Constipation

• It is normal to have some constipation at times as a result of what you eat or other habits. 
• If there is ongoing pain with bowel movements or there is blood in your stool, take expert opinion.

The  incidence has doubled in the last decade.  Constipation could broadly be classified into broad categories.

• Nerves related  cause Hurschsprung’s disease : – The relaxation of muscles is not  adequate due to abnormality in the ganglion cells.  Constipation starts very early in life in this condition. Usually accompanied by abdominal distension. A barium enema is done followed by anal manometry and rectal biopsy to confirm the diagnosis.  If diagnosis is confirmed then a surgery  is indicated.
• Habitual Constipation – here  the underlhying cause is not surgery. The constipation usually results secondary to bad dietary habits or post infection.
• Constipation may be secondary to hypothyroidism, hypo/hypercalciemia., vitamin D deficiency, coeliac disease, lactose intolerance/drug induced, irritable bowel syndrome.
• Very rarely it may be secondary to motility disorders which are more difficult to treat.

Some examples of medicine that can cause constipation are :

• Pain medications (mainly narcotics).
• Some antacids.
• Antispasmodic drugs, which suppress muscle spasms.
• Antidepressant drugs.
• Tranquilizers.
• Iron supplements.
• Anticonvulsants, for epilepsy
• Calcium channel blockers, for high blood pressure and heart conditions.

Diagnosis : A very good history and clinical examination provides a lot of information.

• If the patient has hard or small stools that are difficult or painful to pass
• If consistently skips days without having normal bowel movements
• If the patient has large stools that clog the toilet.
• Other symptoms that can accompany constipation are stomach pain, poor appetite, irritability and bleeding from a fissure (tear in the anus from passing hard stool).

Anal manometry is a useful instrument which is available only at very limited centre such as our  and it provides us a lot of information such as

• First sensation
• Squeeze pressure
• If the patient has large stools that clog the toilet.
• RAIR