Chronic Constipation
The term constipation; It can be perceived as a small amount, hard consistency, infrequent and difficult defecation. Conditions such as difficulty in defecation and the feeling of not being emptied after defecation should not be considered as constipation.
Constipation is a symptom, not a disease. However, it should not be forgotten that there are many organic diseases that cause this symptom.
In constipation, the quality of the stool is hard. Another feature is the amount of defecation. Although it varies depending on societies, individuals and foods; 3 or less defecations per week are considered constipation when taken together with hard and difficult defecation.
Normal defecation mechanism
The normal consistency of stool begins to form by absorbing the water of the intestinal contents coming from the small intestines to the first part of the large intestine in semi-liquid consistency. As a result of these processes, the thickened stool comes to the upper part of the hindgut and is stored here. Usually, after meals, stool is pushed into the hindgut by the gastroenteric reflex. Stool that starts to accumulate in the last bowel stretches the last bowel wall and creates the need for defecation. With the contraction of the last bowel muscles, intra-abdominal muscles, defecation occurs. In summary, constipation occurs through 3 mechanisms.
1- The scarcity of the material reaching the first part of the large intestine (this happens as a result of hunger and feeding with a diet that does not leave pulp)
2- Decrease in the movements of the large intestine that push the stool forward (as in some neurological diseases)
3- Disruption of the defecation mechanism (like in events that prevent the excretion of stool due to organic, neurological and psychological reasons in the last bowel and anus)
Causes of constipation
Congenital disorders, cultural, psychological , environmental factors, suppression of the need for defecation due to unsuitable conditions, diseases that make it difficult for stool to progress in the intestine, disorders that prevent proper defecation position in the elderly, joint problems, some neurological diseases such as Parkinson’s disease, lack of movement can be the cause of constipation. Some drugs used can also cause constipation.
Apart from these reasons, the most common cause of constipation in our country and in the western world is; It is the wrong and inappropriate use of many constipation medications that are taken to get rid of constipation that develops as a result of malnutrition in terms of intestinal health and become a habit after a while.
When to go to the doctor in case of constipation?
People who suffer from constipation for a long time should consult a doctor and have some tests done to determine the cause. Apart from this, a doctor should be consulted immediately if there is a recent change in defecation habit, weight loss, severe abdominal pain or blood with defecation. These symptoms can be a sign of a very serious condition. Defecation habits may also change in goiter gland disease and diabetes.
What tests should be done in those with constipation?
First, the severity of the problem should be determined. Physical examination and laboratory tests should be done. Colon film or rectoscopic examinations may be requested. It can be done with a lighted, bendable device called Colonoscopy, where the entire large intestine can be evaluated. In this way, polyps (small or large “mole-like” formations in the intestine) or tumors can be detected.
How to solve the constipation problem?
Eating regular meals, healthy foods and adequate fluids should be taken. Regular exercise, eating fiber-rich foods, to summarize, 10-12 glasses of water a day, physical activity (for example, walking), plenty of fiber diet.
What is fiber?
Fiber is the indigestible part of plant foods. There are 2 types of fiber. Water soluble and insoluble. Water-soluble fibers are digested by bacteria in the large intestine. Oat bran is an example of water-soluble fiber. It also helps in lowering blood cholesterol. Water-insoluble fibers are best for constipation. Examples include wheat bran, cereal grains and the skins of various fruits such as apples and pears.
Why is fiber important?
Fibers increase stool bulk. Fibers retain water, increasing the amount and water content of stool. In this way, they help by increasing the movement of the material in the large intestine along the intestine. It is also very important that they adsorb and dispose of toxic substances.
Where and how much fiber should we get?
30-35 g fiber should be taken per day for a proper movement. (World Health Organization recommendation) There are many foods rich in fiber. Fruits, vegetables, and wholemeal flour are the best examples. Brown rice should be used instead of white rice. Bran is a great source of fiber. It is found in abundance in various natural grain products. Ready bran can be eaten by mixing it with other foods.
Practical Suggestions
In the morning on an empty stomach, after drinking 2 glasses of water on a few dried apricots, dried figs or prunes, after a plentiful breakfast; Whether you need a toilet or not, go to the toilet for 10-20 minutes. It should be seated. The bowel habit that can be achieved in this way will be long-term relaxing. The individual should be given time for this defecation attempt every day in the morning. In this defecation training, better results are obtained in young people. Osmotic excretory agents (Magnesium salts, sodium phosphate, lactulose are from this group) can be used safely for a long time.
Those who cause defecation by stimulating bowel movements are consumed in large quantities in the form of many tablets or dragees in the market. They can cause electrolyte disorders, osteoporosis, protein loss and addiction. Some of them, when used for a long time, may cause pigment accumulation in the intestinal mucosa and lead to the formation called melanosis coli.
Liquid petrolatum, mineral oils can be administered orally or by enema. In severe constipation, especially if there is bloating in the abdomen, the intestine should be emptied with an enema.
