CONSTIPATION
What is constipation
Constipation is a disorder of intestinal motility characterized by a reduced frequency of evacuation (less than three times a week), a marked effort in the expulsion of feces or a sensation of incomplete emptying of the rectum (tenesmus).
In physiological conditions, the colon absorbs water from food residues; a slow intestinal transit leads to excessive reabsorption of water, hardening the feces and making their elimination more difficult.
Constipation, although often benign, can be associated with complications such as hemorrhoids, anal fissures and pain during defecation.
It is important to pay attention to sudden changes in bowel habits, as in rare cases they could represent the first sign of more serious pathologies, such as colorectal cancer.
Chronic constipation is defined as a persistent condition, lasting at least three weeks, in which fewer than three bowel movements occur per week.
It affects approximately 16% of the adult population in Western countries, with a prevalence of up to 30% over the age of 60.
The most common symptoms include straining to evacuate, hard or fragmented stools (ball-shaped), prolonged defecation time, sensation of incomplete bowel emptying, abdominal pain and, in the most severe cases, anal lesions such as fissures.
The symptoms may vary between individuals, but the impact on quality of life is often significant.
A correct diagnosis and a targeted nutraceutical approach can contribute to improving intestinal function.
Constipation is a very common condition in pediatric age and can have various causes. In most cases, however, it is a functional problem linked to behavioral and educational factors.
Many children develop the habit of holding in stool early, often due to a variety of painful experiences associated with evacuation (hard stools, anal fissures, bleeding). This triggers a vicious circle: the more you hold in your stool, the more it dehydrates, becoming hard and painful to expel.
Hence the need for a rigorous approach based on:
– a diet rich in fiber and liquids,
– education to listen to the evacuation stimulus,
– reassurance and emotional support.
Other children avoid bowel movements outside the home due to embarrassment or insecurity, while stressful events (moving, family conflicts, school anxiety) can alter intestinal regularity.
In the most serious cases, actual fecal obstructions form, which require specific interventions and do not resolve spontaneously.
Early intervention, educational and nutritional, is essential to avoid the chronicization of the disorder.
Many elderly people consume refined and low-fiber foods, also due to chewing difficulties or poor appetite, often associated with loneliness or depression. Furthermore, to avoid frequent urination at night, some individuals (especially men with prostatic hypertrophy) tend to limit fluid intake, further compromising stool hydration.
Reduced mobility (bedridden, sedentary lifestyle, prolonged hospitalizations) and the chronic use of drugs such as antidepressants, antihistamines, antacids, diuretics and antiparkinsonian drugs aggravate the slowing of intestinal transit.
Not infrequently, the fear of constipation leads to habitual and often improper use of stimulant laxatives, with consequent tolerance and loss of natural motility of the colon. Correct management of senile constipation requires integrated interventions: diet, hydration, adapted physical activity, pharmacological review and educational support.
The causes of Constipation
Chronic constipation is a multifactorial disorder, often a symptom of functional alteration rather than an actual disease. Its causes can be multiple and, in some cases, not clearly identifiable.
However, there are numerous recognized predisposing factors.
1. Inadequate diet
A diet low in fiber and high in animal fats and simple sugars is among the main causes. Fibers, especially insoluble ones, increase stool volume and stimulate intestinal motility. An adequate intake of fruit, vegetables, and whole grains promotes regular bowel movements.
2. Irritable Bowel Syndrome (IBS)
Often associated with constipation, IBS is characterized by altered motility and colon spasms that slow down transit, increase water reabsorption, and harden stools. Unlike functional constipation, IBS is accompanied by abdominal pain.
3. Lifestyle and behavioral habits
Ignoring the urge to defecate can reduce rectal sensitivity over time, promoting stool retention. An incorrect posture on the toilet also plays a role: the squatting position (as in “Turkish” toilets) facilitates evacuation by relaxing the puborectalis muscle. The use of supports (e.g., “squatty potty”) can simulate this posture even on Western toilets.
4. Pseudo-constipation
In some cases, the subjective perception of constipation does not correspond to an actual functional alteration. Not having daily bowel movements is not necessarily a problem if evacuation occurs without effort and with soft stools.
5. Occasional and environmental factors
Travel, changes in routine, pregnancy, or taking certain medications (e.g., opioids, antidepressants, antacids, iron, calcium channel blockers) can negatively affect bowel regularity.
6. Diseases and dysfunctions
– Motility disorders: such as colonic inertia (slowed transit) and pelvic floor dysfunction (difficulty coordinating muscles during defecation).
– Painful conditions: anal fissures or hemorrhoids may trigger an inhibitory reflex to the urge.
– Endocrine or neurological dysfunctions: hypothyroidism, multiple sclerosis, Parkinson’s disease, stroke, or spinal injuries can impair bowel function.
– Mechanical obstructions: post-surgical stenosis, diverticulitis, tumors, or external compressions can slow fecal transit.
7. Excessive use of laxatives
Chronic use of stimulant laxatives can lead to a progressive loss of intestinal sensitivity, resulting in drug dependency and impaired colon function.
8. Hydro-electrolyte imbalances
Dehydration, vomiting, or prolonged diarrhea can reduce the availability of fluids in the intestinal lumen, making stools harder and more difficult to pass.
When to tell your doctor
In case of worsening of symptoms or absence of improvement after three weeks of dietary-behavioral corrections, it is advisable to consult a gastroenterologist. During the visit, the doctor will collect a detailed anamnesis, perform the objective examination and evaluate any risk factors (e.g. family history of colorectal cancer).
In the first instance, the specialist may suggest the use of:
– osmotic or bulk laxatives,
– soluble fiber supplements,
– possible probiotics for dysbiosis.
If necessary, diagnostic tests may be prescribed, such as blood tests (complete blood count, ESR, sideremia) or instrumental investigations (choloscopy). In the absence of alterations, we will speak of functional constipation, that is, not associated with organic pathologies.
Role of the gastroenterologist and laxatives
The medical specialist is able to identify the most suitable type of laxative based on the patient’s clinical picture. There are different categories of laxatives (bulk, osmotic, emollient, stimulant), and the choice must be personalized.
It is important to know that effective therapy against constipation requires time, consistency and gradualness.
You cannot expect a problem that arose over weeks or months to be resolved in a few days.
INTESTINAL MICROBIOTA AND CONSTIPATION: A NEW HORIZON
The most recent knowledge on the intestinal microbiota has opened new scenarios in the understanding of chronic constipation. Stool is not only made up of food residues, but contains a large amount of live bacteria, which represent the main component of fecal material. The human intestine, in particular the colon, acts as an anaerobic bioreactor, hosting over 100,000 billion bacteria, for a total weight of approximately 1.5 kg.
This complex ecosystem, known as the intestinal microbiome (IM), includes almost 1,000 bacterial species and thousands of different strains. An alteration in its composition (dysbiosis) can negatively affect intestinal motility, causing constipation or diarrhea.
Deep dysbiosis can lead to a reduction in the substances produced by bacteria (such as short-chain fatty acids, intestinal serotonin or regulatory gases), altering fecal content and causing motor dyskinesias. Constipation, in this context, is therefore not only a symptom, but also a sign of an intestinal ecosystem in imbalance.
In conclusion, for effective management of constipation, an integrated approach is essential that considers:
– correct nutrition,
– hydration,
– physical activity,
– balance of the intestinal microbiota,
– appropriate use of pharmacological or nutraceutical therapies under medical supervision.
There is growing evidence that
colon motility is influenced by the
composition of the MI: Constipation can be the
consequence of altered production of
substances that occur in the
intestinal lumen due to deep DYSBIOSIS of
its ecosystem: an unbalanced, poor fecal
content causes motor dyskinesias in both constipation and diarrhea.
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