Constipation is the infrequent passage (less than 3 times per week) of a hard, dry motion usually with discomfort, abdominal pain and bloating.
Most patients with inflammatory bowel disease suffer with diarrhoea rather than constipation, but for a small number of people constipation may be a real problem.
Many patients who have left-sided colitis also suffer from periods of proximal constipation, i.e. constipation on the right side of the bowel. This tends to exacerbate the colitis and although it is not clearly understood why, it often settles once the bowel has been completely emptied.
One of the main functions of the large intestine is to re-absorb water from food residues which pass into it following digestion. If too much water is re-absorbed the motion becomes hard and difficult to pass.
The main factors contributing towards constipation include:
Once organic causes have been excluded a number of approaches can be adopted for the management of constipation.
Adjustment of the diet is the simplest approach. The greatest proportion of the diet should be made up of fruit and vegetables with whole grain cereal products (e.g. brown rice, high fibre breakfast cereals and wholemeal bread). The fibre should be sufficient enough to produce bowel motions, which are easily passed without causing pain, abdominal bloating and too much wind. Fibre intake should be increased gradually to ensure that fluid intake is adequate.
Adequate daily fluid intake is important in the prevention of constipation. Daily intake should be at least 1.5 litres. High fibre without extra fluids may actually increase constipation. Caffeine and alcoholic beverages may have a dehydrating effect and therefore intake should be limited.
Lack of exercise causes the bowel activity to slow down, thus allowing more water to be extracted from the residues. If your work involves spending large amounts of time sitting or crouched over a desk, ensure that you are more active when at home. For example, where possible, walk instead of using the car, take the stairs instead of the lift and have brief, regular breaks from desk work.
The ‘gastro-colic reflex’ is the movement of the bowel in response to food in the stomach. This is a natural urge to empty the bowel and is usually strongest following breakfast. If the urge is ignored because we are too ‘busy’ the motion remains in the bowel where even more water is extracted making it increasingly difficult to pass. It is also important to allow sufficient time to enjoy regular meals.
Laxatives are substances which stimulate the bowel to move by various actions: