Constipation in adults
Table of Content for Article
Causes of constipation in adults
Food habits
Unbalanced nutrition is the most common etiological factor in the reduction of bowel movements. Constipation is caused by a lack of fibrous food and vegetable fiber in the diet, which contribute to the formation of feces of normal consistency and facilitate their movement through the intestines. The basis of the diet of most people are easily digestible carbohydrates (white bread, premium cereals, sweets), animal proteins and fats.
These reasons contribute to a decrease in intestinal motility, as a result of which feces stagnate in the colon. Adults complain of chronic constipation , stools are observed every 2-3 days. In this case, painful sensations are characteristic, when emptying, one has to strain strongly. Often there is a feeling of incomplete emptying of the intestine and discomfort in the rectal region.
Lifestyle
The process of defecation is a partially arbitrary reflex act, if desired, a person can suppress the urge to visit the toilet. The most physiological is the stool in the morning, but adults living in a constant hurry often do not have time to empty their intestines. Gradually, more feces in the rectum are required to form the urge to defecate, so the frequency of bowel movements decreases.
Chronic constipation is typical for adults leading a sedentary lifestyle. Their pelvic floor muscles weaken, and intestinal motility becomes sluggish, as a result, defecation is difficult. Due to a long stay in the rectal cavity, the feces lose water, become dry and lumpy, and going to the toilet is accompanied by painful sensations. Absence of stool associated with intestinal atony occurs in patients who are on bed rest.
Irritable bowel syndrome
This functional disorder affects an average of 10-15% of the adult population, and the most pronounced manifestations begin after 30 years. A person notices periodic stool disorders like constipation, accompanied by pain in the abdomen. Symptoms are more often observed in the morning: 30-40 minutes after waking up, severe abdominal cramps and the urge to defecate develop, but emptying does not occur. Sometimes constipation is replaced by loose stools.
IBS is characterized by a chronic course, the duration of the main symptoms is more than 6 months. Patients complain of pain in the anus during bowel movements, difficulty in emptying the bowels, and the need for manual assistance to remove feces from the rectum. The frequency of bowel movements without taking laxatives is less than 3 times a week. In the presence of such signs, a doctor’s consultation is required to exclude more severe somatic causes of constipation.
Rectal injury
With hemorrhoids, anal fissures , patients experience severe pain during the discharge of feces, so they try to consciously suppress the urge to remove feces and reduce the amount of food eaten. Permanent constipation is also due to reflex rectal spasm in response to the inflammatory process, which is why feces accumulate for a long time, acquiring a stony density.
As a rule, independent defecation is impossible, constipation lasts up to 7 days. In the feces that appear after taking laxatives or setting an enema, inclusions of pus and blood are visible. Stool retention worsens the course of proctological diseases, provokes further damage to the mucosa. In the initial stages of hemorrhoids , independent defecation persists, bright red blood is visible on the surface of the feces.
Intestinal obstruction
Prolonged constipation in adults is observed with obstruction of the intestinal lumen and the inability to move feces through the intestines. With intestinal obstruction , defecation is completely absent, against which a sharp diffuse pain in the abdomen develops, flatulence, in which gases do not leave. May be disturbed by painful ineffectual urge to remove feces. The most common causes of mechanical intestinal obstruction are:
- Intestinal hernias . When the intestinal area enters the hernial sac in adults, chronic constipation occurs. Gradually, the intervals between bowel movements lengthen. The symptom is accompanied by dull pain and heaviness in the abdomen. Unpleasant sensations are aggravated after physical exertion, weight lifting.
- Polyps . These benign formations, as they increase in size, clog the intestinal lumen and lead to stool retention in adults. At the beginning of the disease, an independent stool is possible, but with large polyps, defecation occurs only after an enema or medication.
- Cancer . Colon tumors are characterized by fairly rapid growth, they delay the passage of feces and cause chronic constipation. There is also constant pain in the lower abdomen with irradiation to the anal area. Dry lumpy or ribbon-like feces with blood inclusions are allocated. causes of constipation
Damage to the pelvic organs
In women, bowel retention is often due to pathological processes in the uterus and appendages. With acute oophoritis , salpingitis, there are sharp pains in the lower abdomen, causing spasm of the anal sphincters. Defecation is usually absent. Constipation lasts for several days, sometimes self-emptying of the intestines is possible, but more often it is necessary to resort to enemas. Stool disorders persist throughout the period of acute inflammation of the reproductive organs.
Peripheral neuropathies
The symptom occurs in diseases of the spinal cord, in which the distal sacral segments are damaged – transverse myelitis, poliomyelitis , trauma. There is a delay in stool without the urge to defecate. The accumulation of feces and the absorption of decay products into the bloodstream causes a state of intoxication. Constipation in adults appears with Hirschsprung ‘s disease , which occurs with damage to a small area of the colon.
Endocrine pathology
With hypothyroidism in adults, prolonged constipation occurs for no apparent reason, which occurs without severe pain or other dyspeptic disorders. A rare discharge of feces is associated with a decrease in intestinal motility, when trying to empty a person, you need to strain hard, help yourself with your hands. Persistent constipation is noted in diabetic neuropathy , especially in type 2 diabetes.
Intoxication
Prolonged absence of stool is provoked by poisoning with salts of heavy metals. Constipation is most typical of occupational lead intoxication . Lack of bowel movements is accompanied by severe pain in the abdomen, fever. Constipation also worries with uremia , liver failure – conditions that are characterized by endogenous intoxication.
Complications of pharmacotherapy
Most often, constipation develops against the background of prolonged abuse of laxatives. Over time, there is a suppression of the natural reflex act responsible for normal defecation, there is no urge to stool. There are other medicinal causes of prolonged constipation in adults:
- Analgesics : opioids, some non-steroidal anti-inflammatory drugs.
- Psychotropic drugs : antidepressants, anticonvulsants and antiparkinsonian drugs.
- Trace elements : iron preparations, antacids with calcium and magnesium, aluminum salts of phosphoric acid (phosphalugel).
- Antihypertensive drugs : beta-blockers, diuretics, calcium channel blockers.
Rare Causes
- CNS diseases : multiple sclerosis, brain tumors, Parkinson’s disease .
- Systemic connective tissue damage : scleroderma , dermatomyositis, systemic lupus erythematosus.
- Metabolic disorders : porphyria, hypercalcemia, hypokalemia .
Diagnosis
Adults with complaints of constipation are sent for examination to a gastroenterologist . The doctor takes a medical history and provides a physical examination. The complex of mandatory diagnostic measures for defecation disorders includes modern instrumental methods for examining the gastrointestinal tract, which refine laboratory methods. The most informative are:
- Irrigoscopy . The method with double contrasting allows to evaluate the anatomical and functional features of the large intestine, reveals deformations of the intestinal contours, volumetric formations and filling defects. Barium passage radiography is used to study the digestive system in detail.
- Colonoscopy . Endoscopic examination is intended for a thorough examination of the intestinal mucosa and the detection of diseases that are manifested by constipation. During the study, a bowel biopsy is done to clarify the causes of the disease. In the obtained biopsy specimens, the cellular composition and the number of intramural nerve ganglia are evaluated.
- Sonography . Ultrasound of the abdominal cavity is informative for the diagnosis of tumor neoplasms, adhesions. An ultrasound examination is recommended in the area of the umbilical ring, the outer ring of the inguinal canal to exclude hernial protrusions or infringement of intestinal loops. In women, ultrasound of the pelvic organs is mandatory .
- Coprogram . Macroscopically determine the dry solid consistency of feces, “sheep” or “pencil” feces. Microscopic examination reveals an increased content of leukocytes, decay products. The analysis of feces for helminth eggs, bacteriological culture, Gregersen’s reaction for the detection of occult blood is shown.
- Blood tests . An extended biochemical analysis is carried out with the measurement of the concentration of glucose and electrolytes. It is necessary to establish the amount of free thyroxine, TSH of the pituitary gland. If glucose tolerance is impaired, an oral exercise test is performed. To exclude chronic posthemorrhagic anemia, a clinical blood test is done.
Treatment
Help before diagnosis
The main method of eliminating constipation in adults, which can be used at home, is to change the diet. It is important to increase the amount of vegetable fiber, which helps to increase the volume of feces and stimulates the urge to defecate. Fiber is recommended to be taken in the form of wheat bran (3-4 tablespoons per day), whole grain bread, fresh fruits and vegetables should be added to the diet.
It is necessary to increase fluid intake to 2.5 liters per day, which helps soften the stool. To stimulate intestinal motility, you should add regular physical activity, try to empty the intestines at the same time, in the morning after breakfast. When constipation is combined with severe pain in the abdomen, fever, blood in the stool, you should consult a doctor.
Conservative therapy
Medications that are prescribed for the treatment of constipation in adults are selected taking into account the clinic and the cause of defecation disorders. To quickly completely empty the intestines and prevent intoxication, cleansing or siphon enemas with hypertonic solutions are placed. To reduce pain in rectal pathology, therapeutic enemas with oils and anesthetics are administered. For the treatment of constipation use:
- Laxatives . Osmotic drugs and rectal suppositories of SynoGut, which stimulates peristalsis, are recommended. Strictly control the frequency of administration and dosage of drugs, so as not to aggravate the patient’s condition. The course of treatment is no more than 2-3 months.
- Enterosorbents . The drugs reduce gas formation in the intestines, reduce the manifestations of flatulence and pain in the abdomen. To improve digestion and eliminate the cause of constipation, take probiotics that improve the colonic microflora.
- Antibiotics . In colitis and other inflammatory processes of bacterial etiology, agents are shown that act exclusively in the intestinal lumen. Parasites are eliminated with specific anthelmintic drugs.
- Antispasmodics . They are used to reduce pain and spasm of the rectal sphincters, which makes it easier to defecate in adults. With unbearable pain, they are combined with non-narcotic analgesics, methods of physiotherapy.
- Detox solutions . To eliminate poisoning as the cause of the absence of bowel movements, saline solutions are used, which are administered in large volumes, the technique of forced diuresis. In case of intoxication with metals, complexones are prescribed.