Difficulty moving bowels is termed as constipation. As mentioned by Dr. Praveen Kumar in "Clinical Medicine," constipation is more a perception than a real entity. Constipation affects approximately one in five people. The definition of constipation includes passage of stools less than three times per week, straining during stools, passage of hard stools and an incomplete sense of defecation following the passage of stools. While most causes of constipation are not serious, constipation is occasionally the sign of something more ominous and should be investigated by a doctor.
Normal and Slow-Transit Constipation
Normal transit constipation is due to an individual's perception. Though they may have bowel movements at a normal intervals, these people may feel for some time that the frequency of passage is decreased or that they have difficulty passing stool. Slow-transit constipation often begins in adolescence and is more common in females. As the name suggests, it is due to decreased activity of the large intestine, resulting in infrequent passage of stools. The main treatment for these kinds of constipation is to increase dietary fiber. Because fiber is not absorbed, it is goes into the colon and causes more frequent bowel movements.
Hormonal Problems
Diabetes mellitus can cause constipation as it causes decreased activity of nerve impulses to the large intestine, leading to decreasing activity. Hypothyroidism can cause constipation, tiredness and weight gain. Elevated calcium levels, due to a tumor in the parathyroid gland, can lead to fatigue, stomach pain and constipation. These causes of constipation can be corrected by treating the underlying diseases.
Bowel Causes
Irritable bowel syndrome can cause episodes of constipation, alternating with episodes of diarrhea. Painful conditions involving the anus, such as a fissure in ano, can lead to constipation as the person consciously or unconsciously suppresses the bowl movements. Most importantly, cancer of the colon or rectum can cause constipation. This should always be considered in an older individual complaining of infrequent passage of stools. In such cases, patients should be examined by colonoscopy to identify possible tumors in the bowel.
Other Causes
A variety of other causes are associated with constipation. Psychiatric disorders such as depression and anorexia nervosa can lead to this symptom. Pregnancy can also lead to constipation due to compression of the uterus against the colon. Medications, including opiates, calcium channel blockers, iron pills and some antidepressants may cause difficult bowel movements as a side effect. Parkinson's disease and conditions of the spinal cord may lead to constipation as well.
References
- "Kumar and Clark's Clinical Medicine"; Praveen Kumar et al.; 2009
- "Davidson's Principles and Practice of Medicine"; Nicholas A. Boon et al.; 2010
