constipation

ruit a day keeps constipation away

Your Health
DR GITA MATHAI

“If you don’t clear your bowels every morning,” explained the grandmother, “the poisons from the stool will get absorbed in your blood.” She paused dramatically for effect. “That is what is happening to me.”

Now that statement is not strictly true. If you are constipated, the rectum continues to absorb water from the stool, making it hard. It can then become impacted (stuck) and cause painful excoriations and fissures at the anal opening. No toxins, however, are released into the blood stream.

There is no real "normal" for bowel movements; it varies from person to person. Fewer than three movements a week, however, may indicate constipation and more than three a day diarrhoea. Only about 50 per cent of the population regularly clears its bowels every morning.

Pooping has both voluntary and involuntary components. As faecal matter enters the rectum, it causes it to stretch. Nerves from the rectum carry the message to the brain. The anal sphincters relax, the abdominal and pelvic muscles contract. This increases the pressure and the motion is forced out. If the signal is ignored, the signal ceases. The motion remains in the rectum. If the signal is consistently ignored, the motion becomes hard and then gets impacted or stuck.

The stool should be well formed, sausage shaped, brown and passed painlessly. If there is a sudden change in the frequency, consistency and colour of the stool, if it is mixed with blood or mucous, if diarrhoea suddenly begins to alternate with constipation or there is significant weight loss, there is reason to be concerned. Consult a doctor at once.

Sudden acute constipation is also a worrisome symptom. It may signify a serious medical illness like an obstructive tumour. Constipation also requires an immediate assessment if it is accompanied by pain, vomiting and abdominal pain.

Chronic constipation occurs over a period of months. It is always caused by the slow movement of the stool through the colon. This may be due to hormonal imbalances, particularly deficiency of the thyroid hormone. It may be due to medicines like painkillers (codeine), cough medication, antidepressants, antacids that contain aluminium and even laxatives. Laxatives can be habit forming. The dosage has to be gradually increased for the same benefit. The intestinal nerves and musculature may cease to respond, aggravating the problem. If constipation is due to abuse, side effects or misuse of medication, the constipation disappears when the offending medication is discontinued.

Fibre is required to provide bulk to the stool. Many diets are deficient, particularly in people who consume mainly refined flour (maida) and do not eat the recommended 4-5 helpings of fruits and vegetables. (Juices do not count as the dietary fibre is strained out.). This results in constipation.

The pelvic floor musculature has to function efficiently to push out the stool. The nerves may be inefficient as a result of old age, uncontrolled diabetes or some other neuropathy. This can result in inertia of the large intestine. The nerves and muscles may be damaged as a result of repeated childbirth or surgery. Both colonic inertia and pelvic floor dysfunction can cause constipation.

If the medical evaluation for constipation does not reveal any specific treatable cause, some non specific modifications of diet, life style and simple medications can help. The goal of treatment is to achieve one bowel movement every two to three days without straining.

8 Increase you physical activity. A sedentary lifestyle slows all the muscles in the body, including abdominal and pelvic muscles.

8Modify your diet to include 4-5 helpings of food and vegetables a day. Drink enough water (not juices, colas, tea or coffee).

8Try to sit on the toilet at a specific time every day. Your body will eventually get the message.

8Women are more prone to constipation during the premenstrual phase and pregnancy. They need to increase their intake of dietary fibre at this time.

8Ipsagol husk dissolved in water increases the bulk of the stool and is safe and effective.

8Stimulant laxatives should be used as a last resort because of the possibility that they may permanently damage the colon and worsen constipation.

Herbal laxatives are marketed as “natural products”. Many of them contain senna and other stimulant plant-based laxatives in unregulated quantities. They should not be used without medical advice.

Mineral oils like paraffin act as lubricants. Long term use results in a deficiency of fat-soluble vitamins.

Hyperosmolar laxatives like sorbitol or lactulose, saline laxatives and stool softeners are efficient, unabsorbed and fairly safe.

Your body may take time to respond to these simple measures. Patience and persistence are required to make the treatment programme successful.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

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