Nothing debilitates like chronic constipation. People feel embarrassed to talk about it, feel shy in discussing it but agree nevertheless that this disease is energy-sapping and concentration dissolving. Having less than 3 bowel movements per week is called constipation. 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.
All about intestine and muscular contractions
From inside outwards the intestine consists of the mucus membrane, lamina propria, the muscular mucosae, the submucous coat, the muscular externa, and the serious coat. The layers that are of interest to us in understanding constipation are the submucous coat and the muscular 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.
Reasons for constipation
There is another reason why constipation occurs and that is when stool moves through the colon, water is gradually absorbed from the fecal mass. If too much water is absorbed the stool becomes hard and is difficult to excrete.
Chronic constipation is caused by a variety of causes. Let us consider them one by one together with their antidotes. Then we would have answered the question—What to do in chronic constipation?
Diets deficient in fibers cause chronic constipation.
Fibers mix with water to form a gelatinous mass which stretches the intestine thus promoting stool emptying. In chronic constipation, one should include in his diet, fruits, and vegetables which have a lot of fibers in them. A high protein diet in eggs or meats will cause chronic constipation.
Drinking a lot of water
It cures to a large extent chronic constipation. Water softens the stool and makes it easier to pass to the exterior.
Related: How To Avoid Getting Constipated
Physical inactivity gives rise to constipation.
That is why elderly men, bedridden patients, and the infirm all suffer from chronic constipation. An active lifestyle should be led.
Changes in the routine of life
Changes like pregnancy cause constipation either due to hormonal changes or because the enlarging uterus presses down on the intestine. Things will revert back to normal when this phase passes.
Persons taking laxatives for a long time develop chronic constipation as their bodies become tolerant to the dose. The cure is either to stop laxatives or switch to another form of laxatives.
Suppositories and enemas are available over the counter for people with chronic constipation.
Parkinson’s disease, multiple sclerosis, pseudo-obstruction, stroke, and spinal injuries cause severe constipation followed by metabolic diseases such as diabetes, uremia, hypercalcemia, and hypothyroidism
You are advised to consult a doctor or neurologist as the treatment in each case is different.
Diseases that occlude the lumen of the intestine like diverticulitis, intestinal adhesions, and colorectal strictures cause chronic constipation. The treatment is both surgical and medical.
If nothing works for you, you have to take recourse to laxatives to cure your problem.
There is a large variety available.
Bulk-forming laxatives generally increase the bulk of the stool promoting defecation. Stimulants induce rhythmic contraction of the intestine facilitating absorption Osmotic also increases the bulk of the stool by drawing in water to the lumen of the intestine by osmotic pressure. Stool softeners soften the stool while saline laxatives grease the stool and the anus making it easier to pass excreta. Saline laxatives like milk of magnesia draw water into the lumen like a sponge increasing the bulk thus making it easier to pass the stool to the exterior. Also available are chloride channel activators that increase intestinal motility.
In conclusion, I can state that though the problem of constipation is worrisome there are remedies readily available at hand and for the sufferers, the future is bright.