Constipation is a condition of the digestive tract present in about 20-40% of adults, manifested by a decrease in the frequency of fecal elimination or the effortful elimination of hard stools. Occasional constipation is quite common in adults, while the chronic form of the condition is less common and is represented by the elimination of less than 3 stools per week.
What is constipation in adults?
Causes of constipation in adults
Symptoms of constipation in adults
Diagnosis of constipation in adults
Treatment of constipation in adults
What is constipation in adults?
Constipation is a condition of the digestive tract present in about 20-40% of adults, manifested by a decrease in the frequency of fecal elimination or the effortful elimination of hard stools. Occasional constipation is quite common in adults, while the chronic form of the condition is less common and is represented by the elimination of less than 3 stools per week.
Causes of constipation in adults
The risk factors that contribute to the occurrence of constipation in adults are in the vast majority of cases represented by:
- An unbalanced diet high in animal fats, processed sugar or low in dietary fibre
- Inadequate chewing due to dental disease
- Environmental changes (holidays, busy schedule) that predispose to delayed defecation consciously
- Use of certain drugs that decrease intestinal peristalsis: antacids, antispasmodics, tricyclic antidepressants, anticonvulsants, opioids, iron supplements, non-steroidal anti-inflammatory drugs, antihypotensive drugs
- Abuse of laxatives
- Pregnancy: during pregnancy, there are several factors that can cause reflex spasms of the anal sphincter: pressure exerted by the pregnant uterus on the colon, hormonal changes specific to pregnancy, dietary changes, hemorrhoids, anal fissures
Muscle dysfunctions that prevent the elimination of the fecal bolus during the act of defecation are part of the causes of adult constipation and are represented by:
- inability to relax the pelvic muscles – anismus
- lack of coordination of the muscles responsible for relaxation and contraction of the pelvic girdle – dyssynergia
- weakness of the pelvic muscles due to multiple loads, obesity or connective tissue diseases
Another cause of constipation in adults is blockages in the colon that prevent the mobilization of the fecal bolus along the colonic frame and are caused by: postoperative adherent flange, tumor formations in the bowel (colon and rectum cancer), rectum, intra-abdominal tumor masses, intestinal obstructions. Spinal trauma with nerve involvement, multiple sclerosis, Parkinson’s disease and stroke are neurological causes of adult constipation, affecting the nerve roots responsible for the physiological contraction of the muscles of the colon and rectum that ensure the movement of fecal material along the large intestine.
Hormonal changes are another factor involved in the development of adult constipation and may be due to a broad metabolic imbalance such as diabetes mellitus, over-reactivity of the parathyroid gland (hyperparathyroidism), pregnancy or decreased thyroid function (hypothyroidism).
Symptoms of constipation in adults
The main symptoms of constipation in adults are:
- Difficulty emptying the intestinal contents
- Painful defecation
- A feeling of incomplete elimination of the fecal bowl; a person suffering from constipation may have to go to the toilet several times a day due to the sensation of persistence of fecal matter in the rectum
- Abdominal pain, abdominal meteorism
- Digestive symptoms: loss of appetite, nausea, vomiting
- Halo, tongue-lashing
- Mucus secretion that soils linen, recurrent vomiting and the presence of intense abdominal pain accompanying constipation are specific symptoms of intestinal obstruction – a medical emergency! which requires surgery as soon as possible
Chronic constipation can lead to complications including dilatation of the hemorrhoidal veins with the appearance of internal and/or external hemorrhoids, anal fissures (ruptures of the anal mucosa due to the difficult passage of fecal material of increased consistency), fecal impaction (solidification of the fecal bolus and the impossibility of its mobilization in the intestine by physiological peristaltic movements) and rectal prolapse (protrusion of the rectal mucosa outside the anus).
Diagnosis of constipation in adults
The diagnosis of constipation in adults is established on the basis of the patient’s history and clinical consultation which includes a rectal cough and paraclinical examinations represented by:
- Laboratory investigations: haemolucogram, digestion sample, investigations to determine thyroid function, determination of calcemic and glycemic values to exclude metabolic pathologies
- Imaging investigations: abdominal X-ray (for the diagnosis of intestinal perforation or obstruction), sigmoidoscopy (investigation to explore the sigmoid colon), and colonoscopy (to exclude the diagnosis of colorectal cancer)
- Radiography and nuclear magnetic resonance may also be performed during defecation after the application of a barium contrast paste or gel to the rectum, for evidence of rectal prolapse or possible rectocele
- Rectal manometry is a procedure during which the doctor will insert a catheter fitted with sensors into the patient’s anal canal to investigate anorectal sphincter activity
- Assessment of the speed of reaction of the anal sphincter muscles used in conjunction with anorectal manometry can provide useful information on the time required to expel a rectally placed water balloon by contraction of the anal muscles
Bowel transit assessment uses an enteric capsule fitted with a wireless camera. After oral administration, the capsule moves along the patient’s digestive tract and can provide useful information about possible bowel motility dysfunction.
Treatment of constipation in adults
Hygienic dietary treatment involves changing eating habits by adopting a diet rich in plant fibre, adequate hydration, reducing intake of foods high in over-processed sugar and daily exercise to stimulate bowel motility.
Drug treatment is used in cases unresponsive to lifestyle changes and involves the administration of different types of laxatives (bulk laxatives to increase the volume of the fecal bowl represented by plant fibre and stool softening laxatives) and osmotic saline purgatives (retain water in the bowel, increase intestinal peristalsis resulting in rapid bowel evacuation). Stimulant medication is used to promote intestinal muscle contractions while mineral oil eases the passage of faeces through the colon facilitating their rapid elimination during defecation.
In certain situations, treatment of constipation in adults may include performing voiding enemas and administering glycerin or bisacodyl suppositories to remove the hardened fecal bolus from the last portion of the colon. If constipation is an undesirable side effect of opioid medication, there are pharmaceutical preparations that improve bowel motility through their effect on opioid antagonist receptors.
Surgical treatment of constipation is generally aimed at patients with a chronic form of the disease that is unresponsive to drug treatment, which is associated with complications such as bowel strictures, anal fissures, rectocele or fecal impaction and may involve removal of a portion of the colon to restore the physiological intestinal passage of fecal material.
Learn more:
- The Treatment of Chronic Constipation in Adults – https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1525-1497.1997.12103.x
- Diagnosis and management of chronic constipation in adults – https://www.nature.com/articles/nrgastro.2016.53
- Chronic constipation in adults – https://www.bmj.com/content/338/bmj.b831.full
