Constipation and Its Complications

Overview

• The opposite of diarrhea; characterized by infrequent, hard, dry stools.
• Can be acute or chronic.
• Causes abdominal distension and pain.
• Important to address to prevent complications like obstructions or ruptures.

Causes of Constipation

• Decreased peristalsis:
  • Slowed movement of food through the GI tract.
  • Leads to more water reabsorption.
  • Results in hard, dry stools that are difficult to pass.
• Alternating diarrhea and constipation:
  • Periods of rapid transit followed by slow peristalsis.
  • Can lead to hard stools after diarrhea.

Factors contributing to Acute or Chronic Constipation:

• Aging:
  • Weaker smooth muscle in the intestines.
• Diet:
  • Inadequate fiber intake.
  • Insufficient fluid intake.
• Reduced physical activity:
  • Muscle atrophy and decreased neural signaling.
• Immobility:
  • Prolonged bedrest reduces muscle activity.
• Delayed defecation:
  • Ignoring the urge to go.
• Neurological issues:
  • Failure to respond to the defecation reflex.
  • Damage to neural pathways controlling muscles involved in peristalsis.
  • Conditions like multiple sclerosis or spinal cord injury impair neuronal signaling.
• Medications:
  • Opiates depress neural activity and peristalsis.
  • Anticholinergics reduce peristalsis

Anticholinergics

• Block acetylcholine, a key neurotransmitter of parasympathetic (rest and digest).
• Effect: Suppress parasympathetic activity, leading to decreased peristalsis.
• Result: Stagnant contents in the intestines with increased resorption time, contributing to constipation.

Other Factors Contributing to Constipation

• Antacids and iron medications:
  • Commonly cause constipation if fluid intake isn’t increased.
• Laxatives:
  • Overuse without adequate hydration can worsen constipation or cause dependency.
• Obstructions:
  • Tumors or strictures (narrowing of the GI tract) impede material passage.
  • Scarring from previous surgeries or inflammation can cause strictures.
    • These blockages cause material to hang out longer in the intestines, increasing absorption of water and leading to harder stools.

Structural Complications

• Hemorrhoids:
  • Swollen veins caused by chronic irritation and straining.
• Fissures:
  • Small wounds or tears in the anal canal caused by hard stools.
• Diverticulitis:
  • Inflammation of diverticula (small outpouchings of the colon wall).
  • Diverticulosis: presence of diverticula without inflammation.
  • Diverticulitis develops if diverticula become infected or irritated.

Prevention and Management

• Prompt bathroom habits:
  • Respond to the urge to prevent stool hardening.
• Maintain a high-fiber diet.
• Stay hydrated.
• Stay active:
  • Exercise promotes normal bowel movements.
• Address underlying neurological or muscular causes.
• Seek medical attention if persistent or complicated.

Summary

• Constipation is caused by slowed or ineffective peristalsis.
• It can lead to hemorrhoids, fissures, diverticulitis, and bowel obstruction.
• Lifestyle modifications and medical interventions are key to prevention and treatment.

• Medications that block parasympathetic activity, like anticholinergics, can lead to or worsen constipation.
• Non-drug factors like medication side effects, obstructions, and strictures also contribute to difficulty passing stool.
• Proper hydration and addressing underlying causes are essential for managing constipation.