Are you also having trouble going to the toilet these days? Let's talk about constipation!

Do you sometimes have to spend a lot of time on the toilet? Do you feel like your stomach is dry? Or do you feel like something is stuck in your stomach even after going to the toilet? This is a problem that many people have and that causes some discomfort. But there is no reason to be ashamed or afraid to talk about it. Today, we will talk in detail about this condition called constipation, or `(Constipation)`.

What is constipation?

Simply put, if you feel the need to go to the bathroom less than three times a week, it is medically known as constipation. However, the frequency of going to the bathroom can vary from person to person. Some people go several times a day, while others go only once or twice a week. Whatever your normal pattern is, it is unique to you, and it is normal. The problem arises when you deviate from that normal pattern. Whatever your toileting pattern, one thing is clear: the longer you wait to go to the bathroom, the harder it is to pass stool. There are several key signs that can help you identify constipation:

• Your stool is dry and hard like a rock.
• I feel pain when going to the toilet, and it is difficult to defecate.
• Even after going to the bathroom, I feel like my stomach hasn't completely emptied.

In fact, this condition called constipation is very common. It's not just you, millions of people around the world suffer from this problem. Therefore, it is important to consider this as normal and take the necessary steps.

How does this constipation occur?

It's very simple. Constipation occurs when your colon (or large intestine) absorbs too much water from your stool. This causes your stool to become dry, hard, and difficult to pass. To explain it a little more, as the food we eat passes through our digestive system, our intestines gradually absorb nutrients. The waste products left over from the digested food are what form stool. This waste passes from the small intestine to the large intestine. The large intestine absorbs water from this waste and makes it solid. If you're constipated, your food takes longer to move through your digestive system than it should. This gives your large intestine more time to absorb water. The result? Your stool becomes dry, hard, and difficult to pass.

What are the causes of constipation?

There can be many causes of constipation. Some things in our lifestyle, the medications we take, and some medical conditions can affect it.

Lifestyle factors

Some of our daily habits can be a major cause of constipation. See if these apply to you too:

• Eating a diet low in fiber : If the foods we eat do not contain enough fiber, stool will not form properly and will not pass easily.
• Decreased water intake (dehydration): When the body does not get enough water, stool becomes dry.
• Lack of exercise: When physical activity decreases, intestinal function also decreases.
• Changes in daily habits: This condition can occur when traveling, eating, drinking, or sleeping times change.
• Eating too much of things like milk and cheese: Some people get constipated when they eat too much of these.
• Stress : Don't be surprised, stress also affects this.
• Holding back when you need to go to the bathroom: This is a mistake that many people make. It's important to do it when the need arises.

Medications

Some medications you take can also cause constipation.

• Some strong painkillers , for example those containing `(Codeine)`, `( Oxycodone - like Oxycontin®)` and `( Hydromorphone - like Dilaudid®)`.
• Nonsteroidal anti- inflammatory drugs (NSAIDs) , such as Ibuprofen (Advil®, Motrin®) and Naproxen (Aleve®).
• Antidepressants , such as `(Fluoxetine - like Prozac®)` or `(Amitriptyline - like Elavil®)`.
• Some antacids, especially those containing calcium or aluminum (such as `Tums®`), are prescribed for gastritis .
• Iron pills.
• Antihistamines , for example `(such as Diphenhydramine - Benadryl®)`.
• Some high blood pressure medications , for example `(Calcium channel blockers)` and `(Beta-blockers)`.
• Medications for some mental illnesses , such as `(Clozapine - Clozaril®)` and `(Olanzapine - Zyprexa®)`.
• Antiseizure medications , for example `(Phenytoin)` and `(Gabapentin)`.
• Some medications for vomiting , such as Ondansetron - Zofran®.

Many medications like these can cause constipation. If you have any questions about the medication you are taking or about this condition, ask your doctor or pharmacist.

Other medical conditions

Constipation can also be caused by certain medical conditions.

• Endocrine conditions, for example, hypothyroidism, diabetes, uremia (accumulation of waste products in the blood due to kidney failure), and hypercalcemia (increased calcium levels in the blood).
• Colorectal cancer.
• Irritable Bowel Syndrome (IBS).
• Diverticulitis (infection of small pouches in the large intestine).
• Weakness of the pelvic floor muscles (outlet dysfunction constipation). These muscles help to expel stool.
• Obstructed defecation syndrome (a condition that causes obstruction of defecation).
• Intestinal pseudo-obstruction (temporary cessation of bowel function).
• Neurologic disorders , such as spinal cord injury, multiple sclerosis, Parkinson's disease, and stroke.
• Lazy bowel syndrome (weakened contractions of the large intestine).
• Intestinal obstruction.
• Structural defects of the digestive system (e.g., `(Fistula)`, `(Colonic atresia)`).
• Multiple organ diseases , for example `(Amyloidosis)`, `(Lupus)` and `(Scleroderma)`.
• Pregnancy.

What are the symptoms of constipation?

A person with constipation may experience symptoms such as:

• Going to the bathroom less than three times a week.
• The stool is dry, hard, and lumpy.
• It is difficult to defecate and it feels painful.
• It feels like a stomach ache and a limp.
• I feel nauseous, as if my stomach is full.
• Even after going to the bathroom, I feel like my stomach hasn't completely emptied.

Who is more likely to develop constipation? (Risk Factors)

Anyone of any age can experience occasional constipation. However, some people are more likely to have this condition on an ongoing basis (`chronic constipation`). Factors that influence this include:

• Age: People over 65 are generally less active than younger people, their metabolism is also a bit slower, and the contraction strength of the muscles in the digestive system may also be reduced.
• Being a woman, especially during pregnancy and after childbirth: Hormonal changes can cause constipation. During pregnancy, the baby in the womb can push on the intestines and slow down the passage of stool.
• Eating less fiber-rich foods.
• Use of certain medications.
• The presence of some neurological diseases (diseases of the brain and spinal cord) and diseases of the digestive system.

Can constipation cause other health problems?

Yes, if the stool is not passed properly and on time, some complications can occur.

• Swelling and inflammation of the veins in the rectum (hemorrhoids).
• Anal fissures (cracks in the skin of the anus) when trying to pass hard stool.
• Infection of stool inside small pouches (diverticula) that form in the wall of the large intestine (diverticulitis).
• Large accumulation of feces in the rectum and anus (Fecal impaction).
• Straining while going to the bathroom can damage the pelvic floor muscles. These muscles also help control bladder function. Straining for a long time can also cause urine to leak from the bladder (stress urinary incontinence).

Important: Constipation usually does not cause toxins to build up in your body and make you sick. Your colon is a structure that can hold waste and expand. However, unless you have a severe condition of the colon (such as ``Toxic Megacolon''), toxins do not leak through its walls.

What happens when you talk to a doctor about this?

Talking to a doctor or anyone else about your toilet habits (or lack thereof!) can be a daunting task. But remember, your doctor is there to help you. They are trained medical professionals, and they have talked to patients about every health topic you can think of. The doctor will first ask you questions about your medical history, toilet habits, lifestyle, and daily routine .

Questions about medical history:

• What illnesses do you currently have and have had in the past?
• Have you lost or gained weight recently?
• Have you had any previous digestive system surgery?
• What medications and supplements do you take to relieve constipation or other illnesses?
• Does anyone in your family have a history of constipation, digestive system diseases, or colon cancer?
• Have you had a ``(Colonoscopy)''?

Questions about toilet habits:

• How often do you go to the toilet?
• What does your poop look like? (color, consistency)
• Have you seen blood or red streaks in your stool?
• Have you ever seen blood on the toilet seat or on the toilet paper after wiping?

Questions about lifestyle and habits:

• What do you eat on a typical day?
• How many fruits and vegetables do you eat?
• How much water do you drink?
• How are your exercise habits?

In addition, the doctor will perform a physical examination. This will include taking your temperature, pulse, and blood pressure. He will listen to your stomach sounds with a stethoscope. He will also palpate your stomach to check for any pain, swelling, or lumps.

Remember, your doctor may also do a rectal exam. This is a quick test that can be felt with a finger to check for any lumps or other problems.

What tests are done to find the cause of constipation?

Your doctor may not do any tests, or they may order various tests and procedures. This will depend on your symptoms, medical history, overall health, and what the doctor thinks is the cause. In most cases, no additional tests are needed to make a diagnosis. However, your doctor may decide to do more tests depending on your symptoms.

• Lab tests: Blood and urine tests can detect conditions such as hypothyroidism, anemia, and diabetes. A stool sample can be tested for signs of infection, inflammation, and cancer.
• Imaging tests: Your doctor may order a CT scan, MRI scan, or lower gastrointestinal tract series to look for other problems that could be causing your constipation. However, these are not usually ordered.
• Colonoscopy: The doctor may do either a ``Colonoscopy`` or a ``Sigmoidoscopy`` - this involves inserting a tube with a camera (``scope``) into the rectum to look inside the large intestine. During this time, a tissue sample (``Biopsy``) may be taken to check for cancer or other problems, and any polyps, if any, may be removed.
• Colorectal transit studies: In these tests, you take a small dose of a radioactive substance, either as a pill or with food, and then the time and way the substance moves through your intestines are monitored.
• Other bowel function tests: Your doctor may order tests to see how your anus and rectum hold and expel stool. These include a special X-ray test called a defecography (used to look for outlet dysfunction and constipation), and tests that involve inserting a small balloon into your anus (a balloon expulsion test and anorectal manometry).

How to get relief from constipation?

Most cases of mild to moderate constipation can be managed at home. Self-care starts with being mindful of what you eat and drink and making the necessary changes. Things you can do at home for immediate relief:

• Drink two to four extra glasses of water a day. Avoid caffeinated drinks and alcohol, which can dehydrate the body. Also, cut down on fruit drinks and highly sweetened beverages.
• Avoid processed meats, fatty foods, and refined carbohydrates like white bread, pasta, and potatoes. Eat lean meats like chicken and low-fat dairy products.
• Include fruits, vegetables, legumes, whole grains, and other fiber-rich foods in your daily diet. Reduce high-fat foods like meat, eggs, and cheese.
• Eat prunes, bran cereal, and fiber-rich fruits like oranges, pineapple, strawberries, mango, avocado, and papaya.
• Keep a food diary and identify which foods cause you constipation.
• Exercise. Even something as simple as walking can help.
• Be mindful of how you sit on the toilet. Raising your legs slightly, leaning back, or sitting cross-legged can make it easier to pass stool.
• Try taking a fiber supplement (such as Metamucil®, MiraLAX®, Citrucel®, or Benefiber®) from a pharmacy. It's best to start small when starting these.
• If necessary, take a stool softener or laxative (such as Docusate) from a pharmacy. Mineral oil enemas and stimulant laxatives are also options. There are many types of laxatives. Ask your pharmacist or doctor for help choosing the right one for you. Do not use laxatives for more than two weeks without consulting a doctor. Overuse of laxatives can make your symptoms worse.
• Don't use things like newspapers or phones while trying to go to the toilet.
• Don't hold back when you feel the need to go to the bathroom. Doing so can block the signal from your colon to your brain (telling you to defecate).

Be careful with medications and supplements.

In addition to self-care measures, your doctor will also look at the medications and supplements you take (if you take any). Some of these can cause constipation. If so, your doctor may recommend changing the dosage, switching to a different medication, or stopping the supplement. Never stop taking your medications or supplements without talking to your doctor first.

Prescription constipation medicine

There are several types of medications that doctors prescribe to treat constipation:

• `(Lubiprostone (Amitiza®))`
• `(Prucalopride (Prudac®, Motegrity®))`
• `(Plecanatide (Trulance®))`
• `(Lactulose (Cephulac®, Kristalose®))`
• `(Linaclotide (Linzess®))`

Based on the results of your tests, your doctor will choose the medicine that is most suitable for you.

Surgery

Surgery is rarely needed to treat constipation. However, if your constipation is caused by a structural problem in your colon, your doctor may recommend surgery. For example:

• Intestinal obstruction.
• Narrowing of a part of the intestine (Intestinal stricture).
• Anal fissure.
• Rectal prolapse is the protrusion of part of the rectum into the vagina.

Some conditions that cause outlet dysfunction constipation can be treated with surgery. This can only be discussed after tests. Also, if a colonoscopy reveals that you have cancer in your colon, rectum, or anus, you may need surgery.

How can you prevent constipation?

The same home remedies used to treat constipation can also be used to prevent it from becoming a chronic problem:

• Eat a balanced diet rich in fiber. Fruits, vegetables, legumes, nuts, and whole-grain breads and cereals are good sources of fiber. Fiber and water help move stool through your colon. Most fruits have fiber in their skins. Fruits that can be eaten with the seeds (like strawberries) are high in fiber. Bran is also a good source of fiber. Eat bran cereal, or add bran to foods like soups and yogurt. People with constipation should eat between 18 and 30 grams of fiber a day. (If you have diverticulitis, your doctor may advise you to avoid fruits with seeds.)
• Drink 8 8-ounce glasses of water a day. (Note: Some people may experience constipation when drinking milk.) Caffeinated beverages like coffee, tea, and soft drinks can dehydrate you. You may want to stop drinking these until your toilet habits return to normal.
• Exercise regularly. It doesn't have to be a lot, even just walking helps a lot.
• A supplement like magnesium can be used for constipation. (Not everyone should take magnesium. Ask your doctor before taking it.)
• When you need to go to the bathroom, do it. Don't delay.

When should I see a doctor?

In such a case, you should definitely see a doctor:

• If constipation is a new problem for you.
• If you see blood in your stool.
• If you lose weight unintentionally.
• If you have severe pain when going to the toilet.
• If your constipation lasts more than three weeks.
• If you have symptoms of `outlet dysfunction constipation`.

What questions should you ask a doctor?

When you see a doctor, you can ask questions like these:

• Why am I constipated?
• What can I do/take to get instant relief from constipation?
• What home treatments do you recommend?
• What should I eat and drink to prevent constipation?
• How else can I prevent constipation?

Remember, be open and honest with your doctor about your toilet habits and any concerns or questions you may have. Going to the toilet is something we all need to do. Constipation can be a temporary condition, a long-term problem, or a symptom of a more serious condition. So be safe. See a doctor, especially if you notice a change in your toileting pattern, or if you feel like your bowels are controlling your life.

Remember the most important thing (Take-Home Message)

So, constipation is a condition that affects many people, but it can usually be managed at home. The main things are to drink plenty of water, eat a high-fiber diet, exercise, and not delay going to the bathroom. Sometimes, it can be caused by medications we take or other medical conditions. So, if you have this problem that continues, or if you have any dangerous symptoms like bleeding, definitely see a doctor and get advice. There is nothing to be ashamed of or afraid of, because your health is the most important thing!

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