Opeyemi Adefemi
A consultant gastroenterologist and Head of the Gastroenterology Unit, University of Benin Teaching Hospital, Edo State, Prof. Casimir Omuemu, discusses the causes, prevention, and treatment of constipation in this interview with OPEYEMI ADEFEMI
What is constipation?
Constipation is a term that has been widely misused and misunderstood. Most times people just use it to describe abdominal discomfort and all that. But by definition, constipation is a situation where an individual does not pass stool as frequently as they used to. Usually, in constipation, the stool is hard. And if you are used to passing stool twice a day and you end up passing it every two days, that is constipation. If since you were born you used to pass stool every three days and that has been your normal pattern since you were born, that is not regarded as constipation. The most important thing is that it is a change in the frequency or pattern of one’s defecation habit.
What are the causes of constipation?
There are so many different causes but the commonest causes include not drinking enough water, and not eating foods with enough roughage and fibre. Foods that contain roughage and fibre include fruits and vegetables and basically unprocessed foods. Other causes include living a very sedentary lifestyle, with a lack of exercise. Some drugs can also cause constipation. Some medical conditions too can cause it; as mild as some kind of abdominal upsets to as severe as cancer. The commonest causes are the first three that I mentioned earlier, which are insufficient water intake, insufficient roughage intake and insufficient exercise. Those are the most common causes.
You mentioned earlier that is a change in one’s stooling habit. Does it have to come with discomfort or does just the change in the pattern represent constipation?
Exactly. Once there is a change, it is constipation. Eventually, if it lasts long enough it will cause discomfort and that is what usually brings the person to seek medical attention. The discomfort comes in form of abdominal swelling, or tightness in the abdomen, or it may just be a feeling of fullness when you have only just eaten a little quantity of food.
Constipation is a symptom of a problem. It is not a problem itself, so all it does to its patient is to make the person uncomfortable. Constipation itself can’t kill but the underlying condition may. Cancer, for instance, can kill if the constipation is stemming from it. If you have constipation over a long period of time it can become uncomfortable. It doesn’t do anything other than abdominal swelling, passing a lot of gas, and causing discomfort.
There is an additional condition that we call the diverticular disease of the colon. That can happen when the colon gets stretched out a bit. That itself is not very dangerous but it makes the person more uncomfortable. If one has hemorrhoids or piles, hardened stool can make one bleed from that hemorrhoids. Other than that, constipation itself is basically harmless.
How is constipation diagnosed?
Most of the time when a patient has constipation, we would just generally examine the person. There are some tests that we would like to conduct to make sure that the constipation is not underlined by a very serious condition. There are three basic tests that we would do. The first is called the stool occult blood test, for which a small sample of the patient’s stool is collected to check if there is blood in it. The second test is what is called the colonoscopy, in which we pass a tube that has a camera through the anus into the intestines to see if anything is causing an obstruction or if there is a tumour. Either it is a cancerous tumour or just a growth that is not cancerous. We’ll be able to see if it is any of these that is blocking the way and in some cases, we even remove the obstruction through the colonoscopy. We can also do what is called a radiological examination. We do a special X-ray or CT scan of the abdomen with a basic ultrasound scan to check if serious problems are causing constipation or if there are any consequences of this constipation already occurring.
Do symptoms differ in people?
Not really, but pregnant women are more prone to constipation than other people because the pressure of that foetus on the intestines can slow down the emptying of the bowel. Otherwise, symptoms are basically the same in children and adults. Constipation tends to occur more in elderly people because they might not eat as much as others and they might often not be active like younger people
What should be the first line of action when one notices constipation?
The first thing is to drink a lot of water. Secondly, eat fruits and vegetables. It is important to note that when you are taking these fruits, it’s not a matter of squeezing out the juice. You should also eat the roughages in fruits, not just the juice.
Can constipation, in any way, become a medical emergency?
Most of the time it is not. But yes, in some rare situations where we have a twisting or a sudden blockage of the intestines causing constipation. The situation would need urgent attention. An operation may even be required to free the part of the bowel that is obstructed, but this is very rare. Most of the time constipation is resolved using simple methods and drugs.
Are there any eating habits that can increase the risk of constipation?
If you don’t eat fruits and vegetables and if you don’t drink enough water. It is not a matter of eating certain things but a matter of not eating enough fruits and vegetables.
How can it be treated?
If you are constipated and you take the first step of drinking a lot of water, eating fruits and vegetables, exercising yourself and the stool is not coming out, then there is a problem. The patient should see a doctor because it is one of those very serious situations. Treatment should begin early rather than doing self-medication at home. I would say simply just take the first three steps: drink water, eat vegetables, and exercise. If nothing happens after a day, see your physician about this
Can antidepressants cause constipation?
As I mentioned earlier, some drugs can cause constipation. Some types of antidepressants, not all, can cause constipation. It depends on the particular one that one is placed on. Some painkillers, and drugs used for treating some upsets. So many different drugs can cause it. Another important thing is that if you are on medication and you are constipated, get back to your doctor. Your doctor will look into it and simply substitute the drug causing constipation with another.
How can it be prevented?
Drink plenty of water. I’m our environment, you should drink at least three liters of water a day. Then eat fruits and vegetables after every meal. That is the healthiest way to take it. Sufficient exercise is equally important. Exercising for between 30 and 40 minutes a day is sufficient for the intestines to be kept active.
Are there foods that should be avoided?
Not really. There is no specific food to be avoided in relation to constipation.
What advice or caution do you have for people during the New Year celebration?
This season there is an opportunity to be offered different kinds of food. You don’t necessarily have to eat everything placed before you. Regardless of what you eat, just make sure you drink a lot of water and eat your fruits and vegetables.
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