Many people think that not evacuating every day is a sign of constipation. But according to the American College of Gastroenterology (HAG), this is a myth. If your stomach works up to 3 times a week, or even 3 times a day, relax because everything is fine. In constipation, it is important to be a little "be a little watch": what defines is the presence of hard chairs, their small volume and the feeling of incomplete evacuation.
Constipation or constipation is considered to be a fairly common complaint that accounts for about 16% of the population worldwide. Women are most affected by the problem, which can manifest itself at any age, from childhood to adulthood, when its prevalence increases in people over 65 years.
Some of these groups will still suffer from bowel movement and will also have abdominal distension.
Most have been living with constipation for years, therefore, on a chronic basis, but difficulty in evacuating can occur at once, especially during times when changes in diet, travel or between patients in bed occur. In them, the colon moves slower as a result of lack of physical activity or medication use.
Why is this happening?
For 8 out of 10 people, the problem is related to bad lifestyle habits, ie. improper diet, physical inactivity and poor hydration.
"Another very common reason, especially in women, is so-called functional constipation: no physical origin has been identified for the disease," explains Joachim Prado P. Moraes Filo, Professor of Gastroenterology at CMSU (University of S наo Paulo School of Medicine). and a member of the board of CBG (Brazilian Federation of Gastroenterology).
Know other reasons, some rare, some common:
Structural diseases of the colon or rectum (exit obstruction)
- Anti-inflammatory drugs
- Calcium drugs
- Emotional or psychological problems
- In the elderly, loss of muscle strength in the stomach, use of drugs and degenerative diseases (Alzheimer's and Parkinson's)
- In children, the same causes as in adults, especially dietary errors and psychogenic factors, besides Hirschsprung's disease.
- Hormonal and metabolism change
How to recognize the symptoms
In addition to the difficulty in evacuating, you may notice the following signs:
- Abdominal cramps;
- Difficulty eliminating gases;
- Abdominal distension;
- Pain in the anal result of stool dryness and increased faecal bolus, which causes anal cracks that can bleed.
When is it time to seek help?
José aoakim Ribeiro da Rocha, professor of the Colloproctology Department of the Hospital das Clínicas at FMRP-USP (University of Sоo Paulo at Ribeirio Preto Medical School) reports that people usually "get along" with home remedies or self-treatment, without seeking medical help. What these people do not know is that "self-treatment is incorrect, does not address the cause of constipation, and even worsens the picture," he says.
According to the expert, it is ideal to make an appointment to realize that the symptoms persist for more than 30 days without improvement.
Beware of the warning signs: Constipation begins after age 40, there is blood in the stool; weight loss; abdominal fixation or fecal impaction (stool hardening). If you notice any of these situations, make an appointment immediately for a gastroenterologist or proctologist appointment.
Among children, parents should see their pediatrician when symptoms persist for more than 2 weeks or gradually increase shortly after birth.
How is the diagnosis made?
The doctor will collect data on your clinical history, lifestyle and personal and family history, as well as a physical and proctological examination. Additional testing may be required not only to determine your general health, but also to detect any disease associated with your complaint.
Depending on each case, the most important tests are large contrast radiographs of the intestine (opaque enema), colon transit time, blood tests and colonoscopy (if any), rectal biopsy and anorectal manometry – to assess blood pressure. the muscles of the anal region.
In the elderly, in addition to age characteristics, it is necessary to examine colorectal tumors.
How is the treatment done?
Once the diagnosis is defined, the therapeutic approach is always personalized. Gastroenterologist Sandra Beatriz Marion, a professor of medicine at PUC-PR (Parish Catholic University in Paraná), explains that, in most cases, therapy involves changing lifestyle habits.
Patients receive guidance on diet, hydration, and physical activity, as well as strategies for establishing a new bowel movement routine. Fiber based medicines can also be useful and may be of continued use.
"The first thing you need to know is that there is no miracle cure that makes the gut work for a lifetime," says the doctor. "If there is no partnership with the patient, if he is not aware of the importance of these basic concerns, he will not achieve the result he wants," he adds.
For people who do not respond to this strategy, there are a number of remedies available, such as moisturizing chairs (osmotic laxatives) or making them more oily (relaxed). There are also drugs that work to balance a type of intestinal serotonin.
The latter are disturbing laxatives, precisely those that people first use in self-medication. Very powerful, they have an immediate effect, but if used for a long time, they damage the (nerve) gut nerves. The result is that constipation only worsens.
When constipation is more severe, especially in women and the cause is not known, beyond all the possibilities described above, treatment may have a surgical solution by removal of the small intestine or total colectomy (colon removal).
Recently, sacral neuromodulation, a pacemaker in the lumbar region that releases electrical stimuli into the modular nerves, has been used.
Learn how to adjust your diet
Proper consumption of soluble fibers is associated with proper fecal bolus formation, with softer and larger stools, while insoluble fibers accelerate bowel transition. Their indicated daily intake is 25g / day. And it is not useful to eat 5 leaves of lettuce and 1 tomato a day! These products have 0.9 g and 1.5 g fiber respectively.
On the fibers, add proper water consumption (to be calculated by its weight: 0.35 ml per kg) and avoid sedentary lifestyle. Even the introduction of probiotics and prebiotics into the diet can be helpful and necessary.
Nutritionist guidance is welcome. This is because "not everyone responds to the same diet and, therefore, should be evaluated individually, always given their dietary habits, limitations and preferences, to ensure a better outcome," explains nutritionist Camila Naegeli Caverny, Clinical nutritionist and master student at EPM-Unifeps (Paulista School of Medicine, Federal University of Sоo Paulo).
Note that for some people, changing their eating habits is helpful, but it does not completely solve the problem. In this case, the gastroenterologist and nutritionist should work together to provide better results.
How to co-operate with treatment
Constipation is not always possible. However, careful consumption of fiber should be a lifelong habit. Also, always stay well hydrated and engage in regular physical activity.
You can also take the following steps to avoid crisis discomfort or co-operate with therapy:
- Organize the right time to go to the bathroom, preferably in the morning after breakfast – or after eating;
- Go to the bathroom when you feel the need to evacuate. Avoid delaying this urgency;
- They prefer natural and whole foods;
- Drink at least 1 liter and 1/2 fluid per day;
- Learn how to read the label of the products you consume to identify their fiber content;
- Avoid processed and ultra processed foods such as white rice, refined wheat flour, corn flour, flour;
- Table Priority: beans, lentils, peas, brown rice, flaxseed, oats, corn, rye flour, vegetables (all), fruits (all);
- Maintain satisfactory physical activity – 30 minutes, 4 times a week.
Sources: Joachim Prado P. Moraes FiloProfessor of Gastroenterology at FMUSP (Faculty of Medicine, University of Sao Paulo) and member of the Management Board of CBG (Brazilian Federation of Gastroenterology); Jose Joachim Ribeiro da Rocha, Professor of the Department of Coloproctology at the Department of Surgery and Anatomy, Hospital das Clínicas, FMRP-USP (University of Sоo Paulo at Ribeiro Preto Medical School) and physician in charge of Ribeiro Pretto Proctogastro Clinics; Sandra Beatriz Marion, Professor at the Medical School of PUCH-PR (Pontic Catholic University of Paraná), a specialist in gastroenterology and a qualified endoscope; Camilla Nigel Cavern, Clinical Nutritionist at the Headache Center Brazil and MSc Student of EPM-Unifes (Paulista Medical School, Federal University of Sao Paulo). Technical inspection: Sandra Beatriz Marion.
References: Ministry of Health; ACG (American College of Gastroenterology); Maria Vasquez Rook, Ernest P. Buras. Epidemiology and management of chronic constipation in the elderly. Clinical interview aging. 2015; Constipation Treatments: An Overview of Systematic Reviews. Rapid Response Report: Critical Assessment Summary. Ottawa (ON): Canadian Agency for Medicines and Health Technologies; 2014