Constipation
Introduction
• Definitions of constipation tend to be highly
subjective but usually include hard stools,
straining with defecation, and infrequent large
bowel movements.
• Children may also exhibit vomiting,
abdominal pain, anorexia, or encopresis (i.e.,
involuntary passage of stool or fecal soiling)
• In adults normal stool weight is about 100 to 200 g daily, and
normal frequency may range from one stool every 3 days to
three times per day.
• Children normally have more frequent stools, ranging from an
average of two to three stools daily for the first few months of
life to approximately one and a half bowel movements daily at
age 3.
• The most common causes of constipation in otherwise healthy
persons include repeated lack of response to the urge to
defecate, lack of fiber in the diet, insufficient fluid intake,
inactivity, and chronic use of laxatives.
• Nervous strain or anxiety may aggravate the condition.
Medical Treatment for Adults
• The first approach to treatment of mild and functional
constipation is to ensure adequate dietary fiber, fluid, and
exercise and to advise the patient to heed the urge to
defecate.
• Patients dependent on laxatives are usually encouraged to
use milder products and reduce the dose until withdrawal
is complete.
• When the patient is unable to consume an adequate
amount of fibrous foods or exercise, substances that
promote regular evacuation of soft stools may be
prescribed.
• Polyethylene glycol, psyllium seed, and lactulose have
shown to be effective.
• Number of other bulking and osmotic agents such as
magnesium hydroxide and sorbitol have been used.
• Impactions of stool require evacuation and a more
stringent preventive and maintenance program,
including combinations of medications, fluids, activity,
and perhaps enemas.
• In more extreme cases such as toxic megacolon,
surgery may be advised.
Medical Treatment for infants and
children
• About 3% to 5% of all pediatric outpatient visits are
related to chronic constipation.
• In the most severe cases of functional constipation
with frequent stool retention, the rectum becomes
insensitive to distention, and encopresis develops.
• After organic disease is ruled out, treatment includes
laxatives and lubricants and ensuring adequate dietary
fiber and fluid intake
Medical Nutrition Therapy
• Primary nutrition therapy for constipation is consumption of
adequate amounts of both soluble and insoluble dietary fiber.
• Fiber increase colonic fecal fluid, microbial mass, stool weight
and frequency, and the rate of colonic transit.
• Fiber also softens stools and make them easier to pass.
• Fiber can be provided in the form of whole grains, fruits,
vegetables, seeds, and nuts.
• These foods are also high in nutrients, healthful
phytochemicals and resistant starches, and may serve as
prebiotics to maintain the desired colonic microflora.
• Bran and powdered fiber supplements may be helpful
in persons who cannot or will not eat sufficient
amounts of fibrous foods.
• When changes in diet and activity patterns do not
improve constipation, further evaluation is warranted.
High-Fiber Diet
• Dietary fiber refers primarily to edible plant materials not
digested by the enzymes in the upper digestive tract of
humans.
• It consists of cellulose, hemicelluloses, pectin, gums, lignin,
starchy materials, and oligosaccharides that are partially
resistant to digestive enzymes.
• Ideally fiber in the diet should be ingested in the form of foods
such as fruits, vegetables, whole-grain breads and cereals,
legumes, nuts, and seeds.
• These foods are not only rich in fiber but are excellent sources
of vitamins, minerals, trace elements, antioxidants, and
numerous protective phytochemicals.
• Fibrous powders or bran concentrates may be necessary to
obtain the desired fiber level in some persons.
• Several of these concentrates available on the market are
palatable and can be added to cereals, yoghurts, fruit sauces,
juices, or soups.
• Cooking does not destroy fiber, although the structure may
change.
• Consumption of at least eight glasses (2L) of fluids daily is
recommended to facilitate the effectiveness of a high-fiber
intake
• Gastric onstruction and fecal impaction may occur when
boluses of fiboruos gels or bran are not consumed with
sufficient fluid to disperse the fiber.
• Appropriate cautions are also warranted for persons with GI
strictures or dysmotility syndromes.
• In these situations the fiber content of the diet should be
increased slowly, taking a month to reach desired intakes of 25
to 38 g of fiber per day.
• Gradual initiation of a high-fiber diet may help reduce
unpleasant side effects such as increased flatulence,
borborygmus (intestinal rumbling), cramps, or diarrhea.
• GI disturbances associated with initial fiber ingestion usually
decrease with 4 to 5 days.
• The high-fiber diet is most effective when consumed
continuously for several months.
Reference
• Mahan, L.K. and Stump S.E., krause’s food
nutrition and diet therapy ,12th edition ,W.B
saunders , Philadelphia.
• Dietetics, 2012. [Link]