Nobody talks about it but it is at the back of everybody’s mind. No complaint had ever given rise to more distress and discomfort than this common and mundane ailment. Yes, I am talking about the problem of constipation which affects about 4% of people worldwide. Such large numbers dictate that we take some measures to alleviate the problem. Constipation is having less than 3 bowel movements per week.
Food as you know moves down the intestine with recurring waves of contraction called peristalsis. Though peristalsis is an automatic process requiring no stimulus its intensity is dependent on how the intestine is stretched by food. . To understand what causes constipation we have to understand something of the ultrastructure of the intestine and the physiology of nerve conduction and muscle contraction
Formation of intestine
From inside outwards the intestine consists of the mucus membrane, lamina propria, the muscularis mucosae, the submucus coat, the muscularis externa and the serous coat. The layers that are of interest to us in understanding constipation are the submucous coat and the muscularis externa. The submucous coat contains two bundles of nerve fibers arranged in two plexuses, the Messner’s plexus and the Auerbach’s plexus. These nerve fibers conduct electrochemical currents in the form of moving sodium and potassium ions. These impulses occur when the nerve fibers are stimulated by the stretch receptors which as their name suggests are themselves stimulated by stretching of the intestine in whose walls they are situated. The muscularis externa contains two layers of smooth muscle cells. These smooth muscles contract when a nerve impulse initiated by stretching of the intestinal walls reaches its cell surface forcing calcium ions into the cytoplasm and making its contractile protein actin and myosin interdigitate. The contraction of these muscle cells forces the stool stored in the intestine through the rectum to the exterior. In constipation, the intestine is not stretched and these muscles do not contract. This is the basic pathophysiology of constipation.
Tips to Relieve Constipation
Now the million-dollar question is –how to relieve constipation. Can constipation be relieved? The answer is yes—to a large extent by dietary changes, lifestyle changes, and laxatives.
Diet The diet has to contain enough fiber, approximately 30 gms per day.
The fiber mixes with water to form a bulky paste that stretches the intestinal wall leading to increased force of defecatory contraction. High fiber foods such as those contained in fruits and vegetables should be eaten High fat or high protein diets should be avoided. Drinking water should be encouraged as water softens the stool and makes it easier to pass.
Changes in Lifestyle: A sedentary lifestyle is discouraged. An active lifestyle with regular exercise each day relieves constipation Also one should set aside enough time for a bowel movement and should not ignore or postpone the urge when it occurs.
Laxatives: If other recourses fail one has to resort to drugs. Drugs that relieve constipation are known as laxatives. There are many varieties of laxatives.
Bulk-forming laxatives: These laxatives combine with water to increase the bulk of the stool.
Stimulants These induce rhythmic contraction of the intestinal muscles.
Osmotic laxatives suck water into the large intestine by osmotic pressure thus increasing the bulk of the stool.
Stool softeners: These laxatives soften the stool making it easier to pass.
Lubricants: These lubricants like liquid paraffin or castor oil grease the stool thus preventing straining during the bowel movement.
Saline Laxatives: Laxatives such as these like the well-known milk of magnesia draw water into the lumen of the gut like a sponge, increasing the bulk of the school and making it easier to pass to the exterior.
Chloride channel activators Drugs such as these increase intestinal fluid thus increasing motility.
Related: How To Relieve Infant Constipation
Laxatives should be used with caution in intestinal obstruction, a disease where fibrous bands forms across the intestine thus obstructing the passage of stool. Too many laxatives may result in the perforation of the gut. Specific conditions causing constipation like rectal prolapse or anorectal dysfunction have their own specific treatments.
Rectal prolapse is a condition where the rectum descends to the exterior turning inside out. This condition is cured by surgery. In anorectal dysfunction, the related muscles are retrained to pass stool. Sensors suitably implanted, display pressure readings on a computer screen which a health technician reads to re-educate the patient. Neurological diseases causing constipation should be treated with specific remedies.
So it is apparent that the hydra-headed problem of constipation can be managed to a great extent with appropriate therapy.