Constipation

Written by Sylvester Ikhisemojie

Sylvester Ikhisemojie

Constipation is the inability to open the bowel less frequently that normal. This is a common problem that has fascinated people of all races throughout history. It is traditional for some people to desire to have bowel motions every day. In some cases, such people want to have it every morning. They feel something is fundamentally wrong with them when they are unable to do so. Perhaps their worry is justified but most times it is not.

Some individuals have been known to take extreme measures to ensure they empty their bowel in the morning before they set out for the day's business. And yet, it need not be looked upon as something like an obligation. Understanding the facts that make it a problem should liberate many people and perhaps help them to focus less intently on the need to pass stool. Sometimes, these anxieties are passed on even to little children. Every individual will experience some form of constipation at some point in their lives. Most of the time, it is not at all serious and will correct itself with a slight change in diet or the use of vegetables and fruits.

The normal bowel motion takes different patterns in everyone. Some people use the toilet once a day and that is fine for them. Others use the toilet three times a day and that also is their pattern. Some others go to the toilet once in three days or twice a week. Between all these variants, however, fall the vast majority of people. It is essential to understand very clearly what one's pattern is and to take necessary action when that pattern seems abnormal. When the interval between two bowel motions is longer than three days, the stools become a lot harder and more difficult to pass.

However, it is not all the time that constipation is innocent. On some occasions, it is actually a product of some of the things we are engaged in doing. Therefore, I will endeavour to itemise the various situations in which constipation might be evident.

1) When people have eating disorders as a result of emotional challenges or because of pressures at work, they also will tend to pass out stools irregularly. This is a common thing to be seen in people who have stringent targets to meet at work and therefore do not find the time to eat as a result of that. Sometimes, bereavement and personal loss could also take away one's appetite, as a result, such people are unable to eat properly and consequently use the toilet.

2) Frequent movement from one location to the other may dislocate one's emotional balance so much so that they are unable to make use of the toilets available. Often, this is also caused by the fact that certain people are unable to use toilet facilities in their new environment despite their cleanliness. It just represents a psychological attachment to their homes.

3) Hypothyroidism, which is a condition of low activity in the thyroid gland, is sometimes evident in new born babies, where they are found to be low energy babies with a low pitched cry, possessing coarse skin and a prominent navel. In adults, there is mental slowness and a reduced ability to do things that require energy. In both age groups, constipation is a prominent result.

4) Pregnancy is a common cause of constipation because the enlarging uterus often does two things; it would compress the stomach and significantly reduce the volume of food a woman can consume. It would also exert pressure on the intestines and thus make it difficult to empty them by stooling.

5) Excessive use of laxatives would act in a perverse way to cause constipation. It is no more than a rebound effect. The constant usage of the various medications progressively weakens the intestinal muscles to the point where they are unable to respond properly to the usual stimulus of faeces in the intestine. As a result, constipation results.

6) Cancer occurring anywhere in the intestines, especially in the colon and the rectum will cause constipation. This result from the physical blockage of the tube itself and the result is thus a mechanical one.

7) Reduced physical activity resulting from injury, obesity or illness can diminish intestinal activity to the point of causing constipation.

8) People who do not take enough fibre in their diet in the form of vegetables and fruits are particularly liable to suffering from constipation. The same is true for those individuals who do not take an adequate amount of water with their meals and even after they have had their meals.

9) People who have nerve and muscle disorders of the intestines that make them unable to respond appropriately to stimuli. This is seen in adults with Parkinson's disease and other forms of dementia and in children who have Hirschsprung's disease. Among these people, it is not unusual to pass stools once in 10 days or even in two weeks.

10) People who are on strong pain killers such as narcotic drugs like morphine. Other drugs that can make this kind of problem evident are iron-containing drugs such as those commonly used in ante-natal clinics and anti-depressant medications prescribed by Psychiatrists for people suffering from depressive illness.

11) People who intentionally hold back on their stools because they suffer pain when they have problems like fissure-in-ano or who bleed because they have haemorrhoids are particularly prone to suffering from constipation. Unfortunately, such constipation supervening also makes their situation worse and the eventual result is therefore, a reinforcement of the predisposing disease.

12) Finally, individuals who take antacids that contain calcium or aluminium are also likely to suffer from constipation because of the effects of those two salts or minerals on the body.

The features of constipation would depend on the type. If it is an acute constipation, which means that the cause occurred suddenly, the main features that would be obvious are abdominal pain, distension of the abdomen and vomiting. All of these would progress relatively quickly with the abdominal pain being of such intensity that patients are often left panting between the pangs of pain. However, when it is chronic and the onset of the problem is more insidious, the level of pain could be minimal. Abdominal discomfort, bloating and a feeling of fullness become the major features with vomiting being a later manifestation. There is also a sense that everything within the rectum did not come out and there is thus a sense of incomplete bowel emptying. The stools are typically small and often hard and may even resemble the small type of stools that goats pass. There may be straining while in the toilet in an effort to cause the stool to come out. As a result of all of these challenges, the pattern of stooling is few and far between.

The investigations necessary to determine the cause of this disease and the extent of the problem are varied. At the onset, there will have to be a full clinical assessment which must include a rectal examination performed by inserting a lubricated gloved finger into the anus to determine whether any stool is within the rectum and its nature. It also helps to determine from the outset whether there exists any growth or abnormal presence within the rectum that should be responsible for this. After this stage, it is often of great help to determine the patient's level of fitness by doing a variety of blood tests. Hormone levels are also determined from the blood samples. Thereafter, abdominal x-rays must be requested and more specifically, barium studies must be done. This is achieved when a person is given a special kind of drink to consume followed by a series of x-rays that will demonstrate the progress through the intestine. In the case of constipation, however, that special solution which can otherwise be drunk is introduced into the intestine through the anus instead and its progress shown by a series of x-rays.

In children suspected of having the disease called Hirshsprung's, a biopsy is obtained of the rectum through the anus or in the course of performing some other procedure that may be life-saving. The results obtained would confirm the disease. The specific diagnosis obtained would help determine the further line of treatment over a period of time.

Another diagnostic tool is colonoscopy which helps to uncover any potential problem and also take a little bit of it to perform a biopsy similar to what is done in the children. Beyond this, a computerised tomogram, popularly called a CT scan, is recommended to determine the extent of the disease condition.

Constipation is, therefore, not just a passing period of discomfort. If you experience it and you have tried in your own way to deal with it without success, you must see a doctor. Also, if your stools are thin like pencils or it has some blood in it, please see a doctor. If you have severe pain with every effort to pass stool, see a doctor. If you are losing weight even though you are not on a weight losing diet, see your doctor. You should do the same thing if you have had constipation lasting up to two weeks or more or it is a brand new problem that you are experiencing.

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Ask the doctor

Dear doctor, I am an avid reader of your column in SUNDAY PUNCH. May the Lord continue to bless your work. I have a very small penis and I am not comfortable with it at all. I discussed it with a friend and he advised me to buy penis enlarger. On a second thought, I wanted to get your views on this. Please does it have side effects? Is it something that will trouble me in future? Please I need your urgent reply.

Thank you very much for your prayers. The penis enlarger is said to have no side effects. However, I have no experience with its use or its effects. In order for you to be certain that you are getting value for your money or to be sure that you are not inviting one kind of trouble in a bid to solve another problem, see a urologist for proper examination and treatment. That's the way to go to get the results you so clearly desire.

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Dear doctor, I am a 42-year-old woman. I am on a contraceptive pill, but I noticed that after putting off my bra at night, I normally have some pain, although of recent, that pain has disappeared. However, I sometimes feel as if my breast has been peppery or something is moving inside it. All these don't last five seconds. My concern is whether this pill is causing some reactions in my breast. Thanks for the service. God bless.

There are is nothing to fret about for now because the effects you have described are too brief to be due to the pill you are using. However, if these reactions become somewhat sustained, or they begin to get worse, it may be time to visit your family planning clinic to seek a proper examination and professional advice. Finally, the length of time in which you have used this medicine has much to do with whatever happens. Usage for up to two years on a consistent basis may be fraught with problems.

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Dear doctor, please what are the risks involved in bone marrow transplant of a sickle cell patient? My 25-year-old girl intends to undergo the treatment. Thank you.

Bone marrow transplant has been in use in various countries for nearly 40 years. It is largely a safe procedure. However, it is a procedure which can fail and that is one of its major concerns. It can also suffer what is known as graft rejection which occurs when despite all the precautions taken, the tissues being brought together between the donor and the recipient fail to bond.

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Dear doctor, I am proud of your work in helping Nigerians to proffer lasting medical solutions to their health problems. I am an 18-year-old lady with very small breasts. Please, what can I do or what kind of drugs can I use to make them big and the cost of doing so?

Thank you very much. You do sound very matured. Anyway, the size of your breasts should not worry you unduly now because you are still a growing and have a reproductive career ahead of you. Your breasts will reach their full adult size when you begin to have children.

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Dear doctor, I am an ardent reader of your column in SUNDAY PUNCH and I have garnered so much. Please lend a hand; I am keen on dental wellbeing, having all my molars and premolars on both the lower and upper jaws respectively. Your piece on solution to dental care made an interesting reading. Can one use Lemon mixed with water in a ratio of 1:3? Alum is used in cooking as well as "akaun." Are they injurious to health, causing cancer?

I did not mention Alum or the Lemon mixture in that essay. However, both are naturally occurring substances which should not cause any harm to your teeth. There is no shred of evidence that alum is linked to any form of cancer. In order for you to enjoy comprehensive health with your dentition, you should get to see your dentist once in every six months for proper examination and routine dental care.

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Dear doctor, I am male, and shy of my sixtieth birthday. I recently noticed that I no longer have erection, neither do I get aroused. Is this dangerous to my health?

It represents no danger to your health, sir. What it just means is that you are aging in a profound way. However, the lack of sexual arousal is not a permanent feature provided you do not suffer from such problems as diabetes or a spinal cord problem. It is something which will occasionally recover sufficiently for you to be able to actually have sex.

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Dear doctor, there is a liquid coming out of my right breast whenever I press it. What could be the cause and what is the treatment for it? Secondly I went to do a test called folliculometry on the 12th day of my cycle and the ovary was only on 11 millimetres. Please is there any drug I can take to increase it? Lastly, I have a scanty growth of Staphylococcus. Is there any treatment for it? I have not been able to conceive since the past nine months that I have been married. Please I need some help.

The fluid coming out of your right breast may frequently make conception difficult if not impossible depending on the volume of what comes out. However, if you did a folliculometry which has revealed a growing follicle, it means you are ovulating and can thus get pregnant. You therefore have no need for any drugs to stimulate ovulation or increase the size of the follicle. The size will increase naturally depending on the time of the cycle in which the test was carried out. Frequently, it is important to conduct more than one scan during the ovulation period in a process known as follicle tracking and this will see the follicle increase rapidly in size to something above 22mm where it is considered to be within the range for release. There is no need for you to take drugs for this process to complete. As for the Staphylococcus, part of the test would have determined whether the growth was significant enough to warrant treatment and what antibiotics it was susceptible to. That knowledge is what guides the treatment you would be getting. Good luck.