What're risk factors for constipation?
Not enough fiber in diet. The most common cause of constipation is a diet low in fiber found in vegetables, fruits, and whole grains and high in fats found in cheese, eggs, and meats. People who eat plenty of high-fiber foods become constipated less often. Fiber -- soluble and insoluble -- is the part of fruits, vegetables, and grains that the body cannot digest. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Insoluble fiber passes almost
unchanged through the intestines. The bulk and soft texture of fiber help prevent hard, dry stools that are difficult to pass. On average, Americans eat about 5 to 10 grams of fiber daily, short of the 20 to 35 grams recommended by the American Dietetic Association. Both children and adults eat too many refined and processed foods in which the natural fiber is removed. A low-fiber diet also plays a key role in constipation among older adults. They often lack interest in eating and may choose fast foods low in fiber. In addition, loss of teeth may force older people to eat soft, processed foods that are low in fiber.
Not enough liquids. Liquids like water and juice add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass. People who have problems with constipation should drink enough of these liquids every day, about eight 8-ounce glasses. Liquids that contain caffeine, like coffee and soft drinks, seem to have a dehydrating effect.
Lack of exercise. Lack of exercise can lead to constipation, although physicians do not know precisely why. For example, constipation often occurs after an accident or during an illness when one must stay in bed and cannot exercise.
Medications. Pain medications (especially narcotics), antacids that contain aluminum, antispasmodics, antidepressants, iron supplements, diuretics, and anticonvulsants for epilepsy can slow the passage of bowel movements.
Irritable bowel syndrome. Many people with IBS, also known as spastic colon, have irregular bowel movements. Constipation and diarrhea often alternate, and abdominal cramping, gassiness, and bloating are other common complaints. Although IBS can produce lifelong symptoms, it is not a life-threatening condition. It often worsens with stress, but causes nothing unusual that a physician can see in the colon. Changes in life or routine, such as pregnancy, older age, and travel. During pregnancy, women may be constipated because of hormonal changes or because the heavy uterus compresses the intestine. Aging may also affect bowel regularity because a slower metabolism results in less intestinal activity and muscle tone. In addition, people often become constipated when traveling disrupts their normal diet and daily routines.
Abuse of laxatives. Myths about constipation have led to a serious abuse of stimulant laxatives, especially among older adults who are preoccupied with having a daily bowel movement. Stimulant laxatives should be avoided. Over time, stimulant laxatives can damage nerve cells in the colon and interfere with the colon's natural ability to contract. Ignoring the urge to have a bowel movement. People who ignore the urge to have a bowel movement may eventually stop feeling the urge, which can lead to constipation. Some people delay having a bowel movement because they do not want to use toilets outside the home. Others ignore the urge because of emotional stress or because they are too busy. Children may postpone having a bowel movement because of stressful toilet training or because they do not want to interrupt their play.
Specific diseases. Ten percent of patients that have the symptom of constipation have an underlying disease or disorder. Diseases that cause constipation include neurological disorders, metabolic and endocrine disorders, and systemic conditions that affect organ systems. These disorders can slow the movement of stool through the colon, rectum, or anus. Neurological disorders that may cause constipation include multiple sclerosis, Parkinson's disease, chronic idiopathic intestinal pseudo-obstruction, stroke, and spinal cord injuries. Metabolic and endocrine conditions include diabetes, underactive or overactive thyroid gland, and uremia. Systemic disorders include amyloidosis, lupus, and scleroderma.
Problems with the colon and rectum. Intestinal obstruction, scar tissue (adhesions), diverticulosis, tumors, colorectal stricture, Hirschsprung's disease, or cancer can compress, squeeze, or narrow the intestine and rectum and cause constipation. Colonic inertia is caused by decreased muscle activity in the colon. These syndromes may affect the entire colon or may be confined to the left or lower (sigmoid) colon. Pelvic floor disorders including rectocoeles, pelvic descent, and nonrelaxing puborectalis syndrome may all cause constipation. |
