recommendations for managing constipation

Introduction

I write this blog so that we all know how to deal with constipation. It is very important to differentiate constipation from irritable bowel syndrome, where the second is associated with relief of abdominal pain after bowel movements and the first does not present pain as an important feature.

Definitions: Normal bowel habit and constipation

We will begin by defining the normal bowel habit as a frequency of 3 stools per week, without defecation effort, painless and with a feeling of complete emptying. On the other hand, constipation is considered as the difficulty that occurs during defecation (at least in 1 out of 4 bowel movements) which can present as pain, need for defecation effort, presence of hard stools, need to use manual maneuvers for the complete emptying of the rectal region, all this associated with less than 3 stools per week. It can also be associated with other symptoms such as postprandial fullness (a feeling of fullness after eating), nausea and flatulence. This disease is more common in women, in people over 65 and in those who do not exercise or suffer from depression.

Causes of constipation

At present, multiple causes of constipation are known, including hypothyroidism, diabetes mellitus, drug use, among others. However, the most common is primary constipation, which can be due to slow intestinal transit and / or a series of lifestyle factors that we will discuss later and how to improve them.

Recognizing constipation

In order to make a proper diagnosis of the disease, it is recommended that people with constipation make a diary of symptoms in order to provide the treating physician with an adequate description of the constipation, as well as an adequate identification of the possible causes of constipation. The diary should include:

When did the constipation start?
Have you recently observed a change in bowel habits?
Do you have no desire to defecate or do you have excessive effort to defecate?
How often do you have bowel movements? How are bowel movements? (Look at the stool consistency table).
Do you have the feeling of having completely emptied your bowel?
Do you have pain coinciding with bowel movements? (Which would make us suspect an irritable bowel syndrome)

In addition, the number of food intakes per day, the hours of the intakes, the amount of liquids consumed per day and if there is laxative consumption, write down which ones.

Warning signs

Once the disease is properly characterized, the alarm signs should be identified, which could make the doctor suspect about a set of dangerous diseases for the person, so if any of the following is evidenced, you should attend a consultation as soon as possible .

WARNING SIGNS
Unexplained weight loss (the person should weigh themselves on the same scale multiple times over time and record the weight in the diary if weight loss is suspected).
Presence of blood in the stools as well as black stools.
Family history of colon cancer
Onset of constipation after age 50.
Presence of anemia.

recommendations

Taking into account the above, we can go on to give recommendations that can improve constipation symptoms and that can be done at home, as long as there are no warning signs:

Perform regular aerobic and / or anaerobic exercise, including exercises that strengthen the abdominal wall and according to the person’s capacity.
Consumption of foods high in fiber such as papaya, pitaya, aloe, kiwi, plums and legumes (can increase the number of flatulence).
Water consumption approximately 1.5 to 2 liters per day.
Create a habit or schedule of defecation, it is recommended after breakfast.
Do not suppress the desire to defecation (for those people who cannot resist the urge to go to the bathroom).
Correct position at the time of defecation (you can place an object that slightly elevates the soles of the feet).

Conclusions

In case there is no improvement with the recommendations suggested above or in case of presenting any of the stipulated warning signs, the person should present to their treating physician with the symptoms diary, without abandoning the recommendations given.

Bibilografía

Mearin Fermín ,Balboa Agustín, Montoro Miguel A. Estreñimiento. Instituto de Trastornos Funcionales y Motores Digestivos Servicio de Apa-rato Digestivo. Centro Médico Teknon. España. Pp 147-160.2012
Lindberg, G., Hamid, S., Malfertheiner, P., Thomsen, O., Fernandez, L. B., Garisch, J., … & Wong, B. (2010). Constipation: a global perspec-tive. World Gastroenterology Organisation Global Guidelines, 11
Calvo, M. D. M. P. (2016). Estreñimiento en adultos. Revista Médica de Costa Rica y Centroamérica, 73(620), 611-615.
Portalatin, M., & Winstead, N. (2012). Medical management of constipation. Clinics in colon and rectal surgery, 25(01), 012-019.
Tack, J., Müller‐Lissner, S., Stanghellini, V., Boeckxstaens, G., Kamm, M. A., Simren, M., … & Fried, M. (2011). Diagnosis and treatment of chronic constipation–a European perspective. Neurogastroenterology & Motility, 23(8), 697-710.

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