There constipation, or constipation, comes from the Greek "styphein", or strict and indicates a difficult and incomplete evacuation that has a significant impact on the quality of life. The frequency of bowel movements varies from individual to individual; up to three bowel movements per week are considered physiological while less than three movements per week constitute constipation. Furthermore, L'American College of Gastroenterology defines this condition as an unsatisfactory, difficult and infrequent defecation, which has persisted for at least 3 months, accompanied by disorders such as hard stools, a sensation of incomplete emptying, a sense of anorectal block / obstruction, excessive effort up to the use of manual maneuvers. There constipation it is not a disease but a symptom common to many situations and / or pathologies. It is one of the most common gastroenterological problems in the Western world, affecting up to 28% of the population of all ages and mainly affects the female gender, with a male-female ratio of 1: 4. Women are indeed more prone to constipation due to fluctuations in hormone levels over the course of life; in particular, mechanical causes also occur during pregnancy due to the development of the baby inside the uterus. There constipation it is found more from 65 years of age as in this phase one is less active, the metabolism slows down, as well as the muscle contraction along the digestive tract. In general, the constipation it resolves spontaneously and in a short time. Most people suffer from it for a short time (constipation occasional or acute), while for some individuals it may last for over 6 months or be a lifelong condition (constipation chronic).
Pathophysiology and causes
There constipation it can be primary or secondary to other causes. There constipation primary is further divided into the following subtypes:
- Constipation with normal intestinal transit: the patient feels discomfort, pain, swelling and evacuation difficulties despite regular intestinal transit;
- Constipation from slowed transit: it is the most common form in which intestinal motility is altered by anomalies of the myenteric plexus (or of the nerves that regulate peristalsis) or by deficit of stimulation of the enteric muscles by serotonin. In fact, the correlation between the Enteric Nervous System (ENS) and the Central Nervous System (CNS) has been demonstrated in the so-called "brain-gut axis"(From the English" brain-gut axis "or" theory of two brains "); situations of anxiety, depression, severe stress and fear can stimulate or reduce the secretion of serotonin resulting in accelerated transit (diarrhea) or slowed (constipation).
There constipation secondary is instead caused by intestinal and / or anorectal motor dysfunctions or by some conditions and pathologies, in particular metabolic, endocrine and neurological ones. Examples include people with diabetes, scleroderma, thyroid disease, multiple sclerosis and Parkinson's disease, diverticulosis and chronic inflammatory diseases, colorectal cancer, and damage to the spinal cord. Furthermore, the prolonged use of many drugs (anesthetics, NSAIDs, aluminum contained in antacids, anticholinergics, antidepressants, antihypertensives, antispasmodics, diuretics, antihistamines, and opioids, as well as iron and calcium supplements) can alter the regularity intestinal. There are also many simultaneous causes that aggravate the constipation including: inadequate intake of fiber and fluids in the diet; excessively sedentary lifestyle; environmental and climatic changes but also physiological conditions such as pregnancy.
Finally, the constipation it is often due to poor hygiene habits and the repeated behavior of ignoring or postponing the stimulus because there is no time or time or place.
Symptoms and complications
The main symptoms are: reduction in the frequency of evacuation; difficult passing of hard, dry stools; pain when passing stool; excessive and prolonged efforts; sensation of blockage / obstruction and incomplete evacuation; abdominal bloating; resorting to manual maneuvers or use of aids such as suppositories, enemas and laxatives. The most feared complication is intestinal obstruction due to the presence of fecal impaction: this accumulation of faeces in any part of the colon can in rare cases cause rectal ischemia and must be treated surgically. If the constipation persists for more than 6 months complications may arise such as: pain, anal itching, hemorrhoids, rectal bleeding, anal fissures, diverticulitis, anorectal swelling, cystitis, rectal prolapse, loss of sensitivity in the anal and perianal area up to fecal and urinary incontinence due to damage to the pelvic floor muscles. Many people think that persistent stools in the intestine can lead to a harmful build-up of toxins. However, the colon is expandable and the risk of a bacterial infection is very low and correlated only with the presence of a pre-existing lesion or loss of mucosal integrity. If the symptoms described above persist for more than 3 weeks it is important to contact your doctor without neglecting it.
How fight constipation
There constipation it is not a healthy condition but, fortunately, in most cases, it is enough to improve one's lifestyle to resolve it. Below is a list of products of natural origin to be used alone or in combination against constipation.
- Fiber: dietary choices have a high impact on intestinal regularity. An adequate daily intake of fiber, between 25-30 grams, helps to keep the digestive system healthy. The fibers can be both soluble, to give density to the stool, and insoluble to facilitate its transit in the colon, cleaning it. Foods rich in fiber such as whole grains, bran, oatmeal, flax seeds, legumes, fruits and vegetables contain a good balance of both types of fiber. Furthermore, fiber supplements are available on the market and in different formulations (capsules, powder, tablets ...) to be associated with the diet, taking care not to consume together an excessive amount of foods rich in fiber.
- Vegetable oils and Omega-3 in fish oils: Castor, olive, hemp and linseed oil, as well as the Omega-3 contained in oils derived from salmon and swordfish, are very ancient remedies and they can be taken to lubricate the walls and stimulate intestinal contractions. It is recommended to take up to two tablespoons a day on an empty stomach. It can take about 8 hours to get the desired effect.
- Caffeine: in coffee it stimulates the contraction of the colic muscles to favor the transit of stools. However, drinking too much coffee can cause dehydration, making it worse constipation, therefore it is recommended to always drink water when consuming caffeinated beverages.
- Senna: natural stimulating laxative used for millennia to promote intestinal motility; of this plant (also known as cassia) the leaves, flowers and fruits are used. It is often consumed as an herbal tea and its effect is expressed in a few hours. It is also approved by the Food and Drug Administration (FDA) as a supplement, in tablet or powder form; it is also used in irritable bowel syndrome (IBS) and in the case of hemorrhoids.
- Aloe vera: in addition to promoting the healing of wounds and burns, it is possible to consume the gel or syrup (pure or added to smoothies and drinks) to relieve intestinal inflammation typical of IBS and relieve the symptoms of constipation.
- Fennel: diuretic and natural laxative, excellent eaten raw or roasted or in the form of herbal teas in the evening before bedtime. The seeds also increase the action of gastric enzymes during digestion.
- Fruits such as figs, plums and raisins: especially when dried, they contain sorbitol which has a laxative effect. They are among the most used remedies in all age groups to maintain intestinal regularity.
- Honey: in addition to carrying out a natural antibiotic action, it is a laxative rich in enzymes that promote digestion; it can be consumed pure, a teaspoon a day or added to hot drinks.
- Molasses: sweetening product obtained from the centrifugation of sugar. In particular, brown and black molasses contain vitamins and minerals, including magnesium, which are useful for relieving the symptoms of constipation. It can be used as an alternative to table sugar by adding a teaspoon every evening to promote intestinal emptying in the morning.
- Water and coconut milk: moisturizing and purifying, increases kidney function and stimulates the digestive process. It is also rich in magnesium, which is essential for the contraction of the muscles necessary to expel fecal matter.
- Tea and herbal teas: the intake of hot drinks, in addition to the laxative effect, helps to relax the gastrointestinal muscles. Ginger and peppermint are useful in case of blocked digestion and gastric irritation while the licorice root has anti-inflammatory and digestive effects after a large meal; chamomile on the other hand relieves the constipation from stress and tension. Dandelion relieves moderate constipation and cleanses the liver. Finally, green tea and black tea, containing caffeine, have effects similar to coffee, also associating the benefit of hydration.
- Lemon juice: it is a natural digestive able to detoxify the body; it is advisable to squeeze it fresh and add it to water or tea.
- Prebiotic supplements: help to restore and rebalance the bacterial flora of the digestive tract. They are naturally present in many ingredients such as yogurt but can also be purchased in the form of supplements.
- Vitamins C, B-5, Folic Acid, B-12 and B-1 help maintain gastrointestinal health. Eating foods rich in these vitamins or specific supplements increases intestinal motility.
Prevention of constipation
Finally, to prevent the recurrence of this uncomfortable condition, the following behaviors can be adopted:
- Proper Hydration: When you become dehydrated, your body also excretes water from the colon, resulting in it constipation. It is sufficient to drink between 6 and 8 glasses of water a day (which corresponds to about 1.5 - 2 liters) to keep the stool soft and make bowel movements regular and painless.
- Physical movement: avoiding sitting too many hours keeps the intestines healthy and moving. It is not necessary to practice sports in an intense way, even 30 minutes of walking a day are enough. Constipation, however, especially if cramps and swelling are present, makes physical activity difficult and unpleasant, therefore, you can also opt for stretching and relaxation and breathing techniques such as yoga.
- Abdominal massage: lying on the back pressing the hands on the abdomen in a rhythmic way for about 10 minutes 2 times a day facilitates the movement of stool from the colon towards the rectum. Drinking a hot drink before this procedure enhances the effect.
- Give yourself a routine and do not postpone the stimulus: even if in everyday life and in the workplace it is not always possible, it is advisable to try to evacuate at the same time and above all not to postpone the stimulus when present.