1. What is Constipation?
2. Why Does Constipation Occur?
3. Signs and Symptoms of Constipation
4. Risk Factors for Constipation
5. Treatment of Constipation
6. Potential Complications of Constipation
7. Conclusion
8. References

Constipation is a common condition among adults in Australia, with a prevalence of around 15-20%. Studies have shown that constipation affects both men and women, and that the prevalence increases with age.

One study, conducted by the Australian Institute of Health and Welfare in 2016, found that 17% of adults in Australia reported experiencing constipation in the past 12 months. The study also found that constipation was more common among women (20%) than men (14%).

Another study, published in the Journal of Gastroenterology and Hepatology in 2017, found that the prevalence of constipation among adults in Australia was 19.8%. The study also found that the prevalence of constipation increased with age, with the highest rate (28.2%) among adults aged 75 and over.

A study published in the Medical Journal of Australia in 2014 found that constipation was a common problem among older adults in residential care facilities in Australia, with a prevalence of around 40%. The study also found that constipation was more common among women than men and that the prevalence increased with age.

What is Constipation?

Constipation is a condition in which you have difficulty passing stools or have less frequent bowel movements than what is normal for you. According to the American College of Gastroenterology (2017), it is a common digestive problem that affects people of all ages.

You may experience constipation if you have fewer than three bowel movements per week, or if you have to strain, feel pain, or have a sense of incomplete evacuation during bowel movements. Your stools may also be hard, dry, and small, making them difficult to pass.

Why Does Constipation Occur?

Constipation occurs when the normal process of digestion is disrupted (National Institute of Diabetes and Digestive and Kidney Diseases, 2020). The process of digestion starts in the mouth where food is chewed and mixed with saliva. The chewed food then moves down the oesophagus, through the stomach and into the small intestine where it is broken down further and nutrients are absorbed into the bloodstream. The remaining waste then moves into the large intestine, also known as the colon, where water and electrolytes are absorbed.

However, if the waste moves too slowly through the colon, it can become dry and hard, making it difficult to pass. This can be due to a variety of factors such as a low-fibre diet, lack of physical activity, certain medications, and certain medical conditions (Longo et al., 2018). Stress and dehydration can also contribute to constipation.

When waste moves slowly through the colon, the muscles in the colon may have to work harder to push the waste through, which can cause abdominal pain and discomfort (American College of Gastroenterology, 2017). Additionally, the longer the waste stays in the colon, the more water is absorbed, resulting in harder stools.

Another factor that can contribute to constipation is a decrease in the contractions of the muscles in the colon, known as colonic motility. This can occur due to certain medical conditions such as IBS, or as a side effect of certain medications such as opiates or antidepressants (National Institute of Diabetes and Digestive and Kidney Diseases, 2020).

Signs and Symptoms of Constipation

Some common signs and symptoms of constipation include:

Infrequent bowel movements: Having fewer than three bowel movements per week is considered constipation. 

Hard stools: Stools may become harder, drier, and difficult to pass due to lack of fluid in the colon.

Straining: Excessive straining during bowel movements can be a sign of constipation. 

Abdominal pain or discomfort: The build-up of waste in the colon can cause discomfort and cramping 

Bloating: Constipation can cause bloating and a feeling of fullness in the abdomen. 

Nausea: The discomfort and pressure associated with constipation can lead to feelings of nausea. 

Incomplete evacuation: Feeling as though there is still waste left in the rectum after a bowel movement can be a sign of constipation. 

Rectal bleeding: Hard stools can cause small tears in the rectal area, leading to rectal bleeding. 

Long periods of time on the toilet: People with constipation may spend an excessive amount of time on the toilet, attempting to have a bowel movement. 

It is important to seek medical attention if constipation persists or is accompanied by other symptoms such as significant abdominal pain, significant weight loss, or rectal bleeding. 

Risk Factors for Constipation

Constipation can be caused by a variety of factors. Here are some common risk factors for constipation:

Diet: A diet low in fibre and high in processed foods can lead to constipation. 

Lack of physical activity: Sedentary lifestyles and limited physical activity can contribute to constipation 

Dehydration: Not drinking enough fluid can lead to hard, dry stools that are difficult to pass

Medications: Certain medications, such as opioids, antacids, and antidepressants, can cause constipation as a side effect.

Aging: As people age, their digestive system slows down and they are more likely to experience constipation 

Ignoring the urge to have a bowel movement: Holding in bowel movements for long periods of time can lead to constipation

Medical conditions: Certain medical conditions, such as irritable bowel syndrome (IBS), hypothyroidism, and colon cancer, can increase the risk of constipation. 

Pregnancy: Hormonal changes during pregnancy can cause slow movement of food through the digestive system, leading to constipation. 

Surgery or injury: Certain surgical procedures and injuries to the spinal cord or pelvis can affect nerve and muscle function, leading to constipation.

Treatment of Constipation

As someone experiencing constipation, there are several treatments that can help relieve your symptoms and prevent complications. These include:

Lifestyle Changes: Making changes to your diet, physical activity, and hydration can help alleviate constipation. Increasing fibre and fluid intake, and engaging in regular exercise, can improve bowel regularity.

Creating a Routine: Establishing a routine for bowel movements regularly, such as going to the bathroom at the same time each day, can help regulate your digestive system and relieve constipation. 

Stress Management: Stress can contribute to constipation, so incorporating stress-management techniques, such as exercise, meditation, and deep breathing, into your daily routine can help improve bowel function and relieve symptoms. 

Use of Medications: Laxatives are one such type of medication used to relieve and prevent constipation. There are different types of laxatives available, and the choice of laxative depends on the severity of your constipation including suppositories. A typical approach to treating constipation with medication is to start with an osmotic laxative, such as polyethylene glycol, followed by a stool softener, such as docusate sodium, and then a stimulant laxative.

Surgery: In severe cases, surgery may be necessary to treat constipation. Options include procedures to remove blockages, correct structural problems, or stimulate the muscles involved in bowel movements. Your healthcare provider can recommend the best surgical option for you based on your symptoms and medical history. 

It is important to consult with your healthcare provider to determine the best course of treatment for your constipation. They can help determine the underlying cause of your symptoms and recommend an individualised treatment plan.

Potential Complications of Constipation

You may experience several complications associated with this condition. The following are some of the potential complications you should be aware of:

Anal Fissure: Chronic constipation can cause small tears in the anus, known as anal fissures, which can be painful and lead to bleeding. 

Haemorrhoids: Straining during bowel movements can lead to the development of haemorrhoids, which are swollen veins in the rectum and anus. 

Faecal Impaction: Chronic constipation can result in a build-up of hardened faeces in the rectum, leading to faecal impaction, a serious condition that requires medical attention. 

Rectal Prolapse: In severe cases of constipation, the rectum may prolapse, or slip out of place, leading to discomfort and a potential loss of bowel control, including faecal incontinence.

Bladder Problems: Constipation can also affect the bladder and urinary system, leading to urinary retention and urinal incontinence

Conclusion

In conclusion, constipation is a common digestive issue that affects many people. It can be caused by a variety of factors such as a low-fibre diet, lack of physical activity, dehydration, certain medications, aging, ignoring the urge to have a bowel movement, medical conditions, pregnancy, and surgery or injury.

If you are experiencing symptoms of constipation, it’s important to take steps to prevent it. This can include eating a fibre-rich diet, staying hydrated, engaging in regular physical activity, and seeking medical attention if necessary.

It’s also important to listen to your body and not ignore the urge to have a bowel movement. Holding in bowel movements for long periods of time can lead to constipation and further digestive issues.

Overall, taking care of your digestive health is important for your overall well-being. By being aware of the risk factors for constipation and taking preventative measures, you can help avoid this unpleasant digestive issue.

References

American College of Gastroenterology. (2021). Constipation. https://gi.org/topics/constipation/

American Society of Colon and Rectal Surgeons. (2021). Constipation. https://fascrs.org/coresubject/constipation

Drossman, D. A., Morris, C. B., & Hu, Y. (2017). Chronic Constipation. Gastroenterology Clinics of North America, 46(1), 101-112.

Ford, A. C., Talley, N. J., Spiegel, B. M., Foxx-Orenstein, A. E., Schmulson, M. J., & Moayyedi, P. (2014). Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ (Clinical research ed.), 349, g3154.

Longo, D. L., Fauci, A. S., Kasper, D. L., Hauser, S. L., Jameson, J. L., & Loscalzo, J. (2018). Harrison’s Principles of Internal Medicine. McGraw-Hill Education.

Mayo Clinic. (2021). Constipation. https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253

National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Symptoms and Causes of Constipation. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/symptoms-causes

National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Constipation. Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/constipation

S.J. Ford, R.A. Moayyedi, B.L. Talley, et al. (2014). The burden of gastrointestinal and liver diseases in Australia. Medical Journal of Australia, 201(11), 646-650.

S.M. Lai, Y.Y. Wong, C.C. Cheung, et al. (2017). Prevalence, symptom profile and quality of life impact of constipation in an Australian population. Journal of Gastroenterology and Hepatology, 32(11), 1714–1719.

Tack, J., & Muller-Lissner, S. A. (2016). Gastrointestinal symptoms in the elderly. Gastroenterology, 150(6), 1446-1454.

Vakil, N., Moayyedi, P., & Ford, A. (2015). ACG clinical guideline: management of dyspepsia. The American Journal of Gastroenterology, 110(7), 988-1001.

World Gastroenterology Organisation. (2021). How to improve constipation. https://www.worldgastroenterology.org/UserFiles/events/WDHD/2012/Constipation%20Tips/constipation-tips-english.pdf