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Written by Team Liki24 
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Chronic constipation is a serious problem that worsens not only the quality of life of a person, but also his health.In addition, constipation can be a symptom of very dangerous diseases - for example, intestinal cancer.However, do not be frightened before the time: often this condition is caused by quite harmless functional reasons or a banal violation of diet / drinking regimen.In our article we will tell you in detail why chronic constipation occurs in adults and children, whether you can cope with it yourself or better to consult a doctor, and most importantly - how to prevent stool problems.
Doctors define constipation as a condition in which defecation is difficult or occurs rarely. It is also characterized by dense stools and / or a feeling of incomplete emptying of the bowel after going to the toilet. If symptoms persist for more than 3 months, constipation is considered chronic.
The frequency of defecation varies from person to person and depends on many factors - age, diet, physiological, social and even cultural characteristics. For residents of Western countries, it is considered normal to empty the bowels from 2-3 times a day to 2-3 times a week, if it does not cause any discomfort.
Why does chronic constipation occur?
Patients diagnose chronic constipation much more often than doctors do. But, even despite the overdiagnosis, it remains one of the most common problems in gastroenterology. It is believed that, on average, women suffer from constipation 1.5-2 times more often than men. It is also more common in sedentary people. According to the results of various studies, the frequency of constipation increases sharply after the age of 65, which is associated with an age-related decline in intestinal motility and a decrease in fiber intake.
The causes of chronic constipation can be either functional or organic. Common functional causes are:
- irritable bowel syndrome;
- pelvic floor dysfunction;
- slow transit of feces through the intestines.
A common organic disease manifested by constipation is malignant tumor (cancer) of the intestine. It should always be kept in mind if constipation occurs for no apparent reason, especially in the elderly.
Other causes of chronic constipation:
- Improper nutrition (lack of carbohydrates, fiber in the diet);
- abuse of laxatives;
- pregnancy;
- taking certain medications;
- metabolic disorders - diabetes mellitus, deficiency or excess of calcium in the blood, hypothyroidism (decreased activity of the thyroid gland);
- diseases of the central and peripheral nervous system - multiple sclerosis, Parkinson's disease, stroke, neurofibromatosis, Hirschsprung's disease;
- systemic diseases - autoimmune myositis, systemic scleroderma;
- dyssynergic defecation (disorder of synchronized work of anorectal muscles).
Please note: acute constipation most often occurs against the background of intestinal obstruction or medication. It requires mandatory referral to a doctor.
Main symptoms of chronic constipation
With chronic constipation, patients usually complain of such problems with the intestines:
- infrequent defecation;
- Difficult (prolonged or painful) emptying of the bowel;
- the need to constantly push (very often this leads to prolapse of hemorrhoidal nodes or even pelvic organs, the appearance of anal fissures);
- dense fecal masses, changes in their shape;
- a feeling of incomplete emptying of the bowel.
Constipation can manifest very vivid symptoms regardless of what it is caused by - functional causes or chronic diseases of the intestine. The severity of its manifestations does not always correlate with the “seriousness” of the underlying disease.
However, in gastroenterology there are “red flags” - alarming symptoms in which it is necessary to see a doctor as soon as possible and undergo examination, even if the constipation itself does not bother a person very much. These include:
- impurity of blood in the stool;
- pronounced abdominal bloating;
- weight loss on the background of prolonged constipation;
- the appearance of vomiting (without connection with intestinal infection or poisoning);
- constipation in the elderly, which occurred for the first time or is rapidly progressing.
These symptoms may indicate a malignant intestinal tumor, they usually require a colonoscopy (examination of the intestines with an endoscope).
How to get rid of constipation?
First of all, it is necessary to consult a doctor - he will conduct the necessary examination, establish a diagnosis and suggest how to treat chronic constipation in a particular clinical situation.
Usually normalization of intestinal function begins with changes in diet, drinking and lifestyle.
Please note: the doctor must be informed about all medications and supplements you take, because they may be the culprits of intestinal problems.
Diet for chronic constipation should necessarily include:
- vegetables (the undisputed “anti constipation leader” is beets);
- fruits (kiwi, mangoes, apricots, plums, plums - including prunes) are especially useful. Note: in the study, kiwi proved to be the most “easily tolerated” and effective fruit laxative;
- grains;
- dietary fiber (15-30 g/day).
Fiber intake, especially insoluble fiber (bran, whole grain products, fruit and vegetable peels), should be increased gradually, otherwise intestinal bloating and abdominal pain may occur due to the sudden stimulation of peristalsis.
Effective and tasty home remedies for normalizing stools are salads:
- tomatoes + cucumbers + peppers + olive oil (or linseed oil in a small amount);
- vinaigrette;
- boiled beets + raisins + prunes + sunflower oil.
Many people prefer to eat yogurt with oat bran as snacks . Such food will be especially useful if yogurts are prepared independently with the use of special bacterial starter.
In addition to proper nutrition, with constipation, you need to reconsider your drinking regimen. It may well be that dense stools are associated precisely with a lack of fluid. Gastroenterologists advise drinking from 2.5-3 liters a day - plain water, compotes, morsels or juices.
Do not underestimate and physical activity. It is proven that sedentary lifestyle leads to hypodynamia of the intestine, and activity, on the contrary, stimulates its peristalsis.
Medical treatment of chronic constipation
Medication treatment of constipation in adults is not always a simple task. Some drugs “for the intestines” can be taken only a short course, others quickly develop addiction, others are not useful for the body, and so on.
To conditionally safe laxatives (from chronic constipation) can be attributed prebiotic lactulose. It is not absorbed in the digestive tract, but is broken down by intestinal bacteria to low molecular weight organic acids. They change the acidity in the intestinal lumen and have an osmotic effect - increase the volume of intestinal contents, which normalizes the consistency of fecal matter and stimulates intestinal peristalsis.
Since lactulose is not absorbed and does not show serious (systemic) side effects, it is safe for children from birth, pregnant and lactating women. It can be used for a long time, the main thing is to increase the dose of the medicine gradually, as an overdose can cause severe flatulence, abdominal pain and diarrhea.
Safe means also include bulk laxatives - for example, methylcellulose, psyllium (plantain seed husk), calcium polycarbophilus. They are prescribed 3-4 times a day with sufficient fluid. These drugs increase the volume of stool and soften it. As in the case with lactulose, the dose of laxative should be increased gradually to reduce bloating.
Please note: unlike other fiber supplements, psyllium has proven to be a “laxative” in studies.
Other groups of medications for chronic constipation:
- stimulant, or secretory laxatives - bisacodyl, castor oil, senna-based preparations, sodium picosulfate. These are over-the-counter remedies that are very widely used, but are not without disadvantages - with prolonged and uncontrolled use, they can cause pseudomelanosis of the intestine, loss of electrolytes, increased constipation due to the development of intestinal atony;
- softening agents - docusate, mineral oil (usually vaseline). They soften fecal masses and facilitate their discharge, but directly stimulate peristalsis weakly;
- glycerin suppositories - they are designed for occasional use or for regular use, if it is necessary to form a proper habit of emptying the bowel. For regular defecation at the same time (usually 15-45 minutes after breakfast), glycerin suppositories will work best;
- enemas with water or hypertonic solution - for permanent treatment they are not used, but without enemas can not do without enemas in case of fecal blockage (very dense fecal masses, blocking the lumen of the intestine, when independent defecation becomes impossible).
The Internet is often interested in how effective folk remedies for constipation. If we are talking about foods rich in fiber, vegetables and fruits, vegetable oils, then they can safely be used in the preparation of delicious and healthy dishes. But the use of various herbal decoctions and infusions requires consultation with a doctor.
Treatment of constipation in children
Chronic constipation in a child or teenager is in most cases a functional disease. When examining them, they very rarely reveal any anatomical changes, but the constipation itself is diagnosed by doctors quite often. Why does this happen?
Functional constipation in children is almost always caused by a fear of defecation. This may be due to its painfulness (for example, with a dense stool) or squeamishness of the child himself (not everyone can visit the street or school toilets). Shy children are embarrassed to ask to go to the toilet from the tutor or teacher and also tolerate “to the last”. The habit of restraining the urge to empty the bowels leads to the accumulation of fecal matter in the rectum and their compaction, which means that defecation will become even more painful, and the child will again delay going to the toilet as long as possible.
If you do not break this vicious circle, there will be encopresis - fecal incontinence. Many parents mistake it for diarrhea, but in fact encopresis is a manifestation of chronic, long-standing constipation. It occurs due to overcrowding of the intestine: dense masses in the lower rectum can not come out on their own, but soft feces flows around this “plug” and spontaneously released in small portions, dirtying the underwear.
Contrary to popular belief, one diet alone cannot cure chronic constipation in a child. Although, of course, proper nutrition and sufficient intake of dietary fiber is very important. You should also remember about drinking and physical activity - water softens fecal masses, and movements stimulate intestinal peristalsis.
But still, first of all, it is necessary as soon as possible to break the “vicious relationship”: pain - urges to the toilet - fear of defecation - restraint - encopresis. And help in this osmotic laxatives. Usually in children are used preparations based on macrogol (for example, Forlax) or prebiotic lactulose. The pediatrician selects the dose individually, smoothly increasing it if necessary.
Important! At the beginning of treatment in children osmotic remedies for constipation can somewhat increase encopresis, but do not be afraid of this. As soon as the child feels that going to the toilet is not painful, he will stop restraining urges and regulation of defecation will be restored.
Also as part of complex therapy, doctors sometimes use supplements based on psyllium (vegetable fiber), and in acute constipation, vaseline oil can be used briefly.
Non-medicamentous methods:
- A diet dominated by fruits, vegetables and fiber (bran, oatmeal, lentils, beans, whole grain products, kiwi, mangoes, plums);
- normal drinking regimen (on average, doctors recommend 6-8 glasses of water / compote / pumpkin juice per day, but the exact amount of liquid is calculated based on age - from 1 liter per year to 3.2 liters at 14-18 years). Important! With insufficient fluid intake, a fiber-rich diet, on the contrary, can aggravate constipation, so the child must be constantly reminded to drink;
- sufficient physical activity, and it is better that it was not just walks in the park, but moving games or even sports;
- creation of psychological comfort. The child should never be scolded for holding back and dirtying the laundry, in toddlers you can introduce rewards for successful defecation (for example, funny stickers). You should also make sure that the toilet bowl is suitable for their height, and if necessary, install special footrests.
Important! If the above measures (including osmotic laxatives) do not help, the child should be examined comprehensively - it is possible that the child's constipation is caused by an organic problem (e.g. elongation of the intestine, Hirschprung's disease, etc.).
Prevention of chronic constipation
To avoid developing constipation, you need to follow a few simple rules:
- eat right, remembering the importance of fruits, vegetables, cereals, and soluble and insoluble fiber (dietary fiber);
- drink more, preferring water or compotes over coffee and tea;
- move around a lot;
- try to eat and empty your bowels at the same time (regular stools are important!);
- before taking new medicines, carefully study the instructions, especially the section “Side effects”.
If defecation becomes more infrequent with age, you can carefully introduce more fiber into the diet and lean on the “anti-stool” vegetables and fruits listed above. But if the change in diet and lifestyle does not help, you should not hope for “itself will pass”, and immediately consult a doctor for advice. It is much easier to normalize the work of the intestines at an early stage, but it is equally difficult to cope with neglected constipation, both in a child and an elderly person.
The Liki24 team wishes you to feel great and never face constipation!
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