New Technique to Improve Bowel Function (Constipation)
The bowel is considered to be a part of the digestive or gastrointestinal system. It is designed to help the body absorb nutrients and fluids from the foods we eat and drink. After taking out everything the body needs, the bowel then expels the leftover waste.
Constipation or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest; it may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction.
In general, though, you're probably experiencing constipation if you pass hard and dry stools less than three times a week. In some cases, constipation also may make you feel bloated or sluggish or experience discomfort or pain.One out of six adults in developed countries suffers from IBS, a chronic condition marked by abdominal pain and disturbed bowel function.
Constipation may involve pain during the passage of a bowel movement, inability to pass a bowel movement after straining or pushing for more than 10 minutes, or no bowel movements after more than 3 days. Infants who are still exclusively breastfed may go 7 days without a stool.
About 16-37% of school-aged kids are affected by constipation. Constipation with overflow soiling affects at least 4% of preschool kids and 1-2% of school-aged kids. In school-aged kids, encopresis is most likely to affect boys.Fortunately, a few common-sense lifestyle changes, including getting more exercise, eating high-fiber foods and drinking plenty of water, can go a long way toward preventing or alleviating constipation.
The term fiber refers to carbohydrates that cannot be digested. Fiber is found in the plants we eat for food — fruits, vegetables, grains, and legumes. Sometimes, a distinction is made between soluble fiber and insoluble fiber. Soluble fiber partially dissolves in water and has been shown to lower cholesterol. Insoluble fiber does not dissolve in water, but that's why it helps with constipation. It's important to include both kinds of fiber as part of a healthy diet.
Increases in fluid intake and physical activity do not appear to relieve chronic constipation, except in patients who are dehydrated. Patients with normal-transit or slow-transit constipation should increase their fiber intake to 20 to 25 g per day, either with changes in their diet or with commercial fiber supplements.
The consistency of the stool is dependent upon many things, including how long the stool sits in the colon, how much of the water has been absorbed from the waste, and the amount of fiber and fluids in your diet.
Patients who do not have a response to fiber therapy should try an osmotic laxative such as milk of magnesia, sorbitol, lactulose, or polyethylene glycol. The dose of the osmotic laxative should be adjusted until soft stools are attained. Colonic stimulants, such as bisacodyl or senna derivatives, and prokinetic medications, such as tegaserod, a partial 5-hydroxytryptamine4–receptor agonist, should be reserved for patients with severe constipation who do not have a response to fiber or osmotic laxatives.
You may experience a bloated feeling and have gas when adding fiber to your diet, but this should pass in a few weeks. It is important to avoid regular use of laxatives and enemas as they decrease the bowels function.Also some laxatives will cause chemical burning of the colon if over used creating problems.
Laxatives can cause damage to the bowel by irritation or lack of use. The colon constantly flowed by liquid movements should not function as well as if it were working as designed dealing with a solid plastic mass. It is as in weight lifting. Strength is developed working against the appropriate load.
A clinical trial shown that eight of 11 patients experienced an improved bowel pattern while on colchicine compared with placebo, as defined by an increase in total number of bowel movements or a decrease in total number of rectal laxatives used. No clinically important complications were related to use of colchicine.
Another clinical data shown that treatment with linaclotide increased frequency of bowel movements and reduced the straining and abdominal discomfort associated with chronic constipation.
If you've tried loading up on fruits, vegetables and whole grains and still can't get relief from constipation, maybe you need more than a boost of fiber.
"The idea that many patients have, and unfortunately their physicians, if we just keep pushing fiber until the grass grows out of their behind they'll have been treated successfully, that's not really true," said Dr. Arnold Wald, a professor of medicine in the section on gastroenterology and hepatology at the University of Wisconsin.
Doctors recommend consuming fiber, because it's easy to take and cheap, he explained, but it doesn't work for every patient. That's because constipation is a symptom that can have many different causes.
About 80 percent of people suffer from constipation at some point in their lives, according to the American Society of Colon & Rectal Surgeons. Brief bouts of constipation are normal. But when symptoms persist, people may need to consult a physician.
Anyone who experiences at least two symptoms of constipation for at least three months -- not necessarily consecutively -- over a period of six months is considered chronically constipated, said Dr. Satish S.C. Rao, a professor of internal medicine and director of neurogastroenterology and gastrointestinal motility at the University of Iowa in Iowa City.
The symptoms are excessive straining, hard stools, a feeling of incomplete evacuation, a sensation of blockage in the anorectal region, use of digital maneuvers to facilitate a bowel movement, and a stool frequency of less than three bowel movements a week, he said.
People become constipated when the colon absorbs too much water or if muscle contractions in the colon become too slow or sluggish, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Diets that are low in fiber and a lack of exercise are believed to be common causes of constipation.
But constipation can also be a side effect of other health problems, Rao explained. Many medications, including painkillers and antidepressants, can cause constipation, for example. And, the NIDDK noted, certain neurological disorders, such as Parkinson's disease; metabolic and endocrine conditions, including diabetes; and systemic disorders, such as Lupus, also can cause problems by slowing the movement of stool through the colon, rectum or anus.
For some people, constipation is the direct or "primary" result of colonic nerve or muscle dysfunction. This group of people includes patients with "dissynergy defecation," a problem that has only been recognized in the last 15 years, Rao said.
"The problem is that the individual has the inability to coordinate the pelvic floor muscles and anorectal muscles to evacuate stool, so many of them have a sense of stooling, but they can't pass, or they only pass small amounts, or incompletely and so on," he said.
Rao and his colleagues recently examined a technique for teaching these patients to improve bowel function. The study, published in the journal Clinical Gastroenterology and Hepatology, compared the use of biofeedback therapy with either sham biofeedback sessions or standard treatments consisting of diet, exercise and laxatives. The biofeedback group came out "far, far superior" to the other two groups, he reported.
Dr. Henry P. Parkman, a professor of medicine and director of the GI Motility Laboratory at Temple University School of Medicine in Philadelphia, said he uses biofeedback -- a form of complementary medicine in which the patient uses the mind to control the body -- quite a bit in his own practice. "It has a response rate of 50 to 75 percent," he said.
Another type of "primary" constipation, called "slow-transit constipation," takes patients longer to pass stool. There's also irritable bowel syndrome (IBS) with constipation, which causes abdominal pain or discomfort.
Until recently, Zelnorm, a drug made by Novartis Pharmaceuticals, had been approved for treating both groups of patients. But on March 30, the company pulled it from the market after new data indicated an increased risk of heart attack, stroke and death. Gastroenterologists say the move leaves a gap in treatment options, particularly for treating women with IBS with constipation.
Like anything else, constipation can vary in frequency and severity, and only when it becomes "a real problem" will people need to seek referrals for specialty tests and treatment, Wald said. In fact, he added, most people may find relief on the shelves of their local pharmacy or grocery store. They can try stimulant laxatives or polyethylene glycol, an over-the-counter stool softener. There are also natural stimulants like raisins and prunes.
And there's always fiber.
"Diet doesn't work in every scenario," Rao said, "but for occasional constipation, that is the group that I think diet will be effective for.
- drink 1500 - 2000 ml of fluid a day, preferably water to minimize gas, bloating and constipation.
- eat 20-30 gm of fibre every day and eat 5 servings of fruit and vegetables every day.Chocolate,coffee and alcohol might cause constipation
- Inactivity reduces bowel function, whereas exercise helps stimulate the bowels and improve regularity. Individuals who are bedridden have increased problems with constipation, and may develop a blockage of stool in their rectum (i.e. fecal impaction).DO walk briskly for at least 20 minutes every day.
- Empiric treatment may be tried initially for patients with functional constipation. Management of chronic constipation includes keeping a stool diary to record the nature of the bowel movements, counseling on bowel training, increasing fluid and dietary fiber intake, and increasing physical activity.