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For some passing stools once in two or three days may be normal while for others passing stools every day is normal.
Some of the risk factors of constipation include:- Lack or inadequacy of fibres and fluids in diet. Fibres are included in fruit, vegetables and cereals Avoiding or delaying urge to pass stools Certain medications may lead to constipation as a side effect Mental ailments like anxiety disorders and depression Elderly over the age of 55. This is due to slow bowel movements, use of multiple medications as well as a relatively sedentary life. Treatment for constipation is effective but it may take weeks before there is a regular bowel pattern.
Diagnosis usually involves detailed history of the condition from the patient about the signs and symptoms. Details of ignoring urges to pass stool and inadequacy of time and privacy for passing stools are also asked.
Lack of fluids and increased amount of red meats, processed meats and canned foods also leads to increased risk of constipation Details of medications and laxative use Several medications may cause constipation as a side effect.
Laxative abuse is also an important cause of constipation and needs to be detected while diagnosing constipation. If inflammatory bowel disease or bowel cancer is suspected a colonoscopy or sigmoidoscopy is advised.
Previous history of sexual abuse, violence, trauma, fear or unusual attitude towards bowel motions, depression and eating disorders have to be ruled out or detected.
Tests include Manometry for Hirschsprung’s disease and Electromyography for spastic pelvic floor dysfunction. Fibres are included in fruit, vegetables and cereals Avoiding or delaying urge to pass stools. Having limited privacy for passing stools and using a community toilet (in schools, hostels or dormitories etc.) could be a reason for exacerbation of constipation.
Some of the medications that may cause constipation as a side effect include aluminium containing antacids, antidepressants, antiepileptics, tranquillizers, opioids like codeine, morphine etc., antipsychotics used in schizophrenia and other mental health conditions, calcium and iron supplements, diuretics etc.
Psychiatric problems, such as ones that result from sexual abuse, violence or trauma may also lead to constipation in the short as well as long run. Mental retardation, Down’s syndrome and other congenital conditions that lead to mental retardation are also associated with constipation. Possible causes include lack of fluids in diet, lack of fibres, over feeding, malnutrition etc.
Constantly intervening while the child is using the toilet interferes with passing stools and may lead to constipation. This leads to poor bowel habits when the child ignores the urge to pass stools and withholds the stools for fear of experiencing pain and discomfort.
They include:- Including enough fibres in diet - Fibres are available in fruits, vegetables, whole grain rice, whole wheat bread, whole wheat pasta, seeds, nuts, oats, pulses etc. Some bulking agents like wheat bran may be added to the diet to increase the bulk of the stools and facilitate passage Including enough fluids in diet - Fluids like water and fruit juices help prevent dehydration and help in softening the stools as well.
Certain fluids like caffeine, alcohol and fizzy drinks are not good for bowel motions and excessive coffee or alcohol may precipitate constipation. Ideally around 150 minutes of moderate physical activity is recommended every week Developing good toilet habits - The urge to go to the toilet should not be ignored. They lead to formation of soft formed stools after a couple of days of use and ease the process of passing stools.
Softening the stools help in their passage and prevents stool impaction or fecal impaction. These agents take around 6 to 12 hours to work and should be used on short term basis only.
They are also useful for clearing the bowel in patients who are to undergo surgery (especially abdominal surgery) or radiological investigations and imaging of the abdomen. Gentle movement of the baby’s legs in a bicycle motion also helps the baby pass stools. They may be given fibres in diet in the form of fruits like apples, apricots, pears, peaches, grapes, plums, bananas, raspberries, strawberries etc. Laxatives that are safe to use during pregnancy include the osmotic laxatives lactulose and macrogols.
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