Constipation - A Multifaceted Concern (Part 2)

Accurate diagnosis is essential for effectively addressing constipation. During the diagnostic process, the doctor will conduct a thorough examination of the patient's medical history, current symptoms of constipation, and related issues such as bleeding and burning pain. Factors such as nutrition, eating habits, and daily activities will also be considered.

To diagnose constipation, the Rome IV criteria stipulate that two or more of the following symptoms must be present for at least 12 weeks:

Fewer than three bowel movements per week.
Excessive straining during defecation that lasts for a prolonged period.
Passage of hard, lumpy, or black stools.
Feeling of incomplete evacuation after a bowel movement.
Sensation of blockage in the anorectal area.
A manual rectal examination is a simple method to assess the condition of the anal sphincter and detect any abnormalities in the anal region, such as hemorrhoids, mucosal prolapse, anal polyps, or fissures.

Additional diagnostic techniques include anorectal imaging endoscopy, colonoscopy, and abdominal X-rays. An unprepared or prepared X-ray can reveal the presence of a significant amount of stool in the colon, with more severe cases showing greater stool accumulation and potential dilation of the bowel loops. 

Barium X-rays can also identify normal or abnormal anatomical shapes of the colon and rectum, including the presence of tumors or strictures. Moreover, the use of oral capsule tests, where multiple plastic markers (Sitzmarks) are visible on X-ray films, can help assess the digestive function of the colon. 

The remaining plastic markers after a specific timeframe can confirm the diagnosis and determine the location of constipation. Modern methods, such as anorectal manometry, CCTV camera systems, and defecography, provide further insights into physical conditions and biological function, aiding in accurate diagnoses and the formulation of appropriate treatment measures.

In conclusion, an accurate diagnosis of the underlying cause of constipation is crucial in managing the condition effectively.

TREATMENT METHODS

In the majority of constipation cases, implementing changes to diet and lifestyle can alleviate symptoms, prevent recurrence, and reduce the risk of complications.

Dietary Modifications:

Increasing fiber intake is essential for preventing and relieving constipation. It is recommended to consume approximately 300 grams of fiber-rich foods such as fruits, vegetables, fresh fruits, and bamboo shoots. Foods low in fiber, such as ice cream, cheese, meat, eggs, and processed foods, should be limited. 

When considering children's diets, age-appropriate nutrition should be taken into account. Breastfeeding mothers should also pay attention to their diet, as it can affect breastfed infants. Children consuming formula milk require special attention due to differences in fiber content, protein, phosphorus, calcium, iron, etc. It may be necessary to add prebiotic fiber to prevent constipation in formula-fed infants.

Adequate Hydration:

Drinking a glass of warm water (approximately 500 ml) on an empty stomach in the morning and engaging in light physical activity can be beneficial. For children, special attention should be given during hot and sunny days or when they are ill with a high fever. Daily water intake for children aged 4-6 is around 1.5 liters, while children aged 7 and older should aim for approximately 2 liters per day in hot weather.

Lifestyle Changes:

Establishing regular bowel habits is crucial in managing constipation. Individuals should avoid delaying bowel movements and strive to use the toilet at regular intervals. For those who sit for extended periods due to their occupation, it is important to schedule appropriate exercise breaks. 

Engaging in physical activities like walking, running, and deep belly breathing can enhance intestinal motility, strengthen muscles, promote overall well-being, and help prevent constipation. In the case of children, regular outdoor exercise and the establishment of a daily bowel movement routine are recommended. It is important to note that children should not spend excessive time sitting on the potty or toilet.

Medications for Constipation:

There are various medications available to treat constipation by directly affecting the nervous function of the intestinal motor system. These medications stimulate muscle contractions in the intestinal walls, promoting peristalsis and facilitating stool passage. 

While these medications can provide effective relief, they should not be used for more than 8 to 10 days. Prolonged use of these drugs may have side effects and can negatively impact the intestinal tract, as well as the liver and kidneys. It is important to understand that these medications do not address the root cause of constipation.

Specific Treatment Approaches:

For individuals with underlying medical conditions in which constipation is a symptom, it is crucial to treat the primary condition alongside implementing appropriate measures to alleviate constipation. In addition to the aforementioned treatment options, several specific approaches are available:

Electromagnetic wave interference constipation treatment machine: This method involves using 2-4 electrodes placed on the abdomen to stimulate peristalsis (colon-rectum) through the application of interference electric waves. It is particularly effective for cases of long-term constipation that have shown limited response to medications.

Local electric stimulator for the anus-rectum: This device is used to treat constipation and fecal incontinence by stimulating the rectal area, causing a tenesmus reflex that helps induce the urge to defecate. It is often combined with an interferometer for optimal effectiveness and is beneficial for individuals with pelvic floor prolapse, urinary incontinence, and constipation.

Biofeedback exercise machine: This device utilizes biological response techniques and is employed for patients with pelvic floor prolapse and urinary incontinence.

Constipation treatment requires patience and a comprehensive approach. If left untreated or unmanaged for a prolonged period, constipation can lead to complications such as hemorrhoids, anal fissures, skin tearing around the anus, rectal bleeding, and even rectal prolapse. 

Additionally, the accumulation of stool in the colon and rectum can result in a condition where the colon's contractions are insufficient to expel the stool effectively, particularly in children and the elderly. Furthermore, untreated constipation and associated conditions can cause inflammation and narrowing of the anal canal, and in some cases, even contribute to the development of cancer, posing significant risks to an individual's overall health and well-being.

In conclusion, it is imperative to address constipation promptly and accurately diagnose its underlying cause in order to implement appropriate treatment methods. By adopting dietary and lifestyle modifications, ensuring adequate hydration, and considering specific treatment options when necessary, individuals can effectively manage constipation, improve bowel function, and reduce the risk of complications associated with this condition.