Constipation is a delay or difficulty passing stools.  It can be occasional (travel, pregnancy, etc.) or chronic.  We speak of chronic constipation when the problem has lasted for at least 6 to 12 months, with more or less marked symptoms.

 Chronic or occasional constipation

 The frequency of bowel movements varies from person to person, ranging from 3 times a day to 3 times a week.  We can speak of constipation when the stools are hard, dry and difficult to evacuate.  In general, this occurs if there are less than 3 bowel movements per week.

 Constipation can be either of transit (or progression), that is to say that the stools stagnate too long in the colon, or terminal (or evacuation), that is to say that they s  accumulate in the rectum.  The 2 problems can coexist in the same person.

 In North America, it is estimated that 12% to 19% of the population, both children and adults, suffer from chronic constipation.

Constipation: what are the causes?

● contracting intestines

 During digestion, the intestines contract to move food through the digestive tract.  This phenomenon of contractions is called peristalsis.  In case of constipation, peristalsis is slowed down and the stool stays too long in the colon.  In the vast majority of cases, no organic cause is found and the constipation is said to be "functional".

● Bad eating habits

 Most of the time, functional constipation is caused by poor eating habits, physical inactivity, stress, anxiety, or the presence of hemorrhoids or anal fissures that cause the person to hold back a bowel movement.  .

 Constipation can result from food allergies or intolerances, especially lactose in cow's milk, a situation which is less rare than one would think in young children who are chronically constipated.

●Refrain from going to the toilet

 Delaying bowel movement when the urge arises is another common cause of constipation.  The longer they stay in the colon, the more the stools become hard like pebbles and difficult to evacuate.  This is due to the fact that the body, through the colon, reabsorbs a lot of water present in the stool.  Holding back their evacuation can also cause pain and anal fissures.

● Contraction of the sphincter

 In some people, during defecation, the muscle of the anus (the anal sphincter) contracts instead of relaxing, which blocks the passage of stool14,15.  To explain this poor synchronization of reflexes, hypotheses often point to psychological factors16.  In many cases, however, there is no cause or trigger.

● A consequence

 Constipation can also result from a more complex disease or accompany it (irritable bowel syndrome, in particular).  It can also be diverticulitis, an organic lesion of the colon (colorectal cancer, for example), a metabolic abnormality (hypercalcemia, hypokalemia), or an endocrine problem (hypothyroidism) or neurological problem (diabetic neuropathy  , Parkinson's disease, spinal cord disease).

 ●Intestinal obstruction

 In rare cases, constipation is caused by an intestinal occlusion (or obstruction), which corresponds to a total blockage of intestinal transit.  Constipation then occurs suddenly and is accompanied by vomiting.  It requires an emergency consultation.

 Many drugs can also cause constipation, including, ironically, some laxatives when taken for long periods of time, anti-anxiety drugs, antidepressants, morphine, codeine and other opiates, some antispasmodics (anticholinergics), anti-  inflammatory drugs, muscle relaxants, some antihypertensives (especially calcium channel blockers such as diltiazem), diuretics, antacids containing aluminum, etc.  Some iron supplements can also cause constipation, but not all have this effect.
Finally, in rare cases, in children, constipation can be a sign of Hirschsprung's disease, a disease present from birth linked to the absence of certain nerve cells in the intestine.

 Constipation: when to consult?

 Constipation, especially when it comes on suddenly, can be a sign of a serious illness, such as colon cancer.  This symptom should therefore not be overlooked.
 It is advisable to consult a doctor in the following cases:

- recent constipation or accompanied by blood in the stool;

- bloating, pain, or constipation that alternates with diarrhea;

- weightloss ;

- stools whose size is constantly decreasing, which may be a sign of a more serious problem in the intestine;

- constipation that lasts for more than 3 weeks;

- constipation that persists in newborns or very -young children (because Hirschsprung's disease must be ruled out).

 Constipation: possible complications

 In general, constipation is mild and disappears on its own in a few days, thanks to a suitable diet.  However, if it persists, certain complications can sometimes occur:

● hemorrhoids or anal fissures;
● bowel obstruction ;
● faecal incontinence;
 ●fecal impaction, i.e. an accumulation and compaction of dry stools in the rectum, which occurs especially in elderly or bedridden people;
● laxative abuse.

Constipation: what are the symptoms?

● Transital constipation

 Hard and rare stools (less than 3 per week), but no difficulty in evacuation.

● Terminal constipation

 A feeling of incomplete or difficult defecation, a feeling of rectal fullness, heavy or repeated pushing efforts.
Note: in both cases, constipation can be accompanied by bloating, abdominal pain and intestinal discomfort.

 Constipation: people at risk

 Women are 3 times more likely to suffer from constipation than men3.  This high prevalence would be partly explained by hormonal causes.  According to one hypothesis, progesterone, which is more abundant during the second half of the menstrual cycle and during pregnancy, makes the intestines lazy.

 Children are frequently constipated, with a peak prevalence around the age of 4 years.

 From the age of 65, the risks increase markedly, for both men and women.

 People who have to stay in bed or who have little physical activity are also prone to constipation (seriously ill, convalescent, injured, elderly).

 Constipation: risk factors

 ●A diet low in fiber and liquids;

● sedentary lifestyle, physical inactivity;

● certain medications;

● consistently ignoring the need to have a bowel movement due to emotional stress or a psychological disorder;

● hormonal changes (pregnancy, menopause);

 ●the frequency of constipation is twice as high in people with low incomes, probably due to a poorer diet.

Constipation: how to prevent it?

 Why warn?

 Simple measures can prevent constipation and avoid the discomfort it causes.

 These measures also help prevent chronic constipation and can be followed at all times.

 Basic preventive measures

    ● Adopt a diet rich in fiber

 Foods of plant origin (fruits, vegetables, legumes, whole grains, nuts and seeds, seaweed) all contain dietary fiber, while those of animal origin do not.
There are 2 types of fiber: insoluble fiber and soluble fiber.  Generally, plants contain these 2 types of fiber, insoluble fiber being the most abundant.  Only a few plants contain good amounts of soluble fibre.

 Cellulose, hemicellulose and lignin are insoluble fibres.  They prevent constipation by absorbing plenty of water, which increases stool bulk and stimulates bowel contractions.

 Pectin, gum and mucilages are soluble fibers.  Psyllium is one of the rare plants to contain essentially soluble fibers.  Oats and barley also contain it.  This type of fiber helps prevent constipation by absorbing water and creating a gel.  They also help control blood sugar and lower cholesterol levels.

 Remember that according to Canada's Food Guide, we should consume 6 to 8 servings of cereal products a day, preferably made from whole or enriched grains.

  •  drink enough

 It is generally recommended to absorb 2 to 3 liters of liquid per day, a good part of which is provided by food. In general, we suggest drinking 6 to 8 glasses of water daily, between meals. Magnesium-rich mineral waters have a mild laxative effect and can be used in cases of constipation.

  •  Regular physical exercise

 Walking, cycling, being physically active has an influence on the abdominal muscles and promotes intestinal transit.

  •  Respond to the need to have a bowel movement as soon as it arises

 After eating, the intestines enter into a wave of contractions in order to evacuate the stool. This is a natural reflex that helps in the smooth exit of stools. By not listening to the urge to have a bowel movement, evacuation becomes more difficult.
Doctors recommend that people who are constipated go to the toilet twice a day, about 30 minutes after meals and not push for more than 5 minutes (as this increases the risk of hemorrhoids)  .  This “ritual” promotes the regular evacuation of stools, especially in children18.

  •  To manage stress

 Do not ignore significant emotional stress.

Constipation: how to treat it?

 Conventional medicine does not consider it necessary for health to evacuate the stools on a daily basis.  The frequency of stool evacuation depends on each person, but we generally speak of constipation if there are less than 3 stools per week and these are hard or difficult to evacuate.

 The doctor will first determine whether it is secondary constipation (following another disease) or primary.  In the first case, he will treat the cause or he will prescribe additional examinations, such as a colonoscopy.  Treat your hemorrhoids if necessary.  They are often the cause of constipation.  If your constipation is recent and you are taking a new medication, talk to your doctor.  Your medication may be the cause of your problem.
Then the doctor will determine whether it is transitory or terminal constipation.

● Transital constipation

 The doctor will first recommend modifying the diet so as to increase fiber intake: raw vegetables, cooked vegetables, legumes, fruits rich in pectin (apple, pear, peach, berries), but especially whole grains.

 Wheat bran, which is very high in fiber, or other cereals can be added to muffin recipes, etc.  To treat constipation, it is recommended to consume about 1/4 cup of wheat bran per day.

 Whole prunes and prune juice are also very effective in relieving constipation because they contain sorbitol, a natural laxative.  A daily dose of 8 ounces is usually sufficient4.  However, it is sometimes necessary to wait several weeks before feeling the benefits of a fiber-enriched diet on transit19.

 At the same time, the doctor will also recommend drinking enough, while avoiding alcohol and caffeinated drinks, which dehydrate and can irritate the colon.  However, if the constipation is chronic and accompanied by intestinal irritation, avoid changing your diet too suddenly.

 If constipation persists, he will recommend a laxative.  There are 6 categories.

● Bulk laxatives

 Bulk or bulk laxatives are usually mucilages or prepared dietary fibers: hydrophilic psyllium mucilloid or methylcellulose.  This type of laxative is the most gentle on the intestines.  By binding to water, the fibers swell, which helps to form loose, bulky stools.
Their volume triggers the peristalsis of the intestines, which pushes the stool towards the rectum.  It may take a few days for the laxative effect to appear.
 It is recommended to drink the equivalent of 5 to 10 times the volume of the quantity of bulk laxative ingested.  Examples include Metamucil®, Prodiem® and Kellogs Bran Buds®.
 Possible side effects: bloating, flatulence and cramps.  Integrating them gradually into the diet limits these inconveniences.

● stool softeners

 Stool laxatives, which soften the stool.  For example, docusate sodium (Colace®, Ex-Lax®, Soflax®).
 Possible side effects: diarrhea and mild stomach cramps.

 ●Osmotic laxatives

 Osmotic laxatives help retain more water in the bowel, thus softening the stool.  They include salts (sodium sulfate, magnesium sulfate or Epsom salt), magnesium hydroxide (milk of magnesia), sugars not assimilated by the intestine (lactulose, mannose, mannitol, sorbitol, etc.  ) or glycerin (as a suppository).

 Polyethylene glycol laxatives (Miralax®, Lax-A-Day®) are osmotic laxatives available for adults complaining of occasional constipation.

 Possible adverse effects: diarrhea, flatulence, cramps, and dehydration in high doses.

 ●Lubricant laxatives

 Lubricating laxatives, which lubricate the stools and facilitate their evacuation.  This is most often mineral oil (paraffin oil or petroleum jelly).  They can be used orally or rectally.

 Possible side effects: diarrhea and mild stomach cramps.  Be careful, inflammation of the lungs can occur if the oil is accidentally aspirated into the lungs.

Stimulant laxatives

 Stimulant laxatives act directly on the intestinal mucosa and all peristaltic movements (bisacodyl, anthracenics, emulsified castor oil).  They decrease the reabsorption of water and electrolytes in the colon.  Stimulant laxatives, which are very irritating to the colon lining, are used as a last resort.They are not recommended in case of chronic constipation.  They should not be taken for more than 1 or 2 weeks without medical supervision.
 Possible side effects: abdominal cramps, diarrhea and burning sensation in the rectum.
 Warning: Overdose can cause habit-forming lazy bowel syndrome, as well as lead to low blood sodium and potassium levels, dehydration and possibly more serious disorders.

 Warning: they are contraindicated for pregnant and breastfeeding women.

 Some preparations are composed of drugs from 2 or 3 of these laxative groups.

 ●Lubiprostone (Amitiza®)

 This new class drug is indicated for the treatment of chronic constipation in adults when other treatments have failed19.  It works by increasing the secretion of water by the intestine.  Possible side effects: nausea, diarrhea, abdominal pain and flatulence.