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April, 2022 Add comment

Chronic constipation is more than just an annoying persisting physical issue

Chronic constipation is more than just an annoying, persistent physical issue that affects many patients worldwide. In fact, it is so prevalent that it represents a significant economic burden worldwide. This is mainly due to the increased use of health care services. 

In addition to irregular bowel movements, constipation has the following characteristics:

  • Excessive pushing, 
  • A feeling of incomplete stool, 
  • Failed or prolonged attempts to defecate,
  • Use of maneuvers to get the stool out, 
  • A bloated feeling in the abdomen and a hard consistency of the stool. 

It is very important to rule out other causes of constipation first. Various diseases/complaints and medication use can be these causes. After excluding these other causes, chronic idiopathic or primary constipation can be classified as:

  • Functional defecation disorder, 
  • Slow-transit constipation (STC),
  • Constipation dominated irritable bowel syndrome (IBS-C). 

The above classifications are not mutually exclusive, however, there is considerable overlap among them. 

First therapeutic approach is always change in diet and lifestyle

The first therapeutic approach to primary constipation, regardless of the cause, involves changes in diet and lifestyle. In particular, encouraging adequate fluid and fiber intake, regular exercise, and dietary modification is addressed in this approach. This often gives an immediate good solution for the constipation. But unfortunately for a large group of people, this also gives too little relief.

Laxatives, however, in these cases form the basis of pharmacological treatment for long-term therapy. This then especially in this group of patients who do not respond to lifestyle and dietary modifications. 

The Functional Defecation Disorder

Dyssynergic defecation, a functional defecation disorder, is an acquired disorder of defecation that occurs in two/thirds of adult patients. The cause is an inability to coordinate the abdominal, recto-anal and pelvic floor muscles during defecation. Biofeedback therapy is the main treatment for dyssynergic defecation. This is then aimed at improving the coordination of the abdominal, anorectal and pelvic floor muscles.

A large percentage of patients with dyssynergic defecation also exhibit rectal hyposensitivity and may therefore also benefit from sensory biofeedback retraining. This appears to be the most effective treatment, at least in the short term. Often the result of this therapy is an objective improvement in rectal sensory function.

Rectal hyposensitivity is most common in patients with functional constipation with or without fecal incontinence. Furthermore, the cause of rectal hyposensitivity is unclear, although there is limited evidence that a pelvic nerve injury and therefore abnormal toilet behavior plays a certain role. The optimal treatment of patients with rectal hyposensitivity has not yet been determined.

At present, fundamental questions remain unanswered about whether rectal hyposensitivity may contribute to the development of functional bowel disorders. Recognition of the potential importance of rectal hyposensitivity is thus required by clinicians and researchers, providing budget and space to initiate studies to determine its relevance.

Slow Transit Constipation

Scientific understanding in the true causes of STC is evolving. The advent of higher-resolution colon manometry provides a much better view of the colon and its motor patterns. It may provide further insight into pathophysiological mechanisms of the colon and why the peristalsis of the colon is so minimized. In a minority of cases of STC, this method of examining the colon neuropathy indicates a condition that is no longer medically treatable, so colectomy will be a consideration. However, this is a highly invasive procedure. In this procedure, all or part of the colon will be removed along with the associated lymphatics. Fortunately, this drastic procedure is still rare on a percentage basis. 

Irritated Bowel Syndrome-C IBS

About how Irritated Bowel Syndrome-C arises there are still many questions in conventional practices. It is an often still poorly understood condition especially since multiple causative factors are involved. 

Many agree that IBS-C is a functional intestinal disorder. In this, the intestinal function is chronically disturbed and therefore gives many chronic intestinal symptoms. These consist of abdominal pain and stool problems and are often accompanied by gas, a swollen belly, nausea and fatigue. The associated pain may be located in several places in the abdomen and may also vary. 

The enteric nervous system and the nerves in the intestine are extra sensitive in people with IBS, this is the same explanation for the varying pain. By the way, the former term for IBS was spastic bowel. IBS is more common in women than in men. 

There are three types of IBS, and based on the abnormality in the stool pattern, we classify IBS into three types. 

  • IBS-D: This type of PDS occurs more often after experiencing an intestinal infection, the complaint is predominantly diarrhea,
  • IBS-C: This type of PDS occurs more often after experiencing an intestinal infection and the complaint is constipation or constipation, 
  • IBS-G: This is the type of PDS where the complaints of diarrhea and constipation alternate.

There is now a great deal of scientific evidence about the origins of IBS-C

Scientific studies, however, confirm that the onset of IBS-C is linked to increased activation of the gut-brain axis. But also with high visceral sensitivity, changes in gut flora and increased immune activation.  

The increased immune activation occurs because with an altered gut microbiome (leaky gut), many food intolerances can develop. A leaky gut with an altered gut microbiome releases nutrients into the blood too quickly, which triggers constant immune responses. The immunity reactions still largely take place around and in the gut, and so these can create changes in the gut microbiome. This can also change, for example, the peristalsis of the gut. 

Often in the treatment of chronic constipation, intolerant foods are not considered

Often in the treatment of chronic constipation, one does look at dietary changes. Unfortunately, it is not advised enough to test the nutrition from blood at IGg level. Such a test shows which food triggers an immune response and which does not. This is essential in the treatment of IBS-C.

Disrupted functioning of the brain-gut axis can also lead to depression and anxiety disorders, two conditions more common in people with IBS. Irritable bowel syndrome is one of the most common functional gastrointestinal disorders encountered in practice. The ROME criteria are used for the diagnosis of IBS and this is mainly based on symptoms. Because of the many different symptoms of IBS-C, finding the right treatment option is often a challenge. 

In the lifestyle and dietary changes required, the strict elimination of multiple foods are the biggest problem, making the diet difficult to follow. Nevertheless, this following of a proper diet is extremely important in which one also directly rebuilds the gut microbiome. If lifestyle changes do not provide sufficient relief, the starting point of conventional treatment is to prescribe medications for the predominant bowel complaint and the most prominent symptoms. 

Laxatives are then often the first choice

Laxatives and antidiarrheals are then the first choice to treat constipation, but have little effect on abdominal pain. For the treatment of gastrointestinal symptoms, antispasmodics are the most commonly prescribed agent. Low doses of neuromodulators can help control gastrointestinal symptoms and central symptoms. However, these also produce serious side effects, limiting their widespread use. 

For unruly IBS symptoms, the physician in conventional practices then has a further choice of probiotics, antibiotics and histamine receptor antagonists. Patients also seek relief from their symptoms through nonconventional therapy, including psychotherapy, hypnotherapy, osteopathy, acupuncture, or phyto-supplements. In general, all available treatment options provide symptom relief only in a portion of patients. Symptoms may also vary from day to day.

We believe, however, that if your constipation has no underlying issue or disease, it can be resolved with the right lifestyle and dietary rules. There are also wonderful natural-based products for sale that can help you with a perfect bowel transit. These interventions are all completely harmless for you and your digestive track.

Just think

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