2014 Volume 60 Issue 1 Pages 16-24
Constipation is a combination of symptoms, such as fewer than three bowel movements per week, hard stool and a sense of incomplete evacuation. Most patients with constipation treat themselves. However, this does not always produce good management and may induce another illness. It is known that patients with constipation show reduced labor productivity and various increased risks, such as for anal diseases and colon cancer.
There are many causes of constipation. The classifications of chronic constipation are as follows: 1) functional constipation including irritable bowel syndrome, 2) secondary constipation due to systemic diseases, 3) drug-induced constipation, 4) organic constipation due to digestive tract obstruction and 5) uncertain pathogenesis.
It is important to be systemic to make a differential diagnosis. By taking the patient’s history and performing a physical examination, secondary constipation can be diagnosed. If one of the following is found, extensive examination may be required and it may be necessary to consult with a medical specialist: 1) anal bleeding at defecation, 2) more than 50 years old, 3) a family history of colorectal cancer and 4) rapid weight reduction. If constipation improves after stopping medication, it is diagnosed as drug-induced constipation. Most cases of chronic constipation are functional constipation, which can be controlled by improvement of lifestyle in many cases. Namely, an appropriate life rhythm includes good sleep, exposure to sunlight, eating breakfast and regular light exercise. Moreover, in order to improve the intestinal environment, consuming yogurt and dietary fiber, as well as 2 liters of water per day, is favorable. In additional, abdominal massage, adjustment of the defecation posture and producing a relaxed environment promote smooth defecation.
There are several kinds of laxative, such as bulk-forming, stimulant and osmotic. 5-HT4 receptor agonist and tegaserod are also effective for slow-transit constipation.
Although the main approach is always to start with changes in lifestyle and diet before commencing treatment with a laxative, functional constipation should be treated adequately with medicine since it may develop into severer constipation, which may require a surgical operation. However, aimless continuation of medication with stimulant laxatives is not recommended.