Managing constipation

The symptoms of “constipation”, Irritable Bowel Syndrome” or defecation disorder evokes concerns of the type: “What is wrong with my gut? Do I have a narrowing or obstruction in my large intestine that is impeding the passage of stools? Could it be colon cancer?, or perhaps an infection or ulcer or swelling somewhere there?”

A thorough history usually helps. One may be able to recognize a temporal pattern with eating late heavy dinners, consumption of excessive chocolates or caffeinated drinks or “stress” (miraculous disappearance of symptoms during vacations or visits to hometown, while recurring on resuming office). On the other hand, loss of weight, weakness, joint pains, red eyes, blood in stools and fatigue could be “alarm symptoms”.

A good starting point is to ensure that there are no structural or serious underlying causes with a good physical examination, a few simple tests such as stool examination especially for occult bleeding, complete blood counts, and sometimes a direct thorough examination of the large intestine by colonoscopy.

If other variants such as poor digestion or intolerance to specific foods are suspected due to loose stools and flatulence, appropriate tests are indicated, especially for gluten sensitivity and lactose intolerance.

Relief or treatment of constipation hinges around three aspects:

■ Getting the character of stools “just right”, that is neither too hard nor too loose, but with some bulk and shape. Adequate amounts of fibre, as in fruits, greens and lentils, and drinking adequate amounts of water helps. Fibre traps water, swell up, give form and shape to stools, and keep the stuff soft.

■ The second aspect is ensuring that the evacuation is smooth, satisfying, and all at one go… giving a sense of complete evacuation. This depends on the coordinated contractions of the muscles of the colon. And quite like our moods and behavior, the muscles of our intestines can choose to be relaxed, coordinated and yielding or tight and difficult, or sometimes sleepy and unresponsive!

■ The third is the “worry factor”: getting to be sure that all is well down there. One feature common to most patients visiting a doctor for this ailment is that the medical files they carry when they walk in to the consultation chamber is bulky, stuffed with several reports of tests and doctors’ prescriptions collected over years.

The last four decades has witnessed a huge surge of interest in biomedical research in trying to understand the mechanisms and causes of this common disorder, and developing medications and methods to modify bowel movements.

Now there are safe non-absorbable agents such as polyethylene glycol, different types of fibres, osmotic agents such as lactulose, liquid paraffin etc. that help soften the stools and give it bulk.

There are also now safe molecules to relax the colon as well as agents to stimulate make it contract and expel stools. And there are new devices and tools to study colonic motility along with a computerized software to teach the patient how to exert the right pressure at the right places to get that satisfactory motion!