Constipation
There are several different definitions of constipation:
- Based on the frequency of defecation (normal = three times a day to once every three days)
- Based on the bulk of the stool (large bulk, difficult to expel)
- Based on difficulty to expel
The causes of constipation can be grouped into three different categories:
- dietary
- abdominal
- anorectal
Dietary
Most of the time, constipation is caused by a lack of dietary fibre. It is therefore important to consume enough fibre, either in the form of:
- raw vegetables (uncooked, since the cooking process destroys fibre)
- fruit (apples, pears or other)
Note that bananas (when consumed daily) are often a cause of constipation.
If dietary or financial restrictions limit the amount of natural fibre in your diet, you can use substitutes such as Metamucil.
Abdominal
Constipation can be caused by different abdominal issues.
Some of the more frequent causes include:
- a dolichocolon (distended colon that has difficulty emptying)
- a colon dependent on the chronic use of laxatives
- colon or rectal cancer, which causes a mechanical obstruction.
In the latter case, there is constipation of recent onset and very often alternating diarrhea and constipation. There may also be blood in the stool or anemia (but not necessarily).
Anorectal
Young children’s rectums are highly elastic and can therefore accumulate a large amount of fecal matter. We’ve all heard how common it is for a young child to clog the toilet when going to the bathroom.
Among women, the anterior rectal wall can be weakened due to delivery. This is referred to as a rectocele. Straining during defecation leads to distension of the rectocele, which further impairs the process.
In adults, dilated hemorrhoidal vessels can form a plug that blocks the anal orifice and thus hinders emptying of the bowels. Straining during defecation then leads to aggravation of the hemorrhoids.
Finally, anal fissure is very often the cause of constipation. Because of the spasm of the internal sphincter and the pain caused by defecation, blockage sets in and becomes chronic. Anal fissures can occur at any age: in children as young as two years old, in adolescents and in young adults. However, it is less frequent after 50 years of age.