Avoid Complications by Treating Chronic Constipation Early

Constipation tends to be more common in women and may get worse with age.
Friday, 18 January, 2019 - 13:00
Cambridge- Asharq Al-Awsat

Like gray hair and wrinkles, constipation is something you're more likely to experience as you age. "Constipation is a very common complaint; mild irregularity is probably even more prevalent," says Dr. Judy Nee, an instructor in medicine at Harvard Medical School. "Women are more likely than men to be constipated."

More than one in three adults ages 60 and older have experienced constipation symptoms, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Constipation is typically defined as having fewer than three bowel movements a week; having stool that is hard, dry, and difficult to pass; or feeling that you aren't able to void completely when you use the bathroom.

And it's more than just a nuisance. Left untreated, constipation can leave you with some uncomfortable and lasting reminders.

"Most commonly, I hear about worsening hemorrhoids," says Dr. Nee. "Straining can cause the hemorrhoidal cushions to enlarge." Other potential side effects include bleeding, small tears known as anal fissures, and ulcerations in the colon, caused by stagnant stool that sits for long periods of time, she says.

In rare cases, stool may even block your body from releasing waste and lead to nausea and vomiting, which are signs of a bowel obstruction. Other problems include rectal prolapse, or pelvic floor dysfunction. (The pelvic floor is a bowl-shaped group of muscles that support the pelvic organs.) These problems are most commonly caused by chronic constipation, which typically lasts for more than three months.

Causes of constipation
If these complications sound like something you'd like to avoid, the best strategy is to be aware of bowel changes and address constipation early, before it becomes chronic. That means understanding the factors that can promote constipation.

Constipation is sometimes related to diet — for example, not eating enough foods that contain fiber. Fiber is a type of carbohydrate that your body can't digest. While having an indigestible substance in your body may sound like a bad thing, when it comes to fiber, it's not. Fiber, in particular a kind called insoluble fiber, can help move waste through your intestines and prevent constipation.

But a low-fiber diet isn't the only cause. Other contributing factors include low liquid intake; certain medications (including antidepressants, opioid pain relievers, and sleeping pills); and some medical conditions, including Parkinson's disease, thyroid problems, multiple sclerosis, and diabetes, says Dr. Nee. In some cases, a physical problem is to blame. For example, in some people, the colon doesn't move forcefully enough to push the stool through the digestive tract. When the body doesn't clear stool quickly enough, the intestines continue to draw water away from the stool, which dries it out and makes it more difficult to pass.

Spotting constipation early can help prevent hemorrhoids and other complications of the condition. This might mean making dietary and lifestyle changes on your own or getting evaluated for the condition by your doctor.

Treatment for constipation

Treatment for constipation is typically individualized to each patient, says Dr. Nee, but very often doctors recommend a laxative as the first step in treatment. Your doctor will likely also want to evaluate your medications and your diet to find the cause.

A diet rich in fiber — 25 to 31 grams a day — can help prevent constipation, according to the NIDDK. High-fiber foods include vegetables, fruits, nuts, whole grains, and legumes (such as chickpeas and black beans).

In addition, drinking lots of water can also help keep your bowel movements regular because the fluid helps prevent stool from hardening, making it easier to pass. Regular exercise can also help.

Besides advising lifestyle interventions, your doctor may want to check for health conditions that could be causing constipation.

"If women over the age of 50 haven't undergone colonoscopy, this should be performed. Although constipation is very common, in an older woman, we would still be concerned about evaluating for colon cancer," says Dr. Nee. The doctor may also order tests designed to evaluate the pelvic floor and may consider other tests to assess gut function.

The right diagnosis and treatment of the underlying cause of constipation can keep the condition from becoming chronic and prevent uncomfortable complications.

Harvard Women's Health Watch

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