The constipation. It is a condition that consists of the lack of regular movement of the intestines, which produces an infrequent defecation or with effort, generally of little and hard stools.
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- 1 Definition
- 2 Causes
- 3 Diagnosis
- 4 Treatment
- 5 When babies have difficulty evacuating
- 1 When can a baby be said to be constipated?
- 6 What to do to remedy constipation
- 7 Sources
Constipation is not a disease as such but rather a symptom that, given its enormous frequency, causes a large number of consultations with the family doctor and in the worst case with the digestive specialist.
It is difficult to define constipation since it is a problem subject to enormous individual variability or, what is the same, to great subjectivity for what can be understood as a normal depositional rhythm. We understand as depositional rhythm, the frequency with which we go to the service to evacuate.
In the healthy general population, the depositional rhythm varies between 3 times a day and 3 times a week, defecating painlessly and without great effort in most cases, in addition to having the feeling of complete evacuation at the end.
If we accept this definition, we can therefore define constipation as the evacuation of excessively dry, scarce or infrequent stools (less than 3 times per week).
Constipation can be occasional, that is, it lasts for a short period of time and is associated with certain diets or habits, or it can be chronic if it continues over time.
In turn, this constipation may be secondary, or have a cause at its origin, (certain diseases produce chronic constipation, such as celiac disease, hypothyroidism, diabetes mellitus &) or, conversely, be Idiopathic, with no direct known cause that justifies it, although in these cases it is usually due to problems with the motility of the intestine.
Constipation, also called constipation, is a more frequent problem than it seems in today’s society, and the true frequency of the problem has not been quantified. However, it can be stated that it is more frequent in the female sex and in the elderly, perhaps related to multifactorial conditioning factors.
Groups of pathologies capable of producing constipation, such as functional or motility problems of the intestine:
- Idiopathic constipation
- Hirschprung’s disease
- Specific diseases that occur with constipation
- Metabolic diseases
- Mechanical obstacles in defecation
- Rectal strictures
- Iatrogenesis or side effect of drugs: Codeine, Antacids.
- Plain abdominal radiography.
- Low fiber diet.
Others: Sedentary lifestyle, Depression.
In many cases constipation is the only symptom, but sometimes it is accompanied by other secondary symptoms such as the feeling of fullness, inflammation of the abdomen , flatulence , slight abdominal discomfort, headache , etc.
The meticulous clinical history, inquiring about dietary, sociocultural factors, toxic habits, diseases that are suffered and their treatments and the characteristics of constipation, are usually enough to guide the diagnosis.
It is important to assess the duration and age of the patient since the appearance of constipation in children is not the same as in adults. In children, chronic constipation is almost always of functional etiology.
It is also important to inquire about the characteristics of the stool and whether or not they are accompanied by abdominal pain. The emission of scallops or “pellets” with mucus is characteristic of spastic constipation, while the emission of blood with the stool suggests either hemorrhoids, proctitis or tumors.
It is important to determine where the fecal transit disorder is and for this the anamnesis (interrogation) is important, asking the patient whether or not he wants to defecate:
If you feel like defecating but can’t pass stool, think of an anorectal disorder. If you rarely feel like defecating, we will think of a colon disorder. In these cases the stool does not reach the rectum.
Routinely, a blood test can be requested, determining glycemia, ions, thyroid study, calcaemia and occult blood in feces, which will allow us to focus on some common causes of constipation.
The main exploration maneuver is digital rectal examination, an essential part of physical examination, and it should never be missed, since it allows identifying mechanical problems or problems with anal sphincter tone.
Among the diagnostic tests that can be requested is Rectoscopy, which consists of introducing a probe with light into the anus that allows the interior of the large intestine to be visualized. In addition, there is a Colonoscopy that uses a probe with a greater range than the previous one and X-rays with contrast, such as the Enema Opaque (radiography after the introduction of a special solution to view the intestine through the anus) that allows us to notice lesions that obstruct the intestinal canal. .
Only in very special cases will other types of tests be requested to refine or confirm a first diagnosis: rectal manometry, electromyography, defecography, etc.
Hygienic-dietary In the first place it is necessary to treat constipation with a fiber supplement in the diet by consuming fruits and vegetables, wheat bran, etc., and to re-educate the patient regarding his bowel habit, avoiding sedentary lifestyle and performing certain exercises postures and contraction-relaxation of the abdominal and pelvic muscles .
Drugs There are several groups of drugs that are known by the name of laxatives and that, depending on the type of constipation, may be prescribed. As for the type of drug to be used, it must be indicated by the GP, as it is not uncommon to observe side effects in patients who consume laxatives indiscriminately or voluntarily (in some cases they are the cause of constipation).
There are medications that increase fecal mass, hyperosmolar agents, prokinetics, motility stimulants, etc., which it is not necessary for the patient to know except when prescribed by their doctor and who will provide them with the necessary information for their correct use.
Enemas or other substances such as glycerin suppositories are sometimes used and, in general, they should also be prescribed or advised by your doctor to avoid adverse effects with overuse or abuse, although at first they may seem harmless. .
Constipation is a generally benign symptom, which has an easy solution if it is detected early and if it is not due to a specific disease that causes it, which is the most frequent.
In this case, it will always be the family doctor who decides both the tests to request to clarify the diagnosis and the adoption of the most appropriate therapeutic measures for each case. Only in very special cases, constipation can give complications of the digestive type, such as fecal impaction, with the consequent intestinal obstructive symptoms.
When babies have difficulty evacuating
When can a baby be said to be constipated?
A baby can be said to be constipated when the toddler becomes nervous and uneasy. He moves his legs incessantly, turns red from the effort, and does nothing but cry, of course. Gas and colic are unavoidable when the baby is in this state. According to specialists, during breastfeeding babies usually dirty diapers almost every time they eat feces, sometimes small stools and others more abundant. The frequency of evacuation decreases as babies get older. From 2 months of age they generally only evacuate once or twice a day. Everything will depend on the type of food he receives as well as his own nature, if the little one has an allergy, etc.
Constipation in the baby requires rapid intervention by the parents and the pediatrician, to prevent the problem from becoming a chronic discomfort, or from complicating. The longer the stool is in the baby’s colon, the drier and harder it will become, and its removal will be even more difficult and painful.
What to do to remedy constipation
When the baby’s stools are scarce, the possibility that he is suckling well must first be ruled out; If the baby does not eat, it is not that he is constipated but that he has nothing to evacuate. In the first days of life, the baby must evacuate at least three times a day, if it does not do it it must be because it is receiving little feeding. If your baby stops having a bowel movement in a day or two, and when you do so again your stools are hard and dry, you may have stopped passing your bowel movement. In this case, the pediatrician should be commented.
To ease babies’ constipation, parents can add a little extra water to the bottle formula. The water will soften the stool a little and prevent it from being retained in the child’s colon. Some pediatricians, in fact, recommend lowering the bottles a little, putting 35 ml instead of 30 ml of water for each level measure of milk. If constipation in the baby becomes persistent, it is advisable to seek medical advice. There are “anti-constipation” milks on the market, suitable to alleviate the problem. Another option is baths with warm water. A benefit for baby’s intestinal transit.
Massages are also very stimulating to help evacuate the baby. The little one’s legs can be flexed over the abdomen, making circular movements; position the hand on the baby’s belly (at the level of the navel), and massage it deeper and horizontally, with the palm and the base of the fingers. A massage of the baby’s back, with movements up and down, can also help the baby to evacuate.
Apart from special milk, a warm bath, massages, and water, one of the most widely used remedies for many parents is the glycerin suppository that is applied to the baby’s anus. There are parents who choose to insert the tip of the thermometer, although this method does not offer any type of security and presents risks of injury to the baby. There are also those who choose to give orange juice very low in water to the little one. In one or the other case, it is recommended that the opinion of the pediatrician be listened to. Anyway, it is good to know that constipation can stop bothering babies from the fourth month of life, when, by medical determination, they start to eat compotes, purees, and creams of fruits and vegetables, rich in fibers.