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Definition
Constipation refers to the symptoms of having a hard time passing a bowel movement and not feeling refreshed even after defecation. Everyone goes through this sort of experience several times in their lives, and even a healthy person can become constipated if they are under stress while traveling or starting a new job.
Many people consider constipation to be insignificant, neglecting them until they become severe and chronic constipation and trying to treat it by taking laxatives on their own. However, there is a saying that if you know your enemy, you will fight a hundred times and win a hundred times. There is a way to manage this constipation, which is considered intractable.
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Risk Factors
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Eating habits
The most common cause of constipation is a diet that lacks a sufficient amount of fiber. Eating an insufficient amount of food due to dieting, eating meat-based meals, drinking less water, or consuming a lot of instant food can all be risk factors.
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Lifestyle
When you do not exercise regularly, the bowel movement would be inactive, and the stool would stay in the intestine for a long time. When you lie down for a long time due to illness and when the amount of your body movement decreases with age, it is easy to get constipated. If you suppress a bowel movement when you are driven to work, or at school or work, your normal desire to defecate will disappear and eventually make you constipated.
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Medication
antidepressants, antipsychotic, narcotic, iron supplements, and anticancer
Hypothyroidism, diabetes, pregnancy, Parkinson's disease, brain damage, myelitis, etc.
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Symptoms
Severe symptoms such as abdominal pain are rare, but when constipation is prolonged, discomfort in the lower abdomen begins, and a feeling of bloating or pressure in the abdomen may be felt. If you have a lot of gas and feces, you will also feel pain in the right abdomen. If constipation is prolonged, loss of appetite, headache, nausea, acne, skin rash, intestinal obstruction, hemorrhoids, intestinal ulcer, intestinal diverticulosis, etc. may occur in severe cases. Furthermore, since the stools stay in the patients’ intestine for a long time, the contact between the mucous membrane of the intestine and the carcinogens contained in the stools is prolonged, which can lead to colorectal cancer, so constipation should not be taken lightly.
Why is constipation more common in women?
In women, the menstrual cycle and pregnancy can change hormone secretion. That is, when the menstruation period approaches, the secretion of estrogen decreases and the secretion of progesterone increases. This progesterone is the main cause of constipation. In addition, women have weak physical strength, do less physical activities, and have weak abdominal muscles, so they have a weaker ability to pass stool during a bowel movement. In addition, the amount of food is smaller, especially if you are on a diet, and skipping a meal can result in fewer stools, which causes constipation.
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Diagnosis
First, through a questionnaire with a doctor, you can predict the causes behind the constipation, and make assumptions about the progress of constipation. Then the doctor decides which further tests are required
How many days have you been constipated?
How many times do you have a bowel movement every day?
How long does it take you to have a defecation?
Do you feel an urge to defecate before actual defecation?
How hard are the stools?
What is the volume of feces?
Do you have a feeling of residues after a bowel movement?
Do you have bloating or discomfort in your abdomen?
Are you pregnant?
Are you using laxatives or enema?
Are there any other diseases?
In addition to the basic rectal and anal finger examination and anal endoscopy, special examinations can be further taken, including sleep colonoscopy, defecation angiography, defecation videography, intraanal pressure test, analysis of fecal colon transit time, anal electromyography, pudendal nerve terminal motor latency (PNTML) test, anal ultrasound test.
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Self-diagnosis
1. How many days do you have a bowel movement?
2. How long does it take for a bowel movement?
3. How many times per day do you fail to have a bowel movement?
4. How long has constipation been?
5. How many times do you feel pain when having a bowel movement?
6. Do you feel like you have residues even after a bowel movement? How many times?
7. How often do you have a hard time having a bowel movement?
8. Do you use any additional methods for defecation?
14 points or less : Normal / 15-19 points : Mild constipation / 20-24 points : Constipation / 25 points or more : Very severe constipation
If you got more than 15 points, it is recommended that you undergo a medical examination for constipation.
Result
Points
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Treatments
Regular bowel habits and good bowel movements
Moderate exercise of about 20-30 minutes, such as walking, is necessary, especially exercises that increase the muscle strength of the abdominal wall and abdominal massage. Regular bowel habits and good bowel movements are important. Eat enough breakfast to dilate your stomach, triggering the stomach-colon reflex, making you feel like you want to go to a bowel movement. When sitting on the toilet, you need to lean your upper body forward a little. In other words, it can be said that a slight squat posture is the best.
A high-fiber diet
A high-fiber diet is also highly recommended. A regular and balanced diet is important, especially for the purpose of increasing the amount of feces and shortening the passage time of feces through the intestines. Multigrain rice such as barley rice, bran bread, fruits, sweet potatoes, fresh vegetables, mushrooms, seaweed, fruit juice, etc. are good for your bowel health. A high-fiber diet is highly recommended because it not only helps relieve constipation, but also lowers blood cholesterol levels and reduces the risk of colorectal cancer. If you consume about 25 to 30 g of dietary fiber and 1.5 to 2 liters of water per day, you can pass stools smoothly.
Drug treatments
There are many laxatives released on the market, so be careful when you choose one for yourself. The point to be careful about when choosing a drug is that it has to have fewer side effects like electrolyte imbalance in the body.
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Bulk Laxatives(mutacylic acid, silicone, etc.) are taken on an empty stomach by mixing them with a sufficient amount of water or juice.
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Stimulant laxatives(Dulcolax, Aloe, Araxyl, etc.) are very effective when used temporarily, but if abused, dependence and 'laxative abuse syndrome' such as electrolyte and body fluid imbalance, osteomalacia, and weakened colon function may occur. Continuous use should be avoided.
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Osmotic laxatives include lactulose and sorbitol. Lacturose (brand name: Duphalac) inhibits ammonia production and absorption and promotes ammonia excretion in feces, so it is used for hepatic coma. It can also be used for constipation in pregnant women, nursing mothers, infants and the elderly. Although it is very sweet, it can be safely administered for constipation in diabetic patients.
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Saline laxatives(including magnesium hydroxide) have been reported to be more effective than lactulose for constipation in the elderly, but should not be administered to patients with kidney or heart failure.
Enema
When constipation is severe, enema is required, and if the stool is hard like a stone, you must dig up the stool with your fingers. Warm saline is the safest solution for an enema, and you should put as much as you can tolerate into your rectum and hold it for about 5 minutes before trying to pass a bowel movement. If you take an enema frequently, you must be careful later because you will not be able to pass a bowel movement without an enema.
Biofeedback therapy
Biofeedback therapy is a treatment based on behavioral science that allows the patient to learn how to control function of the sphincters by watching their own signals in real time through a computer monitor that are created when contracting or relaxing the muscles around the anus (pelvic floor, external anal sphincters). It has a high success rate up to 80% or more, allows outpatient treatments, and there are no complications and risks, so it is highly recommended for constipation patients. Recently, biofeedback therapy is usually tried first for diseases that require surgery, such as rectal and anal hyperplasia, perineal hypoplasia, and rectal disease.
Surgeries
With the recent development of rectal and anal function tests, risk factors of constipation have been revealed, and it allowed many cases be treated by surgeries. In the case of asthenia of the large intestine, if there is severe constipation and administration of various laxatives are showing unsatisfiable results, proctocolectomy is sometimes performed with caution. If colon asthenia and pelvic outlet atresia coexist, if symptoms persist even after applying biofeedback therapy, surgery should be considered to increase the cure rate. As described above, there are many treatments for constipation, but please avoid making a diagnosis by yourself and taking laxatives carelessly. When use of laxatives becomes habitual, the muscle layer plexus of the large intestine is paralyzed and progresses to colonic asthenia, which is extremely difficult to treat. If you find the exact causes and treat them appropriately, you can prevent not only constipation, but also hemorrhoids, colon diverticulosis, and colorectal cancer.
