I Need To Poop, But I Can’t! – Mark Cheong

You’ve probably had it before.

A distended belly.

A feeling of fullness.

And the fact that you have not had a bowel opening  for the last 3 days.

Source: cancer.dartmouth.edu

Rest assured, however, that you are not alone. In fact, you might be one of the million of people who suffer constipation at some time or another in their lives and it can be easily remedied. Before that, let’s get to the facts surrounding this digestive system nuisance.

Constipation is when there is a marked reduction in the frequency of passing motion as compared to the normal frequency or your usual toilet habit. It is also usually accompanied by hard stools which require straining during defecation. Constipation affects people of all ages, but is more common among the elderly for a variety of reasons including a more sedentary lifestyle, reduced fluid intake and change in diet, usually a reduction in fibre. Women are also more likely to get constipation compared to men.

The majority of constipation cases is caused by a lack of dietary fibre  as well as fluid intake. Some medications are also known to cause constipation – such as iron supplements, some antihypertensives, and aluminium antacids (medicine to treat indigestion) and others.

While the features of constipation are widely known i.e. inability to defecate, abdominal discomfort, bloating and loss of appetite which can be easily managed, there are some other signs that may indicate a more serious condition.

If you have symptoms such as:

• Inability to defecate for more than 7 days with no obvious cause
• Substantial amounts of blood in stool (stool turns red or black)
• Severe pain on defecation
• Sudden change of bowel habits in patients aged above 40
• Depression and malaise

To treat constipation, simple lifestyle changes such as increasing the amount of fruit and vegetables in one’s diet, increased fluid intake and regular exercise will tend to suffice for the majority of cases. Nevertheless, medication is available for those that require it. Medication for constipation is usually from one of the four classes:

• Bulk-forming laxatives e.g. isphahula husk, methylcellulose, sterculia
• Stimulant laxatives e.g. senna, glycerol, bisacodyl
• Osmotic laxatives e.g. lactulose, magnesium hydroxide
• Stool softeners e.g. docusate

Each of these classes helps relieve constipation through different mechanisms. Bulk-forming laxatives work by swelling in the intestines, which results in increased faecal mass. This makes the faeces easier to move through the bowels, resulting in easier defecation. Side effects include flatulence and abdominal distension. Stimulant laxatives increase the muscle movement of the intestines and bowels thereby moving the faecal matter more quickly towards the rectum resulting in  defecation. As a result of their mechanism of action, stimulant laxatives tend to work faster than other laxatives, usually within 6 – 12 hours of using them. Many stimulant laxatives are found in oral as well as suppository form. Side effects include abdominal pain. Osmotic laxatives work by increasing the amount of fluid inside the bowel, aiding the movement of faeces and easing defecation. Side effects include flatulence, abdominal pain and colic.

Lastly, stool softeners work by reducing the hardness of the faeces with the bowel, reducing the pain during defecation and easing the movement of the faeces.

In summary, constipation is usually a simple, though disturbing health problem that can be easily remedied through changes in lifestyle and dietary habits. There are also commercially available medications that can be used to relieve the difficulty in bowel movements. Nevertheless, one should always keep an eye out for signs that constipation may have a more sinister underlying cause and seek medical attention immediately if noted.

Mr. Mark Cheong is a pharmacist currently working in Kuala Lumpur. His research interests lie in the implementation strategies of public health measures. Find out more about him at The Team page.

[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.] 

References

• 1. http://www.mayoclinic.com/health/constipation/DS00063
• 2. http://www.nlm.nih.gov/medlineplus/constipation.html
• 3. http://www.nhs.uk/Conditions/Constipation/Pages/Introduction.aspx

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