Constipation

It is defined as an infrequent and difficulty in passing stools. The consistency stools are usually hard and patient feels sensation of incomplete evacuation after defecation. This occurs due to absorption of water from the food if it remains for a long time in colon.

Causes:
1.Dietary factors-
a.Lack of intake of fluid and fibrous diet.

2.Medications- Some drugs causes constipation like
a.Anti- depressants such as amitriptyline (Elavil) and imipramine (Tofranil) etc.
b.Aluminium containing anta-acids.
c.Calcium and Iron supplements.
d.Abuse of laxatives.

3.Gastro-intestinal Disoders-
a.Motility- Irritable Bowel syndrome.
b.Obstructive- Mechanical causes like megarectum, rectal prolapse,
                     rectocele, and enterocele.Retained foreign body like bezoar.
c.Structural- Diverticular diseases like tumors, Hirschsprung's disease.
d.Defecation- Crhon's disease, haemorroids, etc.
                    
4.Metabolic/ Endocrine Disorders-
a.Hypothyroidism
b.Diabetes mellitus.
c.Pregnancy.
d.Hypocalcaemia.

5.Neurological Disorders-
a.Parkinsonism.
b.Spinal cord lesion.
c.Multiple sclerosis.

6.Psychological Disorders-
a.Depression
b.Anxiety disorder.

7.Smoking cessation- Nicotine present in a cigarette is act as a laxative.

8.Any abdominal surgery- like childbirth etc.

9.Lead Poisoning.

10.Old age.

11.Sedentary lifestyle.

12.Altered sleep pattern, mostly found in people who are doing night shifts.

Signs and Symptoms:
There are few common symptoms of constipation are given below-
1.The stool is hard, difficult, and painful to pass.
2.There is an infrequent urge to void.
3.The abdomen may become distended and diffusely tender and cramp, occasionally with enhanced bowel sounds.

Clinical Assessment:
1.Medical History- The onset, duration and characteristics are important to know for a physician in treating cases of constipation for example presence of constipation since birth may suggests Hirschsprung's diseases; painful defecation may suggests anal fissure or any obstruction in the region of anus. It will also help in detecting out whether patient is taking any medicines or not.
2.Physical Examination- Careful examination will in detecting out the cause for the constipation like Rectal examination gives an impression of the anal sphincter tone and whether the lower rectum contains any feces or not, also gives information on the consistency of the stool, presence of hemorrhoids, admixture of blood and whether any tumors or abnormalities are present.
A search is made in order to detect any neurological disorders like spinal injury or any lesion, etc.
 
Other Investigating Procedures:
1.Blood Test- to detect any endocrine disorders, blood sugar and level of calcium.
2.X- Ray- to detect any pathology present or not.
3.Barium enema- A barium enema (lower GI series) is an x-ray study in which liquid barium is inserted through the anus to fill the rectum and colon. The barium outlines the colon on the X-rays and defines the normal or abnormal anatomy of the colon and rectum. Tumors and narrowings (strictures) are among the abnormalities that can be detected with this test.

Treatment:
1.Don't suppress urges to defecate. When the urge comes, find a toilet.
2.Increase fiber in diet as it helps in retaining water in colon; it includes fruits, vegetables, wheat, oat etc. 
3.Intake of water should be increased as it helps in softening of stools.
4.Sedentary lifestyle should be avoided and physical work must be promoted like exercises.
5.Check your medicines, whether any medicines is not responsible for constipation.
6.Homoeopathy has excellent result in curing. It offers treatment on the basis of individual case patterns. It is strongly recommended in treating cases of constipation.

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