Constipation Causes, How Often You Should Have a Bowel Movement, and More

What Is Constipation?

Your digestive system is remarkably efficient. In the space of a few hours, it extracts nutrients from the foods you eat and drink, processes them into the bloodstream, and prepares leftover material for disposal. That material passes through about 20 feet of intestine before being stored temporarily in the colon, where water is removed. The residue is excreted through the bowels, normally within a day or two.

Depending on your diet, age, and daily activity, regularity can mean anything from three bowel movements a day to three each week.

As fecal material sits in the colon, the harder the stool becomes and the more difficult it is to pass. A normal stool should not be either unusually hard or soft, and you shouldn’t have to strain unreasonably to pass it.

What Causes Constipation?

Our busy, modern lifestyles may be responsible for most cases of constipation: not eating enough fiber or drinking enough water, not getting enough exercise, and not taking the time to respond to an unmistakable urge to go to the bathroom. Persistent, chronic constipation may also be a symptom of more serious conditions, including inflammatory bowel disease, colorectal cancer, diabetes, Parkinson’s disease, multiple sclerosis, depression, or an underactive thyroid gland.

Bowel habits tend to vary with age and circumstances. Bottle-fed babies, for example, tend to have firmer stools and more bouts of constipation than breast-fed babies. Some children become constipated when they start school or other activities, because they are embarrassed to ask permission to use the toilet. Toddlers often become constipated during toilet training if they are unwilling or afraid to use the toilet. Being sensitive to pain, children may avoid the toilet if they have minor splits or tears in the anus from straining or other irritations. Kids can also become constipated from consuming certain foods, such as dairy products.

Older people, especially those who are more sedentary, tend to develop constipation more often.

Medications that can cause constipation include narcotics, diuretics, iron supplements, antacids, and drugs for blood pressure, seizures, and depression.

Constipation Symptoms And Causes | Bladder & Bowel Community

What Is Constipation?

Constipation is a very common condition that affects people of all ages. It means you are not passing stools (faeces) as often as you normally do, you have to strain more than usual or you are unable to completely empty your bowels.

Constipation can also cause your stools to be unusually hard, lumpy, large or small. It can be either acute or chronic and many people only experience problems for a short period of time with no lasting effects on their health.

Constipation symptoms and signs

You are likely be constipated if you are experiencing any of the following:

• Fewer bowel movements than normal
• Pain and straining when passing stools
• Stomach pain
• Stools are hard and dry, and may be large or small in size like pellets
• Sore bottom
• Unpleasant smell due to passing wind
• Leaking of liquid or loose stools
• Your bowels open less than three times a week
• There may be a bad taste in the mouth, bad breath, abdominal bloating, decreased appetite, lethargy and, for some, the inability to function normally.

Diagram of Normal vs Constipated Bowel

Causes of Constipation

There are many triggers that can cause constipation and associated symptoms which can include:

• Diet – not enough high fibre foods
• Pregnancy
• Lack of fluids
• Slow Transit Colon
• Lack of exercise
• Some medicines, especially pain killers
• Some people with neurological problems such as Parkinson’s disease or Multiple Sclerosis are prone to constipation
• Surgery around the anus can sometimes be a cause of constipation mainly due to pain when emptying the bowel afterwards
• Conditions such as Irritable Bowel Syndrome (IBS), Colitis and Crohns Disease
• Ignoring the urge to open the bowels
• There is a strong connection between emotional feelings and how the gut works. Feeling upset can make your bowel slow down or speed up.

How to Prevent Constipation

There are various things you can do to help keep your bowels healthy and avoid becoming constipated. If you are in any doubt, consult your GP or Healthcare Professional before making significant changes to your regular diet. A dietitian will also be able to guide you.

• As a general rule, eating more high-fibre foods can prevent constipation. However, if constipation is a result of Colitis or Crohns disease, increasing fibre intake could have a detrimental effect
• There are two different types of fibre; soluble and insoluble. Soluble fibre dissolves in the intestines to form a gel type substance. This helps food move along the digestive tract. Insoluble fibre is not dissolvable and moves through the intestines without being absorbed. This fibre adds bulk to bowel movements and helps to reduce constipation
• Make sure you drink lots of fluids to keep the stools moist e.g. at least 1.5-2 litres ( 6-8 glasses) of water based drinks per day
• If you are taking any medicines (prescribed or bought from the chemist) ask your doctor or chemist if they could be adding to your constipation. If possible, try to remove constipating medications
• If really necessary, try using a fibre supplement such as fybogel and possibly suppositories or mini-enemas to help regularise the bowels, but they should not be used long term. Some foods can act as natural laxative for some people, these include; prunes, figs, liquorice, coffee/tea, spicy food
• If possible, increase your physical activity as this helps to increase bowel activity

What is normal?

The normal defecation rate for an adult is between three bowel movements per day to three bowel movements per week. If you are going less than three times a week and are experiencing pain, discomfort and straining on passing a motion, you are probably constipated.

To help gauge how long the stool has spent in the bowel you can use a scale called the Bristol Stool Form Scale. To check if you are sitting correctly on the toilet take a look at our toilet positions guide.

When to seek help

Most people get constipated from time to time and can treat it themselves by making small changes to their diet. However, if you have constipation that doesn’t go away, you might need medical treatment to get your bowel habits back to normal.  

At the Doctors

In order to diagnose your constipation, your doctor will ask you how long your symptoms have been present and if you have any rectal pain or bleeding.  

It may help to fill in a Bowel Diary for one or two weeks before your appointment. The doctor will also ask you for information on your toilet habits, diet and general health and may need to examine you. 

Remember that medicines such as painkillers and iron supplements can cause constipation, so the doctor will review the medicines prescribed for you and will ask you if you take any other medicines you have bought yourself.

All of this information will help your doctor find out what might be causing your constipation, and if necessary refer you for further colonic investigations.

Further Help for Constipation

You will find further information about causes and how it’s diagnosed on our Constipation information sheet.

If you are concerned about your problem and it is starting to affect your day to day life make an appointment to see your doctor, continence nurse or specialist physiotherapist. A continence nurse and specialist physiotherapist are healthcare professionals who specialise in bladder and bowel problems.

Constipation – Children’s Health Orange County

What are the symptoms of constipation?

Although each child may experience constipation differently, symptoms can include:

• Less than three bowel movements per week.
• At least one episode of stool leakage per week
• Withholding behavior
• Difficult, painful or hard bowel movements
• Small “ball like” stool
• Feeling bloated or uncomfortable
• Large diameter stools that could clog the toilet
• Presence of a large stool mass in the abdomen or rectum.

Other symptoms that indicate a child may be constipated include:

Abdominal pain. The most common cause of abdominal pain in children is constipation. Pain is typically intermittent (off and on). The child feels increased pain when holding in their stool, and feels better after stooling. Abdominal fullness and decreased appetite are also common complaints.

Children who are constipated will often try not to go to the bathroom. They will clench their bottoms, cross their legs, get red in the face, hide, cry, shake or dance around. Parents sometimes misinterpret this behavior and wrongly think that their child is in pain.

Urine accidents. Children can have daytime or nighttime urinary accidents. Some children can have multiple urinary tract infections. Learn more about urinary tract infections.

Blood-coated stools. Passage of hard stools can cause anal tears (fissures) leading to blood streaked stools or blood on the toilet paper.

Behavioral issues. Behavioral problems can result from the pain due to constipation, or the social embarrassment that a child faces due to soiling of their underwear at school or in public places.

Ideally, children should have soft bowel movements each day that resemble Types 3 through 6 on the Bristol Stool Chart.

The symptoms of constipation may resemble other medical conditions or problems. Always consult your child’s physician for a diagnosis.

What causes constipation?

More than 90 percent of constipated children have “functional” constipation, which is constipation without any underlying disease.

After children pass hard, painful bowel movements, they learn to withhold stools to prevent further pain. Once the stools are withheld in the colon and rectum, they harden due to water absorption. The rectum becomes increasingly distended, resulting in overflow of stools. This causes accidents in the underwear and decreases rectal sensations. The soiling episodes are sometimes misinterpreted as diarrhea.

Some of the most common causes of constipation include:

• Medications
• Lack of exercise
• Not enough liquids
• Not enough fiber in the diet
• Irritable bowel syndrome
• Ignoring the urge to have a bowel movement
• Changes in habits or lifestyle
• Problems with intestinal function.

Which are the symptoms that could indicate an underlying disease might be causing the constipation?

There are certain red flags or alarm symptoms that could hint towards conditions such as celiac disease, hypothyroidism, inflammatory bowel disease, spinal cord issues, neuromuscular diseases, lead poisoning, anal malformations and other conditions. Routine laboratory testing to screen for these conditions is only recommended in children with constipation in the presence of red flags or when symptoms do not improve with routine treatment.

Red Flags

• Constipation starting early in infancy
• Recurrent fevers
• Vomiting bile
• Severe abdominal swelling
• Poor feeding
• Bloody diarrhea
• Poor growth
• Pus collection around anus
• Feeling cold even when it is warm
• Developmental delays
• Problems with walking.

How is constipation diagnosed?

Your child’s physician will look at the child’s entire medical history, as well as the duration and severity of the constipation. Your child’s physician will also take into account the patient’s age and whether there is blood in the stool, recent changes in bowel habits or weight loss. Some patients may also need an abdominal X-ray so that the physician can see the extent of the constipation inside the patient’s body. Constipation cannot be diagnosed only based on the presence of stool on an abdominal X-ray.

Why is it important to treat constipation?

Constipation is much more than not being able to “go.” Eliminating a child’s constipation may also:

• Reduce the child’s urinary tract infections, as about 10% of children with constipation have recurrent urinary tract infections. Learn more about urinary tract infections.
• Reduce abdominal discomfort.
• Reduce episodes of incontinence. Constipation takes up a large amount of space in the abdomen, which often leads to dysfunction of the bladder. This can cause incontinence, urgency of urination, frequency of urination or a sensation of having to urinate when there is little or no urine to urinate. Learn more about incontinence.
• Reduce the amount of daytime urine accidents, as one-third of constipated children experience daytime incontinence (urine accidents).
• Improve the child’s vesicoureteral reflux, as constipated children with reflux are more likely to have breakthrough infections. Learn more about vesicoureteral reflux.
• Decrease a child’s stool accidents and stool leaking. Often stool accidents (known as encopresis) is actually a sign of constipation. Families should make an appointment with their child’s doctor to get help determining if the child’s diarrhea may actually be stool leakage due to constipation.
• In addition, children who have chronic constipation are at risk for the following:
• Complications such as hemorrhoids, which occur by straining to have a bowel movement or anal fissures (tears in the skin around the anus), which occur when hard stool stretches the sphincter muscle. This can result in rectal bleeding. Learn more about hemorrhoids.
• Rectal prolapse in which a small amount of intestinal lining pushes out from the anal opening.
• Fecal impaction, which takes place when the hard stool packs the intestine and rectum so tightly that the normal pushing action of the colon is not enough to expel the stool.
• Long-term constipation can also cause diverticulitis as an adult.

How is constipation treated?

Mild constipation may be treated with dietary changes. Increased fiber in the diet along with normal water or fluid intake may soften the stools. Fruit juices made from prunes, apples, peaches and pears can be used due to their high sorbitol content. Sorbitol works as a mild osmotic (water retaining) laxative. It is important to note that most of the water we drink is reabsorbed in the colon and is not available to soften the stools; therefore it is not necessary to drink tons of water. Learn more about the amount of water children should drink each day

Children with soiling or more severe constipation usually require medication. However, making changes in your child’s diet at the same time may help wean them from medications more quickly. Getting children, especially toddlers, to change their diet may be a tough task but the extra effort will lead to happier symptom free children.

The following steps are recommended for optimal management of constipation that needs medical attention:

Disimpaction. The best way to start off treatment of a constipated child is to evacuate the old stool from the rectum and colon. This can be achieved by giving rectal enemas followed by oral intake of high doses of osmotic (water retaining) and stimulant laxatives.

Maintenance regimen. Once no longer impacted with stool, the child needs to be on a daily regimen of laxatives as recommended by the physician. Maintenance treatment should continue for at least two months, if not longer. All symptoms of constipation should be resolved for at least one month before the treatment is stopped. Treatment should be decreased gradually. During the phase of toilet training, laxatives should be only stopped once toilet training is achieved.

Often, the pediatrician or gastroenterologist may recommend the child take polyethylene glycol 3350 (Miralax®). This is an osmotic laxative that is very well tolerated and effective in children. It has limited known side effects that can include gas, nausea, vomiting, diarrhea and abdominal pain. A child should take Miralax® according to the instructions on the packaging or according to the doctor’s instructions.

Education. Along with medications, children with severe constipation must make dietary and lifestyle modifications.

• Eat the right amount of fiber. The correct amount of fiber is equivalent to your child’s age plus 5 grams. For example, a child who is 5 years old should eat 10 grams of fiber each day (5+5=10), or a child who is 9 years old should eat 14 grams of fiber each day (9+5=14).
• Children need to sit on the toilet two to three times each day for five to 10 minutes each time. The best time to sit on the toilet is 5 to ten minutes after a meal, since food entering the stomach stimulates movement of the colon.
• While sitting on the toilet your child can be given balloons or pinwheels to blow in order to increase the pressure on the abdomen.
• When the child sits on the toilet, his or her feet should be touching the ground or a step stool so that their legs are not dangling.
• Most important, always be positive and never punish or scold a child who is toilet training or having difficulty with bowel movements.

What are good fiber sources?

There are a variety of foods that can be great sources of fiber in a child’s diet:

• Fiber-enriched cereals
• Whole grain items
• Whole wheat items (such as whole wheat bread)
• Fiber-rich granola bars or cereals
• Oats
• Beans
• Vegetables, especially green leafy vegetables
• Fruit, especially apples, raisins, pears, prunes and figs.

When should you seek help from a pediatric gastroenterologist?

As a parent, it can be frustrating just trying to understand if your child’s constipation is a part of growing up or is it severe enough to discuss with your child’s doctor. If dietary changes do not improve constipation or if any of the red flags mentioned above are present along with constipation, it is important to speak with a doctor. In most cases, your child’s pediatrician can manage constipation. If, with treatment, the child’s constipation does not go away, talk to the child’s doctor about seeing a pediatric gastroenterologist. The pediatric gastroenterologist will obtain appropriate screening evaluations based on alarm symptoms and specialized testing modalities such as motility studies along with treatments tailored to the severity of your child’s case.

Abdominal sounds: MedlinePlus Medical Encyclopedia

Abdominal sounds (bowel sounds) are made by the movement of the intestines as they push food through. The intestines are hollow, so bowel sounds echo through the abdomen much like the sounds heard from water pipes.

Most bowel sounds are normal. They simply mean that the gastrointestinal tract is working. A health care provider can check abdominal sounds by listening to the abdomen with a stethoscope (auscultation).

Most bowel sounds are harmless. However, there are some cases in which abnormal sounds can indicate a problem.

Ileus is a condition in which there is a lack of intestinal activity. Many medical conditions may lead to ileus. This problem can cause gas, fluids, and the contents of the intestines to build up and break open (rupture) the bowel wall. The provider may be unable to hear any bowel sounds when listening to the abdomen.

Reduced (hypoactive) bowel sounds include a reduction in the loudness, tone, or regularity of the sounds. They are a sign that intestinal activity has slowed.

Hypoactive bowel sounds are normal during sleep. They also occur normally for a short time after the use of certain medicines and after abdominal surgery. Decreased or absent bowel sounds often indicate constipation.

Increased (hyperactive) bowel sounds can sometimes be heard even without a stethoscope. Hyperactive bowel sounds mean there is an increase in intestinal activity. This may happen with diarrhea or after eating.

Abdominal sounds are always evaluated together with symptoms such as:

• Gas
• Nausea
• Presence or absence of bowel movements
• Vomiting

If bowel sounds are hypoactive or hyperactive and there are other abnormal symptoms, you should continue to follow-up with your provider.

For example, no bowel sounds after a period of hyperactive bowel sounds can mean there is a rupture of the intestines, or strangulation of the bowel and death (necrosis) of the bowel tissue.

Very high-pitched bowel sounds may be a sign of early bowel obstruction.

Treatment of Constipation in Older Adults

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Symptoms & Types – Bowel Control

Bowel control disorders affect the normal pattern of emptying your bowels. There are many factors that contribute to normal bowel movements, including the consistency of your stools, diet, medical problems, surgical history, ability of the rectum to hold stool and the coordination of various pelvic muscles to allow emptying. 

What is normal? That’s hard to say exactly. When it comes to bowels, we are all different. You don’t have to have a bowel movement every day. On average, normal stool frequency is at least 3 bowel movements a week, and no more than 3 stools per day. Stool consistency often varies based on what you’re eating, how much water you drink, and how much exercise you get. The first stop is to pay attention to your OWN normal.

You may want to keep a diary of your bowels to take with you to your doctor’s appointment – chart out the day, time, and consistency of the stools you pass, including any episodes of leakage. 

Use this guide to help describe your stools:

Accidental Bowel Leakage

Accidental bowel leakage (ABL), also known as fecal incontinence, is the loss of normal control of the bowels, leading to leakage of solid or liquid stool or gas. About 8 out of every 100 women struggle with ABL. The number of women affected increases with age. And, researchers think that in reality, the total number of women is likely much higher, but many are too embarrassed to seek treatment.

Causes of Accidental Bowel Leakage

There are many causes of accidental bowel leakage, including injury caused during childbirth, damage to the anal sphincter or nerves, pelvic organ prolapse, fistula, medical problems and abnormal stool consistency.

Childbirth Injury
Pregnancy can increase the risk of accidental bowel leakage. It is more common in women who deliver vaginally than women who have a C-section. However, research also suggests that just carrying a pregnancy can increase your risk of these changes as well. 

Delivering a large baby vaginally, especially if forceps are used, poses more risk than having a smaller baby. An episiotomy or significant tear of the tissues around the vagina and rectum can result in damage to the nerves, muscles, and tissues around the rectal canal. This can result in a tear of the anal sphincter muscles that help to hold in stool, but also some of the surrounding tissues that are important as well. 

Anal Sphincter Injury
There are two main circular muscles, or sphincters, that help to hold in stool near the anal opening. During vaginal childbirth, the anal sphincter muscles can be damaged or torn. These muscles allow us to control bowel movements. It is estimated that as many as 40% of women experience muscle injuries in this area during childbirth. Some of these tears are recognized and repaired, but some are hidden. Injury is more common after episiotomy or forceps delivery. 

The anal sphincter muscles can also become weakened for other reasons, such as diabetes or neurologic conditions. They can also be damaged during other surgeries, such as surgery to fix an anal fissure or hemorrhoids. This can cause decreased strength resulting in problems controlling passage of bowel movements. 

Ultrasound can help to detect these injuries. Depending on the extent of the injury and the length of time from when it occurred (for example, how long ago you delivered your baby), surgery can repair the damage. If the damage occurred in the past, surgery may not be able to help. 
 

Nerve Injury
Injury to the anal sphincter nerves can cause decreased sensation and muscle strength, both of which can contribute to ABL. Vaginal delivery, chronic constipation, or illnesses that affect the nerves such as diabetes and spinal cord injury can result in nerve damage. For some women, nerve damage that occurs during vaginal delivery improves on its own one or two years after childbirth.
 

Prolapse
Several types of prolapse can affect bowel control.

• Rectocele: A rectocele is a hernia of the bowel upward into the vaginal canal. It causes a vaginal bulge that can sometimes result in difficulty emptying the bowels.
• Rectal prolapse: Rectal prolapse is a condition where the rectum slides out through the anal opening. This causes a bulge coming from the anus, not from the vagina. Distortion of the anal opening can result in damage to the sphincter muscles and bowel leakage.
• Hemorrhoids: Hemorrhoids are caused by enlarged blood vessels near the anal opening. Sometimes they can cause small bulges near the anal opening. These can make it difficult to clean near the anus, resulting in seepage of bowel contents. There are many treatments for hemorrhoids, ranging from medicines to surgery to remove them. However, if hemorrhoids are removed, one out of every 10 women will end up with fecal incontinence.
   

Fistula
Abnormal openings or connections (tracts or tunnels) known as “fistulas” can develop between the bowel and vagina, or the bowel and the skin. Fistulas can occur:

• After vaginal delivery or vaginal surgery. This is more likely if a large tear occurred during delivery but is still unusual. 
• Spontaneously as a result of diverticulitis or other bowel conditions, including Crohn’s disease.
• In patients who have had radiation in the pelvis.
   

Abnormal Stool Consistency
Bowel movements with normal consistency are easiest to control. Ideally, stools should be like toothpaste. Abnormal stool consistency (either loose or hard stools) may contribute to ABL:

• Diarrhea or loose bowel movements are more difficult to control. This can also increase the sensation of needing to pass stool, called fecal urgency.
• Severe constipation. People who have significant problems passing stool can experience a hard lump of stool with diarrhea that develops around it.

Constipation

Everyone is different, but most women normally have bowel movements at least every other day and no more than twice daily. Having a bowel movement less than three times per week, along with straining to produce a hard bowel movement, is called constipation. Constipation is very common, affecting about 1 in 3 women.

Causes of Constipation

Constipation occurs for several reasons. It may be related to diet or changes in the nerves that control the pelvic floor muscle functioning that can affect the bowels. Lifestyle choices, medicines, or supplements, pelvic floor disorders, lack of exercise, and other health problems may also impact bowel movements.
 

Dietary Problems
The most common reason for constipation is not having enough fiber in your diet. This is very common in women who eat a typical American diet and getting enough fiber to fix this problem often requires planning and supplementation. The general recommendation is to aim for 25-35 gram/day of fiber between food and supplements. 

Some foods, especially those high in starch such as white rice, pasta, or white bread, are more likely to lead to constipation. 

Constipation may also be due to lack of fluids in your diet. Some women do not drink enough fluids to keep their stool soft. When there is not enough fiber or water in your diet, bowel movements are more likely to be hard or irregular. However, excessive fluid will not help constipation, especially if there is another underlying dietary problem. Discuss with your provider what the right amount of fluid is for you.
 

Medicines and Supplements
Talk with your doctor about the medicines and supplements you take, as many can cause constipation. Ask about alternative medicines without constipating effects. Medicines that treat bladder urgency, depression, blood pressure, and pain (especially narcotic medicines) commonly cause constipation. Iron and calcium supplements can do this also.
 

Pelvic Floor Disorders
Pelvic pain may prevent relaxation of pelvic floor muscles, leading to problems having bowel movements. Straining excessively with bowel movements may lead to pelvic floor disorders. Rectoceles do not cause constipation. Prolapse, including rectoceles and rectal prolapse, can make constipation worse.
 

Medical Conditions
Irritable bowel syndrome, chronic pain, kidney disease, colitis, thyroid disorders, neurological conditions (such as multiple sclerosis or spinal cord injuries), and cancer are other medical conditions that can impact the bowels. Talk with your doctor if you have these conditions or are concerned about them.

Healthy bowel habits for children

Regular bowel movements are important to your child’s health. Bowel habits—how often, how much, and so on—will vary from child to child. Some children go more than once a day, while others may skip a day.

You can encourage healthy bowel habits by:

• Eating healthy foods — whole grains, fruits and vegetables — and drinking more water each day. Children should have no more than 120 ml of 100% fruit juice per day. Less is better!
• Staying active throughout the day. This will help keep bowels working well.
• Teaching your child not to hold a bowel movement.
• Explaining that regular bowel movements are normal and important for good health.
• Not using negative words like “dirty” or “stinky,” because they can make your child feel self-conscious about going to the toilet.

The most common problems with bowel movements are constipation and diarrhea.

What are symptoms of constipation?

Constipation can happen when bowel movements:

• are passed less often than usual, and/or,
• are hard and dry, and difficult or painful to pass, and/or
• seem unusually large for your child.

Constipation can cause stomach pain and bright red blood on the surface of a hard stool.

If your child is constipated, it may seem like they are straining to go to the bathroom. In fact, they are holding it in because it hurts to go.

What causes constipation?

• A low-fibre diet that doesn’t include enough whole grains, fruits and vegetables.
  • Products with more than 4 grams of fibre per serving (listed on the package) are good sources of fibre.
• Too much milk, juice, or other dairy products can cause your child to feel full. That means they will eat less of other foods that help their bowels work well.
• Being afraid to use the toilet. Your child may also hold back a bowel movement if there is a crack or tear around the anus, causing pain.
• Not enough physical activity.
• Some mediciations.

What can I do if my child is constipated?

• Try to get your child used to a regular daily toilet routine.
• Do not rush toilet learning. Children can worry and hold back bowel movements if they feel pressured.
• Offer foods that are high in fibre such as whole grain breads, fruits like apples, ripe bananas, berries or prunes, vegetables and legumes (split peas, soy and lentils).
• Give your child a firm support for their feet (such as a small footstool), and a toilet reducer ring, when they are passing a bowel movement. It will make it easier to push.

What are symptoms of diarrhea?

• More bowel movements, with stool that is less formed and more watery than usual.

What causes acute diarrhea?

There are many causes of diarrhea, though it’s usually caused by a virus. The most common cause of acute infectious diarrhea in Canada is a virus called rotavirus.   Acute diarrhea usually lasts less than 14 days.

The germs that cause diarrhea, including rotavirus:

• spread easily from person to person, and especially from child to child.
• usually spread easily among children who have not learned to use the toilet.

You can prevent severe diarrhea caused by rotavirus by having your infant vaccinated. You can also reduce the spread of the virus by washing your hands and your child’s hands carefully after every diaper change, after going to the toilet, and before preparing and eating food.

What can I do if my child has diarrhea?

Children with diarrhea can lose fluids quickly. It’s important to keep offering food and drink to your child. An oral rehydration solution (ORS), an exact mixture of water, salts and sugar, can be used to help keep your child well hydrated when diarrhea is serious.

What are some causes of chronic diarrhea?

Chronic diarrhea is diarrhea that last for more than 14 days.  One fairly common cause of chronic diarrhea in children is often called toddler’s diarrhea.

What is toddler’s diarrhea?

Toddler’s diarrhea usually starts between the ages of 6 and 30 months and will go away by the time your child is about 5 years old. Children with toddler’s diarrhea may have 2 to 6 watery stools each day, but otherwise seem well and gain weight normally.

The exact cause of toddler’s diarrhea isn’t known, but it may be because some food moves more quickly through your child’s colon (the last part of the body’s digestive system). 

• Your toddler may drink too many sweetened drinks, such as juice or sports drinks, which can cause loose stool.
• It may also be caused by a lack of fibre in your child’s diet or by eating foods that are too low in fat.  

If your toddler has loose, watery stools often:

• Stop offering juice and give water instead. Juice has sugar that can make the diarrhea worse.
• Offer more food with fibre, such as whole grain cereals, fruits and vegetables.

If the diarrhea continues, talk to your doctor at your next regular visit.

When should I call my doctor?

Call your doctor if your child:

• has diarrhea and is younger than 6 months of age.
• is often constipated.
• has bloody or black stool.
• is toilet trained, but starts to lose some control of their bowel and has accidents in their underwear.
• has diarrhea and a fever with a temperature higher than 38.5°C (101.5°F).
• has signs of dehydration (increased thirst, no tears, peeing less, dry skin, mouth and tongue, faster heartbeat).
• is not gaining weight.

More information from the CPS

Reviewed by the following CPS committees

• Nutrition and Gastroenterology Committee
• Public Education Advisory Committee

90,000 Pain during bowel movements – causes of occurrence, for what diseases it occurs, diagnosis and treatment methods

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For a diagnosis and correct treatment, you should contact your doctor.

Pain during bowel movements: causes of occurrence, for what diseases it occurs, diagnosis and methods of treatment.

Definition

Defecation is the physiological process of excretion of feces from the rectum, which is the end of the large intestine. It ends with the anus, in which two sphincters (muscle rings) are distinguished. Under the pressure of feces, they open up. A person can only control the external sphincter.

The appearance of painful sensations signals a violation of the proper functioning of the intestines and adjacent organs.

With normal bowel function, bowel movements occur 1-2 times a day, sometimes a little less often.The frequency of bowel movements is accompanied by a change in the consistency of the stool. Frequent stools are characterized by a liquid consistency, and with constipation, the feces become hard, can injure the rectal mucosa, causing painful sensations of varying severity.

Defecation is a reflex process that is controlled by the cerebral cortex.

As the rectum fills with feces, a signal is sent to the brain, the muscle rings contract and bowel movement occurs.In a number of neurological diseases, the correct signal transmission is disrupted, and the emptying process slows down, which leads to an accumulation of feces in the rectum, excessive pressure on the intestinal walls and the sphincter.

Pain during bowel movements is a serious symptom of many diseases, so timely seeking medical attention is necessary.

Varieties of pain during bowel movements

Pain during bowel movements can be felt directly in the anus or radiate (give) to the lower abdomen, lower back, legs.Patients describe it as cutting, pulling, throbbing, dull, or aching.

Possible causes of pain during bowel movements

One of the common causes of pain during bowel movements is pinched hemorrhoids. Veins are located around the rectum, which are overstretched when blood stagnation occurs in them. There are many reasons for this stagnation – a sedentary lifestyle, regular weight lifting, hereditary predisposition, unhealthy diet, pregnancy, anal sex, laxative abuse, some sports (cycling, horse riding), etc.e. Blood clots and ulcers form in the enlarged areas of the veins. The swollen walls of the veins can become pinched and fall out of the anus. An attack of hemorrhoids is always accompanied by pain during bowel movements and bloody discharge.

The disease seriously impairs the quality of life, and if the visit to the doctor is postponed and self-medication can lead to complications.

In the presence of fissures in the anal canal, that is, violation of the integrity of the rectal mucosa, during bowel movements, severe short-term pain is felt, the process may be accompanied by the release of blood.The cause of this pathology is often improper diet, sedentary work.

An insufficient amount of fiber in food leads to a disruption of the normal consistency of feces, and a sedentary image negatively affects the work of muscle fibers that are involved in the expulsion of feces from the intestines.

As a result, a person has to put more effort in defecation, which causes fissures in the anal canal. If an infection enters the cracks, a purulent focus, an abscess in the submucosa of the rectum, can form.In addition to pain during bowel movements, there is a feeling of heaviness in the perineum, throbbing pain, body temperature rises, and general weakness occurs.

An unbalanced diet and a sedentary lifestyle increase the risk of developing colon diverticulosis – multiple hernia-like protrusions of the intestinal wall. The cause of the disease is a genetic predisposition, as a result of which the contractility of the intestinal wall deteriorates and diverticula are formed on it. The pain in this disease is localized in the abdomen, radiates to the lower back, anus, groin area and disappears after a bowel movement.

With paraproctitis – inflammation of the tissues surrounding the anus – a purulent focus may be located near the anus. This disease begins suddenly, is characterized by acute pain during bowel movements, high fever, chills, pain can persist at rest and intensify with movement.

Ulcerative colitis and Crohn’s disease are inflammatory diseases of the large intestine that develop as a result of immune disorders in the body, when the body’s own tissues, in this case intestinal cells, are perceived by the immune system as foreign and the body begins to fight them, triggering the process of inflammation.These are chronic diseases, their course is characterized by periodic exacerbations and periods of remission.

The first symptom of ulcerative colitis and Crohn’s disease may be pain during bowel movements, mucus and / or blood in the stool.

There is also general malaise, weakness, weight loss, the temperature can rise to 37–37.5 ° C.

Pain during bowel movements can be a symptom of such a formidable disease as rectal cancer. If you have complaints of weakness, decreased appetite, weight loss, spotting during bowel movements, you should immediately consult a specialist.

What diseases there is pain during bowel movements

1. Hemorrhoids.
2. Anal fissure.
3. Abscess of the perianal region.
4. Acute paraproctitis.
5. Ulcerative colitis.
6. Crohn’s disease.
7. Diverticulosis.
8. Tumor process.
9. Irritable bowel syndrome.

Which doctors should I contact if pain occurs during bowel movements

A proctologist is involved in the treatment of diseases of the large intestine.After a thorough examination and collection of anamnesis, additional tests and instrumental studies are prescribed. Consultation of the following specialists may be required:
oncologist,
a gastroenterologist.

Diagnostics and examinations for pain during bowel movements

To clarify the diagnosis, the following examinations are prescribed:

• Clinical blood test with an expanded leukocyte formula in order to identify the inflammatory process.

Do you have a spinal cord injury? The company “Coloplast” offers an effective solution to this problem

All people with spinal cord injury need to undergo rehabilitation.Rehabilitation enables the traumatized patient to return to a full-fledged independent lifestyle. During rehabilitation, the patient learns to carry out his daily activities in a new way, which includes performing acts of urination. A rehabilitation doctor or nurse can help you find the right tools to control your urination.

What to do in case of urinary retention

If you have difficulty emptying your bladder, use an intermittent catheter.First of all, you need to find a catheter that suits you and your lifestyle. It is very important to follow the doctor’s recommendations regarding the technique and frequency of catheterization.

What to do in case of urinary incontinence

Uro-condoms and drainage bags help many men with urinary incontinence. The urocondom is put on the penis, like a normal condom, and attached to the urine bag. It is important to use a urocondom that is the right size for you. The volume of the urine receptacle is selected depending on the amount of urine that your body produces.

Urinary tract infections

Normally, bacteria are always present in the urinary tract, but they do not cause infectious diseases. A urinary tract infection develops when the number of bacteria exceeds an acceptable threshold. In this case, treatment is required.

Symptoms of urinary tract infection

Symptoms of a urinary tract infection may be substantial or subtle. These include:

• dark and strong-smelling urine;
• cloudy urine;

90,049 blood in the urine;

• fever / sweating;
• bladder spasms;
• leg cramps.

If you have any of these symptoms, you should talk to your doctor.

How to avoid urinary tract infections

There is no single way to prevent urinary tract infections, but there are a number of measures to prevent infections and avoid recurrence:

• drinking plenty of fluids – not less than 1.5 liters per day;
• observance of hygiene, especially during catheterization;
• Regular catheterization with a disposable lubricated catheter with complete emptying of the bladder;
• Normal digestion – regular bowel movements reduce the risk of urinary tract infections.

Using the correct catheterization technique and using disposable, hydrophilic-coated, lubricated catheters is another way to reduce the incidence of urinary tract infections.

90,000 Questionnaire for early diagnosis of malignant neoplasms

Form for the early diagnosis of malignant neoplasms | SPb GBUZ “City Polyclinic No. 122”

Dear Patients!

Evaluate, using the proposed questionnaire, the state of your health, your family and friends at the risk of developing malignant neoplasms by localization.

Colorectal cancer (cancer of the rectum and intestines)

Breast cancer

Stomach cancer

Lung cancer

Esophageal cancer

Prostate cancer, bladder cancer

Melanoma (malignant neoplasm of the skin)

Skin cancer

Cancer of the oral cavity and pharynx

Larynx cancer

Thyroid cancer

Result for each location:

From 0 to 5 points – low risk.

From 6-9 points – moderate risk (you need to go to the polyclinic to see a therapist for examination).

More than 10 points – high risk (you need to urgently go to the clinic for a therapist, oncologist for examination).

Thank you for your feedback!

Your feedback has been received and sent to the administrator!

Rectocele

Proctology in our clinic is the solution to a delicate problem!

Faced with certain proctological problems, people in our country are in no hurry to see a doctor for examination.For the majority, as a rule, a visit to a specialist-proctologist is associated with discomfort, fear, and internal prejudices. Meanwhile – while the trip to the hospital is postponed for weeks, months, and maybe years – the disease is steadily progressing.

In our clinic you can undergo all the necessary examinations related to proctological problems and get advice from experienced specialists – doctors-proctologists.

A widespread pathology today is Rectocele (2.5% of the total number of diseases of the female genital organs).

Rectocele is a pathological condition caused by the prolapse of the pelvic organs and manifested by the protrusion of the rectal wall in the vagina .. Rectocele is usually detected in patients who have undergone difficult childbirth. It can also occur as a result of pelvic floor muscle weakness, excessive physical exertion, congenital anomalies of the pelvic organs, and gynecological diseases.

With age, the likelihood of rectocele increases. Pathology is accompanied by a disorder of the evacuation function of the intestine, while the degree of disorder of the act of defecation directly depends on the severity of the rectocele.In severe cases, bowel movements without additional help (squeezing out fecal masses through the vaginal wall) becomes impossible, other proctological and gynecological diseases develop.

Reasons of rectocele:

Rectocele is a condition in which part of the rectum protrudes towards the vagina and gradually prolapses its wall, forming a sac-like pocket in which fecal masses are retained. The causes of rectocele are various processes that cause a violation of the interposition of the pelvic organs and weakening of the pelvic muscles.The first place in the list of such reasons, according to most experts, is occupied by difficult childbirth, accompanied by an excessive peak load of the pelvic organs and pelvic floor muscles.

Protrusion of the rectum is the cause of the disorder of the act of defecation and the development of severe constipation. A patient with rectocele has to push harder to empty the bowel. The pressure in the intestine during bowel movements increases more and more, this entails an increase in protrusion and further progression of the pathology.Ultimately, rectocele reaches the degree at which the effectiveness of conservative measures is increasingly reduced, the only way to restore normal anatomical relationships between the pelvic organs and to establish an act of defecation is surgery.

Classification of rectocele:

Taking into account the symptoms, proctologists distinguish the following degrees of rectocele:

• 1 degree – no complaints, the act of defecation is not violated.On rectal examination, a small protrusion of the anterior rectal wall is palpated. Due to the absence of complaints, patients do not go to the doctor, rectocele becomes an accidental finding when conducting an examination for other reasons.
• 2 degree – patients with rectocele complain of difficulty during bowel movements and a feeling of incomplete emptying of the intestines. Rectal examination reveals a sac-like pocket extending to the border of the vestibule of the vagina.Sometimes in the protrusion, the remains of fecal masses are found.
• Grade 3 – patients with rectocele complain of severe difficulty in defecation and the need for pressure on the vaginal wall for the successful discharge of fecal masses. The anterior wall of the rectum and the posterior wall of the vagina of the patient with rectocele protrude beyond the genital slit. The protrusion contains feces, sometimes fecal stones. Sclerotic changes in the vaginal wall are noted, ulceration is determined in some patients.

Taking into account the level of damage, the following types of rectocele are distinguished: low (accompanied by changes in the sphincter), medium (manifested by the formation of a saccular protrusion above the sphincter), high (accompanied by the formation of a pocket in the upper part of the vagina).

Rectocele symptoms:

The clinical picture of rectocele develops gradually. At first, defecation becomes less regular, there is a tendency to constipation, there is a feeling of incomplete emptying or a foreign body in the rectum.As the symptoms worsen, the patient with rectocele is increasingly forced to take laxatives or use enemas.

Artificial stimulation of the act of defecation contributes to the aggravation of the existing pathology. The rectocele is progressing.

Constipation becomes more and more persistent. Over time, the ability to have a normal bowel movement disappears; in order to achieve the release of feces, a patient rectocele has to press with his hands on the buttocks, perineum, or the back wall of the vagina.Stool stagnation and trauma to the intestinal walls with solid feces cause the development of proctitis or rectosigmoiditis. Due to repeated excessive straining, the rectocele is complicated by hemorrhoids, fissures in the anus, and other diseases of the rectum and the anus. Fecal incontinence sometimes occurs.

Rectocele diagnostics

The diagnosis of rectocele is made taking into account the characteristic symptoms, examination data of the perineum and perianal region, gynecological examination, rectal examination, endoscopy and radiological diagnostic techniques.When examining the anus in patients with rectocele, anal fissures and enlarged hemorrhoids can be detected. With fecal incontinence in the anal area, traces of fecal masses and areas of irritation are visible. When performing a gynecological and rectal examination, a patient with rectocele is asked to strain. When straining, the intestinal wall protrudes into the vagina. The doctor determines the size and location of the protrusion (high, medium, low), notes the presence or absence of rectocele contents (feces, fecal stones), assesses the thickness of the vaginal septum and the condition of the pelvic floor muscles.

In the process of sigmoidoscopy in patients with rectocele, a characteristic pocket is found in the region of the anterior rectal wall. For a more accurate assessment of the severity of the disorder of the act of defecation and the degree of rectocele, defecography (evacuation proctography) is prescribed. A thick barium suspension is injected into the intestine, and then a series of images are taken during the act of defecation. Sometimes radiological examination is replaced by magnetic resonance imaging. Differential diagnosis of rectocele is carried out with hernias of the rectovaginal septum.

Treatment of rectocele

Treatment of 1st degree rectocele is conservative. At 2 and 3 degrees of the disease, combined techniques are used, including surgical intervention, pre- and postoperative conservative measures aimed at eliminating constipation, restoring intestinal peristalsis and improving the evacuation of contents from the rectum. An obligatory part of the treatment of rectocele is a diet that provides for an increase in the amount of coarse plant fiber (to stimulate the motor function of the intestine) and a sufficient amount of water (to ensure the softness of the fecal masses).

To restore the regularity of the act of defecation, patients with rectocele are prescribed mild osmotic laxatives. Combined probiotics are used to correct the composition of the intestinal microflora. To normalize the motor function of the intestine, prokinetics (domperidone and its analogues) are used. Rectocele drug therapy is supplemented with physiotherapy and special exercise therapy complexes aimed at strengthening the pelvic floor muscles.

Conservative therapy can slow down the progression of the disease, but cannot provide complete recovery.The only radical way to treat rectocele is surgery. All surgical interventions for this pathology can be divided into two groups: aimed at eliminating the pocket formed by the rectum, and aimed at strengthening the septum between the vagina and the rectum. For rectocele correction, access through the vagina, rectum, perineum, or the anterior abdominal wall is used.

During the operation, the doctor sutures and fixes the anterior intestinal wall, strengthens the rectovaginal septum and takes measures to restore the sphincter.In case of combined pathology, along with rectocele, which includes hemorrhoids, anal fissure, cystocele or rectal polyps, a combined surgical intervention is performed to eliminate all existing disorders. In the pre- and postoperative period, exercise therapy, physiotherapy, probiotics and prokinetics are prescribed.

Railway Clinical Hospital will help patients in need of diagnosis and full treatment by the best specialists in proctology
in order to protect health and professional longevity!

We are open to all
Information tel.:
(3952) 638-800, 638-802

90,000 Defecation disorders in people over 55: how to cure?

People over the age of 55 have difficulty defecating about 5 times more often than younger age groups. This is due not only to age-related changes in the body and the natural weakening of muscle tone and gastrointestinal tract. Reducing physical activity and avoiding rough foods, as well as the effects of certain medications, play a major role in constipation.

How to normalize stool at age 55+

Many patients who come to see our specialist want to get a “magic pill”. However, they will be disappointed: first of all, the doctor will demand to increase the level of physical activity and change the habitual diet.

• Regular gymnastics helps to normalize natural peristalsis – breathing exercises, for the press, light massage of the abdomen in a clockwise direction.
• Adding bulking foods and drugs to the diet – for example, bran, vegetables, fiber-rich cereals.

If a person is forced to suffer from hypodynamia, then preference should be given to laxatives that stimulate peristalsis and retain fluid in the intestine with osmotic laxatives.

Senna Danger

Often, physicians prescribe Senna to retirees for complaints of constipation. Patients like the result, they often continue to take the laxative without any control. This is fraught with the accumulation of dark brown pigment in the body and the formation of intestinal melanosis.Melanosis is one of the factors provoking the development of malignant tumors.

Older people often do not think about the consequences of long-term medications, lack of quality nutrition and a healthy lifestyle, relatives should conduct educational work and involve our specialists for preventive examinations, prescribing modern and safe laxatives.

The author of the article is a doctor proctologist

Edelgeriev Magomed Omarovich

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Paraproctitis

Paraproctitis (from the Greek para – ” about ”, proktos – ” anus ”, itis – ” treatment of inflammation ”) is a disease characterized by the presence of an inflammatory process in the rectum and anus.
Most often, this pathology is detected in men.Inflammation in the body is caused by mixed microflora – staphylococci, streptococci, Escherichia coli, Proteus, etc. Rarely enough (1-2% of cases) the cause of the disease is a specific infection – tuberculosis, actinomycosis, etc. In hemorrhoids, anal fissures, cryptitis, acute and chronic infections (sore throat, flu, etc.), constipation or diarrhea, microbes enter the peri-rectal tissue through microcracks in the mucous membrane.

The disease, as a rule, begins acutely: patients note sharp pains in the anus, painful bowel movements, fever, malaise, general weakness, headaches.In this case, the localization of inflammation in the pararectal space can be varied:
subcutaneous
submucosa
ischiorectal (sciatic-rectal)
pelviorectal (pelvic-rectal)
retrorectal

An abscess has, as a rule, several holes: 1 internal and 2-3 external, located more often on both sides of the anus (the so-called horseshoe-shaped paraproctitis). With the further development of the inflammatory process, the abscesses increase in size, become painful and swollen, significantly complicate the patient’s walking, sitting and defecation.

Lack of treatment for acute paraproctitis leads to the development of a chronic inflammatory process, which is periodically complicated by relapses. In this case, the internal opening of the abscess does not heal, which entails the gradual formation of rectal fistulas, or the development of a chronic form of the disease. In most cases, it is accompanied by constant anal itching, moisturizing and thickening of the anal area, mucus or pus, bleeding, pain during bowel movements.Sometimes the discharge is so significant that the patient is forced to wash the perineal area several times during the day or change the sanitary napkin. Careful adherence to the rules of personal hygiene leads to the onset of relative remission, however, if the infection gets to the affected areas of the mucous membrane, the inflammation develops again. Treatment of the inflammation does not take so little time. Such a course of the disease (periods of calm, alternating with periods of exacerbation) lead to a deterioration in the patient’s quality of life and the development of asthenia, headache, decreased performance, depression, sleep disturbances and other disorders.

The most dangerous complication of paraproctitis is the spread of the inflammatory process to neighboring organs. So, often late seeking medical help leads to the development of a breakthrough of pus into the abdominal cavity and retroperitoneal space, the opening of an abscess into the lumen of the rectum or into the vagina. Medical practice also notes cases of purulent fusion of the urethra (urethra).

Chronic colonic stasis (constipation)

Professor Nechai I.A.

The problem of chronic constipation (CZ) is one of the most urgent in modern coloproctology. In the industrially developed countries of Europe and America, significant contingents of the population suffer from chronic constipation. In the structure of morbidity, patients with chronic disease are in second place, second only to hemorrhoids (Yu.M. Militarev, E.S.Simkina 1986). according to other statistics, they affect from 30 to 50% of the adult population. However, it would be wrong to believe that only urbanization is to blame for the occurrence of chronic constipation, a change in the stereotype of nutrition and lifestyle of a modern person.The mention of HZ can be found in Egyptian manuscripts and in the writings of the healers of ancient Greece. But until now, the problems associated with the etiology of constipation, diagnosis and treatment remain largely unresolved.

In the literature, there are various terms to define this condition: chronic constipation, chronic idiopathic constipation, spastic colitis, chronic colostasis, irritable bowel syndrome, colon dyskinesia, slow transient bowel and others. The terms “constipation” and chronic constipation are common in the literature, but they are not nasological forms or symptoms.This generalized concept is understood as a symptom complex of general and gastrointestinal disorders. Symptoms of constipation occur in more than 50 different nosological forms and therefore do not reflect the essence of pathological changes in the colon, and, therefore, the term “constipation” cannot be used to denote an independent disease. However, at the initial visit of a patient to a doctor, when the causes and pathogenesis of the condition have not yet been disclosed, such a term can be used as a working diagnosis that requires further investigation of the patient.

Definitions of constipation

English textbook for doctors and students.

I Constipation – difficulty in emptying the colon for 32 or more hours, that is, excretion of feces less than 3 times a week.

II Constipation is the discharge of feces less than 3 times a week, while every (minimum) fourth bowel movement is difficult and at least every fourth bowel movement is hard.

BME (1982)

Constipation is a delayed, difficult or systematic inadequate emptying of the intestines.

Practical Doctor’s Handbook (1994)

Constipation is a polyetiological syndrome of prolonged delay in defecation.

Drossman 1982

Chronic constipation is persistent or intermittent, lasting more than 6 months, dysfunction of the colon with a decrease in stool frequency up to 3 or less times a week with forced straining, which takes more than 25% of the time of bowel movement.

According to the literature, transit is considered to be delayed if the CBCT (colonic transit time) exceeds 67 hours.Segmental transit time is defined as slow if it exceeds 27 hours for the right-hand divisions; 33 hours for the left sections and 38 hours for the rectosigmoid section.

Constipation is polyetiological. As a rule, in each specific patient it is possible to detect not one, but several causes of their occurrence and, accordingly, various mechanisms of pathogenesis are revealed. Ultimately, there is either a violation of intestinal transit, or evacuation, or the disorders are of a combined nature.

Group 1 – cologenic constipation (patients with delayed transit through the colon).

Group 2 – proctogenic constipation (patients with impaired rectal emptying).

Group 3 – mixed constipation (patients with a combination of these disorders).

Elbow constipation.

The normal transit time of the contents from the oral cavity to the anus is on average 24 – 60 hours in healthy people – as the upper limit of the norm.In patients with chronic disease, the transit time is significantly increased and is 60-120 hours or more. In some cases, transit slows down in all parts of the colon or further segments of it, with normal or accelerated progress in others.

Alimentary constipation . The most common cause of intestinal transit disorders is inappropriate and unhealthy diet. With an increase in the well-being of the population and the use of low-slag food, with irregular and inadequate food intake, a sedentary lifestyle, stressful situations, there is a decrease in the motor activity of the colon, a decrease in the mass of feces and their compaction, which contributes to the development of constipation.

Psychogenic constipation . Regardless of the cause, constipation is initiated or realized by the neuroendocrine apparatus. Dysregulation at any level can lead to their occurrence. It could be:

• Depression or other mental disorders.
• Damage to the central nervous system
• Injury of the lumbar and sacral spinal cord
• Damage to the pelvic parasympathetic nerves

Chronic constipation is associated with many endocrine diseases (endocrine constipation):

• Hypothyroidism
• Diabetes mellitus
• Diseases of the parathyroid glands
• In women with low estrogen levels

An important role in the regulation of colon motility belongs to gastrointestinal polypeptides.Some of them can act as intestinal hormones, others as local chemical agents or neurotransmitters. They are found, in addition to the digestive tract, in the structures of the central and peripheral nervous system.

The involvement of steroid hormones in the regulation of intestinal motility is indisputable. Constipation caused by a slowdown in intestinal transit, with normal intestinal size, is largely associated with the influence of these hormones. In the history of such patients, irregular painful menstruation, severe early pregnancy, hyperprolactinemia, and a decrease in the content of estradiol in the blood plasma are more often detected.Thus, the most important mediators that regulate intestinal motor activity are sex hormones (progesterone, estrogen) and, possibly, prolactin.

Endogenous opioid peptides – enkephalin, endorphin, etc., secreted in the gastrointestinal tract and in the brain, affect motility and intestinal secretion, participate in the regulation of hunger and appetite, pain perception through opiate receptors.

Constipation can be promoted by diseases of the upper digestive tract, which can be explained by reflex influence (gastrointestinal reflex), food factors or medications.

The intestinal causes of transit disorders include:

• Obstruction (tumor, inflammatory or scar structures, adhesions, diverticulosis complicated by diverticulitis)
• Damage to the structures of the musculo-intestinal nerve plexuses (Hirschsprung’s disease, Chagas disease, idiopathic megacolon, slow-transit constipation, Ogilvy’s syndrome)
• Structural disorders in smooth muscle cells (visceral myopathy, systemic sclerosis)

This list of etiological factors of constipation testifies to the extraordinary complexity of the mechanisms of their development, the interlacing of pathogenetic links.Many of the listed diseases and conditions will be discussed in separate lectures. I would like to dwell on slow-transit constipation (MTZ), as a common one.

MTZ – a condition characterized by a decrease in active motor activity of the intestine. Patients do not feel the urge to defecate, but feel a psychological need for it. In such patients, stool retention can be from a week to a month. With a digital examination of the rectum, the normal tone of the sphincter is determined.With sigmoidoscopy – atrophic mucous membrane of pale pink color with leveled folds, decreased bowel tone. There may be hyperemia, edema, changes in the vascular pattern of the mucous membrane, the appearance of mucus. With Rg – study – the absence of any unpleasant sensations during the study, rapid filling with a contrasting mass of all sections up to the cecum. Its lumen, as a rule, is dilated, the haustration is well expressed, the sagging of the colon up to the small pelvis is often noted, with the formation of an acute angle in the form of a double-barreled gun in the region of the left bend of the colon.The relief of the mucous membrane after emptying has a normal appearance. Patients use various laxatives, increasing the dose, which gradually become ineffective. Laxatives, stimulating the active motor activity of the intestine, can lead to the complete disappearance of spontaneous intestinal motility.

Proctogenic constipation.

To find out the causes of evacuation disorders, which play a leading role in the genesis of reflex constipation, it is necessary to understand how the normal natural act of defecation occurs.

Feces enter the rectum, and with an increase in intra-intestinal pressure in the rectum, it stimulates nerve receptors, thus initiating the onset of the act of defecation. Stretching of the rectum (40-50 cm of water column) causes at the beginning a temporary, and as the pressure builds up, a stable occurrence of an imperative urge. Under the appropriate socio-psychological conditions, the act of defecation is performed voluntarily and completely in the appropriate position with the tension of the diaphragm and the muscles of the abdominal wall and the simultaneous relaxation of the striated muscles of the pelvic floor.Intraperitoneal pressure reaches 220 cm of water. Art. Relaxation of the pubo-rectal muscle removes the last obstacle to the exit of feces, expanding the anorectal angle and the evacuation of feces occurs.

Disorders of the evacuation mechanism can be observed at:

I. Inert rectum (megarectum), when there is a decrease in the sensitivity of the rectum. Patients with constipation and an enlarged rectum do not feel the expansion of a balloon of normal volume (50 ml), while healthy people clearly define it in the rectum.They perceive the expansion of the balloon, the volume of which is much greater than N (150 ml), sometimes 1000 ml or more. Desensitization causes the accumulation of feces in the rectum, which makes it difficult to defecate. It is possible that such a decrease in sensitivity occurs when the physiological urge to defecate is ignored or suppressed.

II. Paradoxical reaction of the puborectal muscle. This occurs in the absence of relaxation of the striated muscles of the pelvic floor and external sphincter of the anus.The puborectal muscle does not relax when straining and is in a constant state of tonic tension. As a result, the anorectal angle does not change, the anal canal remains closed, which leads to difficulty or impossibility of defecation. Such patients cannot push out a 50 ml balloon, although healthy people calmly push such a balloon out of the rectum. This condition of the puborectal muscle can be diagnosed using balloon proctography. The reasons for the lack of relaxation of the pelvic floor muscles are still unknown.This condition is also called anism or spasm of the pelvic floor muscles.

III. Rectocele – protrusion of the anterior wall of the rectum in the vagina, which leads to difficulty in emptying the rectum. When examining women, it is necessary to pay attention to any symptoms indicating weakness of the pelvic floor muscles in connection with gynecological diseases, these changes are detected during straining, when a protrusion of the posterior wall of the vagina and the anterior rectal wall, determined by digital examination, is detected.With rectocele II and especially III degree, there is a feeling of incomplete emptying, frequent urge to defecate and prolonged unsuccessful straining. Sometimes in such a “bag” you can find fecal stones. The patient herself may have noticed that the intestines work if you support the back wall of the vagina with your finger.

IV. Anal fissure, causing sharp pain during bowel movements, leads to spasm of the internal sphincter, which in turn prevents the fissure from healing. Patients with a long-standing fissure sometimes have “stool phobia” and patients tend to have less frequent bowel movements.As a result, stool retention occurs, which contributes to the development of constipation.

V. Symptom complex due to acute hemorrhoids .

Careful thoughtful collection of anamnesis can be invaluable in differentiating constipation with impaired transit and impaired evacuation. In favor of the first will be evidenced by a decrease in bowel movements and flatulence. Disorders of the act of defecation can be assumed with the appearance of a sensation of obstruction, incomplete emptying of the rectum, the need for manual assistance.All these assumptions will require further confirmation. According to the literature, up to 70% of patients with refractory constipation have isolated disorders of stool evacuation or in combination with transit disorders, and only 30% of patients suffer from isolated chronic colostasis. Regardless of the etiological factors, any type of constipation must be diagnosed accurately, since the prescribed treatment will depend on it. In all cases, a qualified proctological examination, digital rectal examination, RRS, irrigoscopy, colonoscopy are required.In the arsenal of diagnostic tools used to detail the causes of constipation at the modern level, bowel scintigraphy with segmental transit assessment, proctography, defecography, sphincterometry, electromyography, specific physiological, histo- and cytochemical studies are used.

Treatment

First of all, before starting treatment, it is necessary to establish the form of constipation, since the result of therapy depends on this. Based on the data of the anamnesis, and the examination carried out, it is possible to identify or suggest one or another type of constipation.In symptomatic constipation, the elimination of the leading disease is of decisive importance. Treatment of constipation should be comprehensive, including diet therapy, drug treatment, the use of general health measures aimed at increasing the tone of the abdominal muscles, and the development and consolidation of the reflex to defecate. First of all, the patient needs to explain the nature of his existing disorders, which allows him to intensify cooperation with him. If possible, it is necessary to cancel or replace drugs that can cause or worsen constipation.

Recommendations for diet therapy consists in the regular consumption of foods containing dietary fiber – the so-called ballast substances (hydrophilic colloids, fillers, swelling substances).

These include:

• Wheat and rye bran
• Coarse flour baked goods
• Fresh and dried fruits (apples, figs, dates, prunes, dried apricots), berries and their juices.
• Vegetables (raw, boiled, salads, carrots, beets, cabbage, seaweed, legumes, potatoes)

They must be combined with liquid intake (1.5 – 2.5 liters of liquid per day) – juices, fermented milk products, mineral water.You need to refrain from taking chocolate, strong tea, sweets.

It is quite obvious that in patients with impaired evacuation function, loss of urge to defecate, it is necessary to develop a reflex that ensures the evacuation of feces.

Laxatives.

In general, our attitude towards laxatives is negative. Against the background of the initial beneficial effect, these drugs gradually lose their effectiveness, and when the dose is increased, addiction arises, which further leads to the abuse of laxatives.This leads to a weakening of the intestinal motility and reduces the chances of restoring its normal “work”. Patients who take laxatives for a long time may develop an “inert” colon. In many patients, during therapy with laxatives, atrophic changes in the mucous membrane and inflammatory changes caused by local irritation and dysbiosis are observed. In this regard, many patients note an increase in abdominal pain, flatulence.

Surgical treatment.

Surgical treatment of patients with chronic constipation remains largely an unsolved problem.Clear scientifically grounded indications for surgical treatment have not been formulated, methods of surgical correction have not been developed. At the same time, a significant number of different surgical interventions are proposed, ranging from sphincterotomy, stretching of the puborectal muscle, resection of the sigmoid colon and ending with colectomy.

Data on the effectiveness of these operations are contradictory. Studies carried out at St. Mark’s Hospital have shown that even colectomy in 50% of patients in the long term gives a return to the clinical picture of the disease.Before determining the indications for surgical treatment, patients need to undergo a thorough comprehensive examination, using all the diagnostic methods necessary for this. This is necessary in order to establish the cause of the development of constipation and, accordingly, “refer” the patient to one or another group (cologenic etiology, proctogenic or mixed). The type of surgery will depend on the reasons that caused the development of constipation.

The indication for surgical treatment of patients is a progressive deterioration of the patient’s condition with an increase in the phenomena of colonic obstruction, the lack of effect from conservative therapy.

Summarizing the above, it should be said that the diagnosis of etiological factors that led to the development of this or that type of constipation is a difficult task, which must be solved by coloproctologists, gastroenterologists, endocrinologists and psychoneurologists and other specialists. Making an accurate diagnosis sometimes requires the use of a whole arsenal of diagnostic methods. The treatment of these patients is sometimes a difficult and completely unsolved problem. It should be differentiated, depending on the etiological factors that caused this suffering, complex, combining all possible methods, and the indications for surgical treatment should be well argued and weighed.Only such a comprehensive approach to this multifaceted problem can improve the results of treatment in this difficult category of patients.

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