• 02Dec

    Chronic constipation – why does it occur?

    Constipation is a common condition seen in all age groups. It is related to changing dietary habits all across the world. With the ready availability of fast foods or fancy foods or processed food; which is ready to eat, easy to cook, very tasty but lacks fibre (western diet), may be a major factor especially in the young population.

    Traditionally, constipation is defined as three or less bowel movements per week. Lumpy or hard stools are passed with much straining. Many people complain of a sense of incomplete evacuation and may even evacuate the stools manually. 


    Normally, the residual unabsorbed food enters the large intestine from the small intestine. It consists of food residue, water, electrolytes, bacteria and gas. About 1 to 1.5 litres of water and electrolytes are absorbed leaving 100 to 200 ml of moisture content. In slow-transit type of constipation in which the motility of colon is delayed, more water is absorbed, leaving the stools hard.

    Risk factors of chronic constipation

    The risk factors are associated with an increased incidence of constipation.

    Old age: With advancing age the incidence of constipation increases. The responsible factors are decreased appetite, reduced food consumption, reduced exercise, weakening of abdominal and pelvic wall muscles and intake of pain killers.

    Constipation is a common condition seen in all age groups.

    Constipation is a common condition seen in all age groups.

    Gender: Constipation is commoner in females due to the inhibitory effect of progesterone on large intestine. It results in increased absorption of water and constipation.

    Socio-economic status: in population based surveys, constipation has been found to be more common in lower income group.

    Diet: A low intake of fibre is associated with constipation. Increase fibre tends to retain more moisture and prevents constipation. Lack of fluid intake, especially in cold areas where people tend to take more tea/coffee which cause diuresis (increased urine production) may result in dehydration and constipation.

    Causes of constipation

    Drugs: constipation may be drug induced as in case of consumption of opioids, diuretics, antidepressants, antihistamines, antispasmodics, anticonvulsants, and aluminium antacids.

    Diabetes: In long standing diabetes, due to autonomic neuropathy, the gut motility (forward propulsion of food in intestine) is reduced; allowing more time for water absorption in the large intestine. This results in constipation.

    Hypercalcemia: constipation is commonly seen in hypercalcemia caused by hyperparathyroidism, sarcoidosis and bone cancer.

    Hypothyroidism: Constipation is the commonest complaint in these patients. There is infiltration of the intestine with myxedematous tissue. The transit time in the small intestine is increased.

    Pregnancy: Due to a relaxing effect of high levels of progesterone on the large intestine, water is absorbed and constipation occurs. The other contributing factors for constipation in pregnancy include external compression of rectum by the pregnant uterus causing a delay in passage of stools, increased intake of calcium and iron supplements which directly cause constipation.

    Spinal cord injury: In bed-ridden patients with spinal cord injury, the nerve supply to the lower large intestine and rectum is damaged. This results in failure of forward propulsion of stools and constipation.

    Parkinsonism: This disease is associated with deficiency of dopamine in the central nervous system. A defect in dopamine secretion in the nerve supply of the intestines may be responsible for constipation. It manifests with slow colonic transit of stools, diminished contractility of rectal wall, weak abdominal wall muscular contractions required for passing stools and abnormal contractions of anal sphincter mechanism; all contribute to constipation.

    Multiple sclerosis: This is a degenerative disorder of brain and spinal cord. When lower spinal cord is involved, the nerve supply of colon is affected. There is a reduction of colonic motor activity (peristalsis). They may have incontinence of stools.

     Hirschsprung’s disease: Constipation in children occurs in this disease. This occurs because of failure of development of nerve supply of the terminal large intestine and rectum. Because of this, the affected intestine remains collapsed, without allowing the stools to pass. The constipation is severe and may be life threatening.

    Constipation may be functional or secondary to some disease. A sudden change in bowel habit, any weight loss or alternating constipation and diarrhea should raise alarm and calls for a medical consult. The constipation is treated with lifestyle modifications and treatment of cause where feasible.

    Anna L.

    It’s all about health!
    I have academic background in drugs related Chemical Technology, as well as extensive professional experience in pharma and medical companies. My main area of interest is everyday life medicine. The goal of my articles is to give people informative answers to the questions that bother them, to dispel doubts and some common misbeliefs and also to inspire everyone to keep healthy lifestyle.

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Discussion One Response

  1. January 7, 2016 at 2:57 pm

    Madam,I am 70 years old.I was suffering from constipation for 6 months.After gone through your article,I am now able to understand the reason for my suffering.I am taking Cervin A (pain killer daily) along with covomlo for B,P.Now I will meet my doctor to change drug for my B.P.I personally feel such informative articles in simple and easy language without much technical words,even layman can understand,helps many people like me.Kindly continue your good and useful work.I personally like to thank you for your good work.May God give you the blessings for you to continue your work.

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