Many people think that not being released every day is a sign of constipation. But according to the American College of Gastroenterology (CAG), this is a myth. Relax if your bowels work 3 times a week, or even 3 times a day, because everything is fine. In constipation, it is very important that you be your "watch": it is the presence of hard stools, small volumes, and detection of incomplete bowel movements.
Constipation or constipation is considered a very common complaint affecting approximately 16% of the world's population. When the prevalence among people older than 65 years increases, women are most affected by the problem that can occur at any age from childhood to maturity.
Some of these groups will still suffer from bowel movement and will also experience abdominal tension.
Most live with constipation for many years, so it can be chronically manifested, but only when the difficulties of evacuation occur, especially when dietary changes occur between travels or bedridden patients. In these, the bowel moves more slowly due to physical activity or drug use.
Why is this happening?
In 8 out of 10 people, the problem is related to lifestyle habits, ie malnutrition, physical inactivity and poor hydration.
"Another common cause, especially in females, is that there is no physical origin for the disease," says Joaquim Prado P. Moraes Filho, professor of gastroenterology at the FMUSP (São Paulo School of Medicine). and FBG (Brazilian Federation of Gastroenterology).
Know other causes, some rare, some more common:
Structural diseases of colon or rectum (outlet obstruction)
- Anti-inflammatory drugs
- Calcium Remedies
- Emotional or psychic problems
- Abdominal muscle strength loss, drug use and degenerative diseases in elderly (Alzheimer's and Parkinson's)
- In children, in addition to the same Hirschsprung disease, it causes adults, especially eating errors and psychogenic factors.
- Hormonal and metabolism changes
How to recognize symptoms
In addition to the evacuation difficulty, you may also see the following signs:
- Abdominal cramps;
- Difficulty in removing gases;
- Abdominal distension;
- Anal pain due to stool dryness and expanding fecal bolus, which can also cause bleeding.
When is it time to ask for help?
José Joaquim Ribeiro da Rocha (University of São Paulo at the Ribeirão Preto School of Medicine) at the FMRP-USP Hospital reports that people are often “together ile with a home-made solution or self-treatment and may take years without seeking medical assistance. What they do not know is that ın self-medication is wrong, does not address the cause of constipation and even makes the picture worse ”.
The ideal, according to the expert, is to make an appointment to see that the symptoms persist for more than 30 days without healing.
Also pay attention to the warning signs: constipation began after the age of 40, there is blood in the stool; weight loss; Abdominal stiffness or stool effect (stool hardening). If you notice any of these conditions, make an appointment immediately for evaluation by a gastroenterologist or proctologist.
Among children, parents should see their pediatrician if symptoms last longer than 2 weeks, or they should increase gradually after birth.
How is the diagnosis made?
The doctor will collect data about your clinical history, lifestyle, and personal and family history, as well as a physical and proctological examination. Complementary examinations may be required not only to determine your overall health, but also to detect any disease related to your complaint.
Depending on each condition, the most important tests are large intestinal contrast radiography (Opaque Enema), colonic transit time, blood tests and colonoscopy (if available), rectal biopsy and anorectal manometry – to assess blood pressure. muscles of the anal region.
Among the elderly, colorectal tumors should be investigated in addition to age characteristics.
How is the treatment performed?
Once the diagnosis is identified, the therapeutic approach is always personalized. Sandra Beatriz Marion, a professor of medicine at the gastroenterologist PUC-PR (Papal Catholic University of Paraná), explains that in most cases therapy is about changing lifestyle.
Patients provide guidance on diet, hydration and physical activity, as well as strategies to create a new bowel movement routine. Natural fiber-based drugs may also be helpful and may be in continuous use.
Ilk The first thing you need to know is that there is no miracle drug that allows the intestines to work for life, Doktor says the doctor. Yoksa If the patient doesn't have partnership, he won't get the results he wants if he isn't aware of the importance of basic care, ek he adds.
For people who do not respond to this strategy, there are a number of drugs, such as those that moisturize the feces (osmotic laxatives) or make them more oily (softening). There are also drugs that work to stabilize some kind of intestinal serotonin.
The last options are annoying laxatives, just the first things people use for self-medication. Very powerful, they act immediately, but if used for a long time, they will damage the intestinal nerves. Consequently, constipation only gets worse.
Treatments for more complex cases
When constipation is more severe, especially among women, and the cause is unknown, beyond all the possibilities described above, treatment may have a surgical solution by removal of the colon or total colectomy.
More recently, sacral neuromodulation has been used in the lumbar region, a pacemaker that emits electrical stimulation in the modular nerves.
Learn how to set a diet
Correct consumption of soluble fibers is related to the proper formation of a softer, larger fecal bolus, and insoluble fibers accelerate intestinal passage. The specified daily consumption is 25 g / day. And it's no use eating 5 lettuce leaves and 1 tomato a day! These fractions have 0.9 g and 1.5 g fibers, respectively.
Add appropriate water consumption to the fiber (calculated by weight: 0.35ml per kilo) and avoid a sedentary lifestyle. Even the inclusion of probiotics and prebiotics in the diet may be beneficial and necessary.
The guidance of a nutritionist is clear. This is because “not everyone responds to the same diet and therefore should always be assessed individually, taking into account their habits, restrictions and dietary preferences, EP says EPM's clinical nutritionist and nutritionist Camila Naegeli Caverni – Unifesp (Paulista School of Medicine, Federal University of São Paulo).
For some people, changing eating habits helps a lot, but it doesn't exactly solve the problem. In this case, the gastroenterologist and nutritionist should work together to get better results.
How to cooperate with treatment?
It is not always possible to prevent constipation. However, careful fiber consumption should be a lifelong habit. In addition, always stay well moistened and participate in regular physical activity.
You can also follow these steps to avoid the discomfort of a crisis or to collaborate with therapy:
- Arrange the right time to go to the bathroom, preferably in the morning after breakfast or after meals;
- Go to the bathroom when you feel the need for evacuation. Avoid delaying this urgency;
- Choose natural and whole foods;
- Drink at least 1 liter and 1/2 liquid per day;
- Learn how to read the labels of the products you consume to identify fiber content;
- Avoid consumption of processed and ultra-processed foods such as white rice, refined wheat flour, corn flour, flour;
- Table prioritization: beans, lentils, peas, brown rice, flax seeds, oats, corn, rye flour, vegetables (all), fruits (all);
- Maintain satisfactory physical activity – 30 minutes, 4 times a week.
Sources: Joaquim Prado P. Moraes FilhoFMUSP (São Paulo University School of Medicine) Professor of Gastroenterology and FBG (Brazilian Federation of Gastroenterology) board member; Jose Joaquim Ribeiro da Rocha, Department of Surgery and Anatomy, Hospital das Clínicas, professor of FMRP-USP (University of São Paulo at Ribeirão Preto Medical School) and Ribeirão Preto Proctogastroclinics, professor of Coloproctology; Sandra Beatriz MarionProfessor, Gastroenterology specialist and qualified endoscopist at the PUC-PR School of Medicine (Paraná Papal Catholic University); Camila Naegeli CaverniClinical nutritionist at the Brazilian Headache Center and graduate student at EPM-Unifesp (Paulista School of Medicine, Federal University of São Paulo). Technical review: Sandra Beatriz Marion.
Resources: Ministry of Health; ACG (American School of Gastroenterology); Maria Vazquez Roque, Ernest P. Bouras. Epidemiology and treatment of chronic constipation in elderly patients. Clin Interv Aging. 2015; Treatments for Constipation: A Review of Systematic Review. Quick Response Report: Summary with Critical Assessment. Ottawa (ON): Canadian Health Drugs and Technologies Agency; 2014.