardless of personal characteristics of the body, has led to the overwhelming popularity of laxatives, which in turn has led to the dependence of many people on these drugs.

Causes of constipation

There are a number of causes of constipation. Among them are:

• Insufficient fiber intake;
• Insufficient fluid intake;
• Sedentary lifestyle;
• A sudden change in the familiar environment.

Pregnancy, travel, or diet changes can also lead to constipation. In some people, constipation may occur after prolonged unauthorized refusal to defecate despite the urge.

Do not forget about the more serious causes of constipation. The cause of constipation can also be the appearance of neoplasms in the intestine. Therefore, if self-treatment does not help for a long time, you should consult a coloproctologist. In rare cases, the cause of constipation can be serious diseases such as:

• Parkinson’s disease;
• Lupus
• Diseases of the thyroid gland;
• Stroke;
• Disorders of the nervous system;
• Endocrine Disorders;
• Multiple sclerosis;
• Scleroderma;
• Spinal cord injuries.
• Multiple sclerosis;

Can medicines cause constipation?

Many medications, including pain relievers, can cause or worsen constipation. In addition, some people who do not actually have a problem with deformity take laxatives (for example, for weight loss), which over time leads to dependence on these drugs and causes harm to the body.

When should I see a doctor with constipation?

For any prolonged bowel disturbance (eg, difficulty in emptying), consult a physician.If constipation lasts more than three weeks, see a physician. If traces of blood appear in the feces, you should immediately contact a coloproctologist.

How to establish the cause of constipation?

Since there are many reasons for the appearance of constipation, it is extremely important to establish it for proper treatment. To exclude swelling, the doctor must necessarily prescribe research.

Finger examination of the rectum is often the first research method.Despite the simplicity of the method, it is able to answer many questions. Barium contrast radiography may be required to more accurately diagnose and rule out polyps and diverticular disease.

Other methods help to determine the functional state of the intestine. For example, a study is carried out using markers when the patient needs to swallow special capsules that are visible under X-ray irradiation. The results of such studies are aimed at identifying disorders in the work of the intestinal muscular apparatus.Studies of the condition of the anal canal and rectum can also be carried out. For example, a defecography was performed (an X-ray is taken during a bowel movement).

Most cases of constipation are considered nonspecific. anatomical or functional abnormalities cannot be detected.

Treatment of constipation

Most patients recover successfully after dietary adjustments. Your doctor may also recommend lifestyle changes.

With the regular use of foods with a high content of dietary fiber, not only constipation is cured, but also the level of cholesterol in the blood decreases, the risk of developing polyps and colon cancer is reduced, and the development of hemorrhoids is prevented.

To maximize the benefits of fiber, you should consume enough fiber for at least a few weeks. Unlike laxatives, its continuous use is safe and does not lead to addiction.

Some people may find it helpful to set a deflection schedule when going to the toilet at a specific time. Only in very rare cases, constipation problems have to be solved with the help of surgical intervention. In any case, it is best to discuss all possible treatment options with your doctor.

Make an appointment

You can make an appointment for an initial appointment by calling 303-777 or + 7-914-781-82-04 . You can also use the appointment form.

SRK with constipation. The place of non-absorbable molecules in the treatment of various gastroenterological diseases

Oksana Mikhailovna Drapkina , Professor, Doctor of Medical Sciences:

– Lecture by Yulia Olegovna Shulpekova, she will talk about IBS with constipation.

Yulia Olegovna Shulpekova , Associate Professor, Candidate of Medical Sciences:

– Hello dear colleagues. It is very pleasant to talk with you now. In my lecture, I would like to present the role of various non-absorbable large molecules in the treatment of IBS with constipation and, in particular, to focus on Macrogol.Allow me at the beginning of the lecture to briefly recall the existence of the Roman criteria for the third revision, according to which we assess the presence of recurrent pain or discomfort in the abdomen for at least three days a month during the last three months, and which should be associated with two or more of the following signs: a decrease in pain during bowel movements, a change in the frequency, shape of the stool. As you can see, there may also be additional symptoms that bring patients very often strong anxiety.And the question often arises: how to assess the shape of the feces? There is a special Bristol scale. Although it is well known to everyone, I would like to emphasize once again that you can use this scale to assess whether a patient has normal stool or not, and based on it, make a conclusion about the presence of irritable bowel syndrome. Here are the types of the third and fourth forms of stool – these are normal types. And the first and second types are more characteristic of IBS with constipation. The diagnosis of IBS with constipation is based on the fact that the patient has difficulty emptying the bowel, that is, a subjective feeling of incomplete bowel movement, hard or lumpy stools in more than 25% of bowel movements, and loose stools in less than 25% of bowel movements.And I also want to remind you of the extreme importance of eliminating the symptoms of anxiety:

1. Weight loss, which does not allow us to exclude cancer, colitis or enterocolitis.
2. The onset of symptoms at night, which is not characteristic of functional diseases of the gastrointestinal tract.
3. Persistent and sufficiently intense or increasing abdominal pain as the only or leading symptom. This is not the case with functional diseases.
4. Onset of the disease at the age of more than 50 years.
5. Complicated family history: colon cancer, inflammatory bowel disease, celiac disease in the patient’s relatives. And also the high prevalence of these diseases in the area. In such cases, a more targeted examination is needed to exclude organic pathology.
6. Changes in organs on examination (hepatomegaly, splenomegaly), palpable volumetric mass in the abdomen.
7. Blood admixture in feces.
8. Signs of malabsorption and osteoporosis.
9. Deviations in the general analysis of blood, biochemical parameters and the level of TSH (thyroid stimulating hormone).

Thus, for a sufficiently reliable diagnosis of IBS, it is necessary to carry out the patient not only detailed physical examinations, collection of anamnesis, but also include a general blood test, a fecal occult blood test, a biochemical blood test, and thyroid function tests in the minimum of examinations.IBS with constipation is known to be a fairly common disease. In economically developed countries, the prevalence of irritable bowel syndrome itself can reach 10-20%. And among all these cases, according to various sources, cases with constipation reach half: 34-52% in different studies. And the mixed version of the course, in which constipation is also observed, reaches 33-39%. In IBS with constipation, according to some data, the frequency of depression and anxiety is higher, and the patient’s quality of life is lower. And as an explanation why constipation predominates in these patients, a violation of cholinergic innervation is assumed.As shown by some researchers, they seem to have a changed tone of the cholinergic part of the nervous system. In particular, they explain the influence of psychosocial factors; activation of vagal fibers, which affect intestinal motility, in turn, indirectly affect visceral sensitivity, which is associated with the central nervous system through sympathetic fibers.

In IBS with constipation, to confirm the diagnosis, to objectify the presence of constipation, it is advisable to conduct studies with radiopaque marks, but, unfortunately, this is not widely available in what institutions.On the left image, you can see a uniform distribution of radiopaque marks five days after they were taken along almost the entire colon, more in the left sections. In the middle image, you can see the concentration of these markers by the fifth day after taking them in the rectosigmoid junction, which indicates that constipation appears to be more of a functional proctogenic character. And in the right picture you see one of the reasons for such proctogenic functional constipation, a violation of the relaxation of the anorectal muscle in the form of a loop that covers the rectum.A special study was carried out in which it was shown that in many patients with IBS with constipation, the number of large propulsive contractions of the colon per day was significantly reduced compared to healthy ones. But in other studies it has been shown that in some patients it is not hypotension that predominates, but, on the contrary, the spastic activity of the intestine. In particular, on the left side of the slide, you can see how the contraction of the sigmoid colon occurs after eating a normal meal, there is a relatively small amplitude, rhythmic contractions.And on the right side of the slide, you can see chaotically high-amplitude contractions of the sigmoid colon in a patient with IBS, which can lead to impaired evacuation of feces and to thicken its consistency. In the development of both hypersensitivity and motor impairment, great importance is attached to a change in local reflexes. It is well known that the wall of the colon responds reflexively to an increase in intraluminal pressure, this pressure affects the cells of the enterochromaffin type, which are embedded in the mucous membrane; they secrete serotonin, and the secretion of serotonin modulates the supply of impulses to the local enteric and central nervous systems.And in the enteric local system, the central local system, there are whole varieties of a group of nerve endings and nerve cells. Some of them act as sensory cells, while others mediate motor reflexes, relaxation or contraction of the intestines. And there are also intercalary neurons. Thus, peristalsis largely depends on the pattern of local reflexes that has developed in a given patient.

The involvement of the central nervous system in the development of manifestations of irritable bowel syndrome has also been proven.You can see on the left side of the slide how the activity of the cerebral cortex and subcortical nuclei changes when the rectum is stretched, with the introduction of a balloon that stretches the rectum. And in patients with IBS, the electrical activity of various parts of the brain is altered. And in response to the expected stretching of the rectum, the response is reduced in some areas, while in others, on the contrary, it is pathologically increased.

And on this slide, I wanted to present this amount of knowledge in the form of a diagram. What is known today about the contribution of violations of the inflammatory response, about the contribution of cells of participants in inflammation in the pathogenesis, irritable bowel syndrome.In the lower part of the figure, we see the data obtained in experimental studies that relate to the content of various cytokines in the blood of patients, irritable bowel syndrome and in the mucous membrane. And now, in particular, data were obtained on the high permeability of intercellular contacts, that in these patients, in most cases, the content of pro-inflammatory cytokines, interleukin-6, tumor-necrotizing factor is increased. They are not so significantly increased, but, apparently, they contribute to the pathogenesis.In addition, in the mucous membrane, the content of mast cells, macrophages and individual populations of lymphocytes is increased in most patients. And these cells are thought to affect nerve fibers and modulate pain sensitivity and motor response. While searching for material for this presentation and in search of differences between IBS with constipation and IBS with diarrhea, I came across evidence that there is conflicting evidence that the content of mast cells, in general, in patients with irritable bowel syndrome is increased, as shown on the right. parts of the slide, these cells are colored brown.But in one of the studies (shown on the bottom right), they found that, on the contrary, in IBS with constipation, their number is even reduced compared to healthy individuals. And with IBS with diarrhea, they are significantly increased. Also shown is the change in the production of various hormones that regulate the motility of the gastrointestinal tract in irritable bowel syndrome: in particular, cholecystokinin, somatostatin, various neuropeptides, and so on.

Let me go on to a review of the medicines currently recommended for the relief of the main clinical symptoms of irritable bowel syndrome.These drugs can be divided into groups used:

1. For diarrhea: astringents and adsorbents; regulators of motor skills, mainly suppressing motor skills.
2. In case of constipation, preference is given to the use of osmotic laxatives, the most modern of them: “Polyethylene glycol” and “Lactulose”. Bulk laxatives of combined action represent a kind of osmotic, bulky, and to some extent stimulating laxatives: “Psyllium”, “Methylcellulose”, “Polycarbophil calcium”.And motor regulators: Prukaloprid (a new prokinetic registered in Russia), Trimebutin, Tegaserod (which is not used in Russia).
3. Antispasmodics and tricyclic antidepressants are also used to treat abdominal pain.

Unlike other branches of medicine, non-absorbable molecules are widely used in gastroenterology. Why exactly in gastroenterology? Because the gastrointestinal tract is a receptacle, on the one hand, for diseases; on the other hand, it is a field for the action of drugs.And diseases of the gastrointestinal tract allow prescribing drugs locally. Examples include reflux alginates, antacids, sucralfate, bismuth salts, adsorbents, non-absorbable antibiotics, aminosalicylic acid (5-ASA) preparations and modern laxatives. And all these modern means are designed in order to have as little systemic effects on the body as possible with a high efficiency of treatment of diseases. We are currently trying to prescribe drugs that have the highest level of evidence that have passed large studies.In particular, the first level of evidence includes randomized controlled trials with an adequate sample size that have shown the effectiveness of this drug. And the research should be of high quality in the selection of patients and so on. Such studies, which show the effectiveness of laxatives, include studies on the effectiveness of “Polyethylene glycol” (PEG) to a greater extent, to a lesser extent – “Lactulose” and “Tegaseroda”. All other types of laxatives are categorized as B and C, with fewer studies and less evidence of their effectiveness and safety.

Let me dwell briefly on Polyethylene Glycol (Macrogol), which is an osmotic laxative. These are linear polymers with a mass of 3000-4000, which are able to attract and retain water molecules. Thus, the stool increases in volume, its consistency softens, it stimulates motility by stretching the wall, and thanks to such a soft consistency, its evacuation is facilitated. Dosage forms of “Polyethylene glycol” with a weight of 4000 in our country are represented by “Forlax” and “Fortrans”.The advantages of these drugs are that they: a) are not absorbed from the gastrointestinal tract; b) do not undergo metabolism; c) do not have (as shown in studies) a significant effect on the level of blood protein, that is, they do not cause protein to lose diarrhea; do not affect the pH of the intestine and the composition of the intestinal microflora; d) drug interactions are not described.

The Forlax effect, in particular, has been proven in modern meta-analyzes by Belsey and the Cochrane community.Here is the data from these meta-analyzes. They, in particular, compared the effects of “Polyethylene glycol” and another effective and safe modern laxative – “Lactulose”. And according to a meta-analysis by Belsey and the Cochrane Group, the advantage was in favor of using “Polyethylene Glycol”. In the first meta-analysis, it was expressed in the fact that he provided almost one additional, in comparison with “Lactulose”, free bowel movements per week. And in a Cochrane Group meta-analysis, it was shown to be more effective in relieving abdominal pain and in reducing the need for other drugs to relieve IBS symptoms.It turned out that with the appointment of “Forlax” for long courses (from 4 weeks to 3 months), the aftereffect persists for some time, that is, after the drug is discontinued for about two months and more, an independent, soft stool can persist, as if the patient continues to take drug. And this effect of “gut learning” attracts a lot of interest. By the way, it is now beginning to be studied in relation to other laxatives – this has already been shown for Forlax – and it is explained theoretically by the fact that new reflexes can be established at the level of the spinal cord and central nervous system, which contribute to the normalization of stool frequency.

At present, there are a lot of sites on the Internet where much attention is paid to the issues of neuroplasticity, restructuring, and rapid adaptation of the nervous system to new conditions. As you can see, this excerpt from one of the sites shows that new connections, new axons, are quickly established between various nerve cells. The study of Professor Baranskaya, who works in our clinic, was devoted to assessing the mildness of the effect of “Polyethylene glycol (PEG) 4000”.In particular, she estimated how long after the first intake of Forlax the first normal bowel movement would occur in most cases. And she found that in 70% of patients, loosening of the stool, a mild loosening, was observed within 20-35 hours after the first dose of the drug. Normal transit time for content is 30-48 hours. Thus, as shown by the dark pink bars, in most patients the effect seemed to coincide with the physiological rhythm of the movement of the contents through the intestines.Finally, other fiber-based bulk laxatives cannot be mentioned. These are non-cellulose natural polysaccharides (pectins, gums, mucus, inulin), semi-synthetic (methylcellulose), calcium polycarbophil, which are included in many combined laxatives.

The action of such dietary fibers is based on the fact that they are partly processed by the microflora, promote the growth of the microbial population, and the production of short-chain fatty acids. And all this leads to the fact that there is a stimulation of motor skills, a decrease in water absorption and a laxative effect of these drugs.Such drugs are highly effective, quite physiological, but one should be warned against the possibility of constipation and fecal blockages in some patients, so they must be prescribed carefully, starting with small doses. Thank you for the attention.

Colitis – both pricks and hurts

The lifestyle of a modern urban person is inextricably linked with the influence of a number of unfavorable factors – monotonous diet, excessive consumption of flour and animal food, low physical activity, stress, lack of sleep, abuse of spicy food and alcohol.Of course, such an extensive list of bad habits has the most negative effect on human health, and in particular on the normal functioning of the colon.

Acute or chronic inflammation of the mucous membrane of the colon is called the general term “colitis”, which, depending on the causative factors, is of several varieties. Infectious colitis is caused by intestinal parasites, bacteria (salmonella, shigella) or pathogenic fungi that enter the human body when drinking contaminated water and poorly washed vegetables and fruits, non-observance of personal hygiene rules.Ischemic colitis is a consequence of a violation of the blood supply to the intestine, when, against the background of atherosclerosis in the elderly, narrowing of the mesenteric arteries occurs. The most dangerous is acute blockage of intestinal vessels, since in this situation necrosis of the intestinal wall develops very quickly, which in most cases leads to death. Long-term use of certain drugs, including laxatives, antibiotics, salicylates, can also cause so-called drug colitis, and its toxic form is observed when various toxic substances enter the body – arsenic, mercury, lead, phosphorus.Autoimmune diseases include ulcerative colitis, which occurs as a result of the production of antibodies to the colon’s own mucous membrane.

The main symptoms of the disease are bloating, unstable stools (alternating constipation with diarrhea), abdominal pain of a cramping, dull or aching character, the presence of blood and mucus in the feces, loss of appetite, general weakness, weight loss. Abdominal pain is usually worse after eating or before a bowel movement, and may be relieved by stool, flatulence, or a cleansing enema.The patient may also be disturbed by the feeling of incomplete bowel movement, when a small amount of mushy feces is released during bowel movements. An exacerbation of the inflammatory process is accompanied by the appearance of false desires for defecation, accompanied by the discharge of gases with individual lumps of feces or mucus streaked with blood.

The nature of the treatment depends on the specific cause of the colitis. For example, in the case of infectious colitis, antibacterial or antiparasitic drugs are used, in toxic colitis, saline laxatives, and in ischemic colitis, as a rule, surgical intervention is indispensable.After a course of antibiotic therapy, it is necessary to carry out treatment aimed at restoring normal intestinal microflora with drugs containing bifidobacteria and lactobacilli. Of course, only a specialist can prescribe the correct treatment, after conducting a number of laboratory and instrumental studies. However, the treatment of colitis is based primarily on adherence to a properly selected diet, which should not only be gentle, but also contain all the necessary nutrients for the full functioning of the body.

First of all, it is necessary to exclude spicy, sour, salty foods, alcoholic beverages, plant foods. With an exacerbation of the disease, food should be fractional (6 – 7 times a day), it is recommended to thoroughly chew or grind the food beforehand. In the diet, preference should be given to slimy soups, meat, low-fat poultry and fish, meatballs, steamed cutlets, boiled vegetables in the form of mashed potatoes. Recommended drinks include teas, weak coffee without added milk, fruit and berry juices (except for grape, plum and apricot), jelly, rosehip and black currant decoctions.Do not eat fresh vegetables and fruits, sweets, carbonated drinks. If colitis is accompanied by constipation, it is necessary to increase the amount of foods rich in plant fiber (mashed vegetables and fruits) in the diet. Physical therapy, abdominal massage, herbal laxatives will be very useful. Physiotherapy (diathermy, mud applications) and spa treatment are far from the last place in the treatment of chronic colitis.

Get rid of bad habits and keep your intestines healthy!

Vladimir KHRYSHCHANOVICH, Doctor of Medical Sciences.

Soviet Belarus № 177 (25059). Thursday 15 September 2016

90,000 What is constipation and how is it dangerous?

Constipation. Causes of occurrence. Diet. Treatment.

Every person at least once in his life faced such a problem as constipation. Due to the fact that constipation is extremely common in society, their timely diagnosis and treatment are very important. To solve this problem, several ways are usually used: the recommendation of the pharmacist about the use of certain laxatives; advice from a “neighbor on the staircase” who once heard a recipe for a miraculous potion from your ailment on TV or from her great-grandmother; or consultation with a specialist doctor.In order to determine which path is the most correct, you need to know which condition should really be considered constipation. This is largely due to the fact that the frequency of bowel movements is different for all people.

So what is constipation?

So, constipation is a long (more than 48 hours) delay in bowel emptying, accompanied by difficulty and irregularity of the act of defecation, a decrease in its frequency (less than 3 times a week), a decrease in stool weight (less than 35g per day), often painful defecation with the release of hard masses and a feeling of incomplete emptying of the intestines.If constipation develops within a few hours, days and weeks, it is treated as acute, and if it lasts more than 3 months, it is chronic. Acute constipation often occurs as a result of severe limitation of physical activity or immobility (for example, during travel, hospitalization due to surgery or other acute diseases), which disappear with dietary adjustments (increased intake of plant fiber and water), reasonable temporary use of laxatives funds and increased physical activity.

It is also worth considering the fact that intermittent fast breakfast and too fast food intake can have a negative effect on the gastroolytic reflex. Thus, for one reason or another, you did not manage to have breakfast properly and correctly, and the act of defecation did not follow either, and you safely went to work (to school). Then, during the day, the urge to defecate nevertheless arises, but due to the untimeliness and lack of time and habitual toilet conditions, the stimuli to empty the bowel are forcibly suppressed.Rectal sensory receptors become accustomed to an increase in rectal pressure and do not respond to it over time, i.e. the urge must become stronger and stronger, which ultimately leads to chronic constipation. Today, this mechanism causes a fairly large part of the usual chronic constipation.

Do not forget that the concomitant pathology of the gastrointestinal tract, in the mechanism of which there is a violation of the act of digestion and the subsequent failure in the absorption and formation of feces, also leads to chronic constipation.

A huge role in the mechanism of development of constipation is played by organic blockage of the intestinal lumen (strictures, tumors, hernias, prolapse of the rectum, diverticulosis, syphilis, tuberculosis, ischemic colitis, endometriosis, etc.), diseases of the rectum (rectocele, intussusception), diseases anal opening (stenosis, fissure), neurogenic causes, as well as psychogenic constipation, the presence of metabolic syndromes, pathology of the endocrine system.

To find out the cause and further tactics of managing a patient with constipation, it is necessary to exclude organic pathology.The minimum diagnostic examination should include a colonoscopy, X-ray contrast examination of the colon, sigmoidoscopy, if necessary, ultrasound of the abdominal organs, ultrasound of the thyroid gland, followed by consultation with specialist doctors.

Treatment of constipation for many doctors and patients remains an insoluble task and does not give the desired result and satisfaction for several reasons. First, dietary recommendations are often incorrect. Food contains few mechanical irritants and is overly intensively cooked.Secondly, the abuse in the use of enemas, with prolonged use of which only aggravates the changes in the mucous membrane and increases constipation. The normal contents of the intestines are not water and “healing solutions for washing”, but chyme and feces, the quality of which improves with the appointment of an adequate diet, and, if necessary, enzyme preparations and agents that normalize intestinal motility. Thirdly, it is often necessary to treat the underlying disease that led to the development of a symptom such as constipation.Many mistakes are made in the treatment of intestinal dysbiosis. Often, courses of antibiotic therapy are carried out with the simultaneous administration of microbial bacterial preparations (without observing the time intervals), which are immediately destroyed by these antibiotics.

Thus, the treatment of such a symptom as constipation cannot be limited only to the use of laxatives, enemas or dubious recipes for cleansing the intestines. It is necessary to contact a specialist, find the reason and get competent advice from a specialist with a further choice of ways to solve this problem.

90,000 A sore subject about children’s chair (Constipation).

06/25/2016

A sore subject about children’s chair (Constipation).

Greetings to all mummies and daddies who read my blog.

I decided to start my blog with a sore subject. In my daily practice, I often have to deal with problems and issues related to stool in children, especially in young children. Most of the questions in my online chat on Instagram (@olegovnatatiana) are also related to nutritional and digestive issues.

First, let’s figure out which stool the child should have normal and what to count off nen iem.

In infants of the first months of life who are breastfed, the stool should be light yellow, homogeneous, mushy (the consistency of liquid sour cream) with a sour smell. Stool frequency usually coincides with the number of feedings and reaches 6-7 times a day (up to 10 times in the first month).A breastfed child may have no bowel movements for 3-7 days, while the child is not worried about anything (which is associated with the complete assimilation of breast milk).

Gradually with age, the frequency of stools decreases and by the period of introduction of complementary foods (5-6 months) is 1-3 times a day.

In bottle-fed children, stools are often darker and denser, the frequency usually does not exceed 1-3 times a day. Children receiving therapeutic hypoallergenic mixtures based on cow protein hydrolysis may have a greenish stool.

Stool color is of limited importance with the exception of blood, black or discolored stools.

The presence of undigested particles of plant origin (small grains or pieces of carrots) in the stool of a child of 1-2 years old is a variant of the norm and indicates insufficient chewing of food, and not a violation of its absorption.

Constipation is one of the most common stool disorders in children.

CONSTRUCTION is understood as a violation of bowel function, manifested by an increase in the intervals between bowel movements . Constipation is also considered cases when a child has painful defecation with a dense feces, which is accompanied by straining, even if the frequency of stools corresponds to the age norm.

In children over three years of age, constipation is reported if the stool frequency is less than 6 times a week or if the stool is retained for more than 36 hours.

The Bristol Stool Scale will also help you assess your child’s stool.

What if you suspect your child is constipated?

If it is acute constipation and happened for the first time in life, the child can be helped as follows: insert a suppository with glycerin into the rectum or make a Mikrolax micro enema, these are the simplest, safest and most effective measures.

In the case when constipation takes chronic course, you will have to apply a set of measures to normalize the stool:

organization of a rational feeding regimen, drinking enough water, diet therapy.

If all these activities do not help, it is better to show the child to the pediatrician, because constipation can be one of the symptoms of a serious illness.

And also only a doctor can prescribe the necessary studies, choose a diet for a child, a nursing mother, or prescribe a treatment mixture (if the child is bottle-fed), prescribe medications.

In what situations should you seek medical advice immediately?

These include cases when:

1. constipation is accompanied by vomiting, abdominal pain, bloating, lack of appetite, which may be a manifestation of intestinal obstruction;

2. Blood was found in the child’s stool.

3. The child, against the background of constipation, periodically has an involuntary stool or calorification (encopresis). Encopresis is a condition in which solid feces accumulate in the rectum, and liquid feces are involuntarily released outward due to the child’s loss of control over the sphincter apparatus of the rectum.

To be continued.

90,000 Make your intestines happy and protect against cancer with the Mediterranean diet

Colon cancer is one of the most common cancers both in the world and in our country. Scientific studies have shown that a Mediterranean diet rich in vegetables, fruits, fish, olive oil and nuts significantly reduces cancer and vascular occlusion deaths. General Surgery Specialist of the Liv Clinic prof.Dr.
Hakan Yanar spoke about methods of colon cancer prevention, screening and treatment and the importance of nutrition.

What are the causes of colon cancer? Who is in danger?

More than 90% of colon cancers are caused by pre-existing polyps. While the incidence of polyps before the age of 50 is rare, after the incidence of cancer increases due to the higher incidence of polyps. Eating habits high in fat and low in fiber, a history of colon cancer in close family members, inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease all lead to an increased risk of colon cancer.

Is colon cancer dangerous?

Early diagnosis is very important in colon cancer, which is an asymptomatic and slowly progressing cancer. This type of cancer is especially common in people over 50 and can be treated with early diagnosis. Colon cancer is the second or third most common cancer in the world.

What are the symptoms of colon cancer?

• Anemia
• Constipation
• Overweight
• Rectal bleeding
• Blood in feces
• Reducing the diameter of the chair
• Changing the defecation process
• Failure to relieve urge to defecate
• Abdominal pain lasting more than 15 days

How to diagnose cancer at an early stage?

Although fecal occult blood test can be used to screen for colorectal cancer, colonoscopy is the most effective diagnostic method. The goal of a colonoscopy is to remove polyps before they become cancerous tissue.Therefore, the first colonoscopy screening should be done at age 50 for people with no family history of colon cancer, and if the test results are normal, further screenings are done every ten years. For people with a history of colon cancer in their family, the first colonoscopy should be performed 10 years before the age at which the affected family member developed cancer.

What is colon cancer treatment?

The standard treatment for colon cancer is surgery.Removing some of the healthy tissue in the colon and surrounding lymph nodes along with the tumors is critical. Surgery affects life expectancy, tumor recurrence, and metastasis, so it must be performed by experienced surgeons. Today, these surgeries are performed with a high success rate through the use of laparoscopy and robotic surgery without an incision in the abdomen. Benefits of laparoscopic and robotic surgery include less postoperative pain, a shorter hospital stay, and fewer scars at the surgical site.In the case of tumors close to the anus, colostomy (the attachment of the large intestine to the outer wall of the abdomen) can be prevented with pre-operative chemotherapy and radiation therapy.

Follow recommendations

• Get regular screening tests
• Consult a doctor for prolonged constipation and rectal bleeding
• Do moderate-intensity exercise 4-5 days a week instead of a sedentary lifestyle
• Eat a diet rich in fiber, low in fat and balanced in protein
• Avoid smoking and drinking alcohol
• Maintain Your Ideal Weight
• Scientific studies have shown that a Mediterranean diet rich in vegetables, fruits, fish, olive oil and nuts significantly reduces cancer and vascular occlusion mortality

Constipation

Constipation – prolonged delay in defecation, bowel movement from feces.

Causes of constipation

Among its reasons, neurogenic factor may prevail, associated with various disorders in the central nervous system (stressful situations), conscious suppression of the reflex under certain living conditions and working conditions (traveling work, lack of a toilet). With proctological diseases, accompanied by painful defecation, reflex constipation occurs. They can also be the result of chronic poisoning with lead, morphine, nicotine and other toxic substances, disruption of the endocrine glands – ovaries, pituitary gland .At present, constipation of alimentary origin is quite common – with insufficient intake of fiber of plant fiber with food or constipation associated with a sedentary, sedentary lifestyle.

The mechanisms of such constipation are quite complex. Intestinal peristalsis (muscle contractions) is stimulated by mechanical action on the intestinal wall of coarse and indigestible fibers of plant fiber, contained in natural food in sufficient quantities.These are the shells of grains in cereals, a certain content of bran in plain wheat flour, in vegetables and fruits. But in recent decades, the nature of the diet of the modern city dweller has undergone significant changes. In his diet, semi-finished and deeply refined products began to prevail – premium flour and products made from it (white bread, pasta), refined cereals, rice with an almost complete absence of fiber, and so on. Vegetables also began to be classified as low-calorie foods, and, therefore, with low nutritional value, and they began to be partially replaced by food concentrates and flavorings.Chronic low fiber content in the digestible food of a modern person leads to a slow movement of food in the gastrointestinal tract and has a number of negative consequences in the development of chronic atonic constipation. Fiber loosens food masses in the intestinal lumen and thereby improves access to food lumps of intestinal juice, which, along with normal peristalsis, ensures optimal food breakdown and absorption. The absorption of food in the intestine is also facilitated by the mechanical cleansing of the fibers of the fiber of the villous inner surface of the intestine.With its deficiency, a film forms over time on the surface of the intestinal wall, which prevents the absorption of nutrients into the blood, primarily those having large molecules (protein, vitamin complexes and polysaccharides). In the lumen of the intestine, areas of accumulation of dense undigested food are formed, and putrefactive processes intensify in the large intestine, poisoning the body with absorbed toxins, non-excreted “fecal heaps” and “stones” are formed. Fiber, due to its poor digestion, in the last stages of digestion is involved as a filler in the formation of bulk feces and thereby stimulates the urge to empty the intestines in time.

Calcium deficiency in the food of a modern person also has a negative effect on intestinal motility and absorption processes.

Calcium is necessary for the process of contraction of muscle fibers, including smooth muscles, presented in the intestinal wall, as well as for direct participation as a conductor in the process of absorption of nutrients through the intestinal mucosa into the blood. With a lack of calcium, these processes are suppressed.Calcium deficiency is also associated with a change in the nature of the diet – the use of refined products (yoghurts, low-fat kefir), in which the calcium content is 3-4 times lower in comparison with natural dairy and fermented milk products, neglect of dishes with bone broth. Chronic calcium deficiency (and thus alimentary constipation) is especially common among women over 35. On the one hand, this is due to the reproductive function they perform. Fetal formation, birth and breastfeeding require significant amounts of calcium, which the mother’s body receives from its reserves stored in the bones.With the modern diet, this deficit persists and increases with each subsequent birth. On the other hand, calcium metabolism also decreases during the period of fertility extinction, as a result of a decrease in the secretion of certain female hormones by the ovaries. The calcium content in bones decreases to a critical level – osteoporosis (loosening, rarefaction) of bones, and as a result, along with long-term constipation and chronic poisoning from the large intestine, leading to malnutrition of the skin, hair and other tissues and organs, increased fragility of bones occurs, the likelihood of their fractures with minor trauma.

Quite rarely, there are constipation associated with the anatomical features of the large intestine – lengthening of its sections or excessive narrowing.

With the atonic form of constipation , the delay in emptying is associated, as noted, with the relaxed state of the smooth muscles of the intestinal wall as a result of a decrease in motor function (peristalsis) – muscle contractions of the intestine. The feces in this case are abundant, dense, sausage-like.Defecation is painful, carried out with great difficulty, sometimes with microcracks in the mucous membrane of the anal canal, manifested by streaks of blood on the surface of the feces.

With spastic constipation , a long delay in defecation, on the contrary, is associated with an increased tone of intestinal smooth muscles and is most often the result of a neurogenic reaction of the whole organism to a prolonged stressful situation, mental trauma. It should be noted that the stress reaction indirectly negatively affects the state of the intestinal microflora.Feces in this form take the form of “sheep feces” – dense, small separate lumps, sometimes accompanied by a meager liquid fraction. Spastic constipation is characterized by flatulence, a feeling of fullness in the abdomen, pains of a spastic nature that spread to the upper abdomen.

Treatment of constipation

Treatment of constipation is aimed at eliminating the underlying cause. With atonic constipation, gastroenterologists recommend a gradual increase in the diet of foods containing a sufficient amount of vegetable fiber – cereals, vegetables, fruits, certain types of bread.You should also regularly consume natural fermented milk products, cheese, bone broth. A prerequisite is the restoration of an active lifestyle – daily walks, exercise, water procedures, massage of the abdomen. From medicines, long-term intake of calcium preparations is recommended, preferably of natural origin or in combination with vitamin D (calcium gluconate and analogues can contribute to the formation of kidney stones). Herbal laxatives can be used to facilitate bowel movements.Periodic bowel irrigation and cleansing enemas are also useful.

With spastic constipation, first of all, it is necessary to normalize the state of the nervous system. For this purpose, tranquilizers, adaptogens are recommended (eleutherococcus, lemongrass, preparations of Rhodiola rosea, ginseng). Food should be gentle, mostly boiled. For spastic manifestations, antispasmodics are used (no-shpa, baralgin, etc.), thermal procedures and pine baths have a positive effect to reduce intestinal spasms.

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