Bowels that open infrequently with hard, uncomfortable motions.

Causes of Constipation

Whereas diarrhoea results from excess fluid in the large intestine, constipation is quite the opposite. The contents of the bowel stay so long that excess fluid is absorbed, leaving the motions so hard that they are difficult to pass. Constipation also occurs if something obstructs the passage of motions or reduces the normal rhythmic contractions of the intestines.

Delayed transit time

This extremely common cause affects everyone at some time and the elderly more than most. There is a reduction in the bowel’s rhythmic contractions that normally push food

through the system. Faeces accumulate within the large intestine; the longer they stay the more water is extracted and the harder they become. Eventually the bowels open through sheer weight of material, although it can be painful and leaves the individual feeling that the bowel is incompletely emptied.

Children often deliberately withhold opening their bowels for reasons clear to Sigmund Freud but unclear to everyone else. The resulting pain on defecation leads to a vicious circle of further retaining of motions.

Obstruction and other factors

In an older person, persistent change of bowel habit to constipation (or diarrhoea) could indicate a growth in the large bowel, especially if the change in bowel habit is accompanied by pain or bleeding. Rarely, children are born with congenital malformations of the bowel which interfere with defecation.

Constipation is a feature of both severe depression and an underactive thyroid gland (see Thyroid problems). Most powerful painkillers also cause constipation, for example codeine, morphine and co-proxamol. This can be a problem for those individuals who need to take such painkillers for chronic pain. Constipation is a feature of irritable bowel syndrome and is common during pregnancy (see Pregnancy problems). Constipation can also be an indicator of inadequate dietary fibre.

Symptoms of Constipation

There is no definition of constipation in the sense of how much, how often. People vary from having a bowel action twice a day to having one once a week. Therefore constipation is defined by reference to your usual bowel habit and not by reference to any rules. If the bowels are opened only infrequently but without straining there is no reason for concern, whereas a daily struggle may indicate a problem.

Constipation plus blood in older people needs full investigation. Sudden constipation plus abdominal pain and distension is typical of a bowel obstruction needing emergency care.

Treatment of Constipation

Temporary constipation responds to increased fluid or a laxative. Some laxatives, for example senna, stimulate the muscle of the bowel to move faeces faster and can lead to uncomfortable cramps. Others, such as lactulose or fibre drinks, draw water back into the motions. If necessary a suppository will stimulate the bowel quickly; an enema literally washes out the bowel. Sometimes children with constipation resistant to mild laxatives may have emotional problems that need unravelling. All cases benefit by increasing the amount of fibre in the diet.

Techniques for investigating possible bowel cancer include sigmoidoscopy, colonoscopy to look at the lining of the bowels or a barium enema.

QUESTIONS

Are regular laxatives harmful?

Stimulant laxatives such as senna lead to reduced muscular activity of the bowel and are not advisable. Those that retain fluid and fibre drinks are safe for long-term use.

Why is constipation so common in the elderly?

Older people eat less and often take less bulky foods. They exercise less (immobility is constipating) and may be on painkillers that have constipation as a side effect.

Complementary Treatment

Consult a nutritional therapist or naturopath; boost your fibre intake. Acupuncture and Chinese herbalism – see Diarrhoea. Chakra balancing reduces pain and relaxes the abdominal wall, stimulating defecation. Aromatherapy oils to stimulate digestion are black pepper, marjoram and rosemary. Hypnotherapy can get the bowel moving regularly. Ayurveda offers bowel cleansing with various enemas and laxatives. Other therapies to try: homoeopathy; tai chi/chi kung; auricular therapy; cymatics; shiatsu-do; yoga.

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