Many people think that not evacuating every day is a sign of constipation. But, according to the American College of Gastroenterology (CAG), this is a myth. If your gut works up to 3 times a week or even 3 times a day, relax because everything is in order. With constipation, it does not matter that you "will be hours": it determines the presence of hard stools, their small volume and the feeling of incomplete bowel movement.
Constipation or constipation is considered a fairly common complaint that affects about 16% of the population worldwide. Women suffer most from this problem, which can manifest itself at any age, from childhood to adulthood, when its prevalence increases among people over 65 years of age.
Some of these groups will continue to suffer from bowel movements and will also have bloating.
Most of them live with constipation for many years, so chronically, but difficulties in evacuation can appear suddenly, especially during times when changes in nutrition, travel or between bedridden patients occur. In them, the intestines move more slowly due to a lack of physical activity or the use of drugs.
Why is this happening?
For 8 out of 10 people, the problem is associated with poor lifestyle habits, such as poor diet, lack of physical activity and poor hydration.
“Another very common cause, especially in women, is the so-called functional constipation: the physical origin of the disease has not been identified,” explains Joaquim Prado P. Moraes Filu, professor of gastroenterology at FMUSP (Faculty of Medicine, University of São Paulo). and board member of the FBG (Brazilian Federation of Gastroenterologists).
Know other causes, some rare, some more common:
Structural diseases of the colon or rectum (exit obstruction)
- Anti-inflammatory drugs
- Calcium preparations
- Emotional or mental problems
- Among older people, loss of abdominal muscle strength, drug use, and degenerative diseases (Alzheimer's and Parkinson's)
- Children have the same reasons as adults, especially nutritional errors and psychogenic factors, in addition to Hirschsprung’s disease.
- Hormonal and metabolic changes
How to recognize symptoms
In addition to difficulties with evacuation, you can also notice the following symptoms:
- Cramping in the abdomen;
- Difficulty in eliminating gases;
- Anal pain due to dry stool and increased fecal bolus, which causes anal fissures that can bleed.
When do I need help?
Jose Joaquim Ribeiro da Rocha, professor of coloproctology at the Clinical Hospital FMRP-USP (University of São Paulo at the Ribeiran Preto Medical School), reports that people usually get along with a home solution or self-medication and can take years without seeking medical care help. What these people do not know is that “self-medication is inaccurate, does not eliminate the cause of constipation, and even worsens the picture,” he says.
According to the expert, ideally, you need to make an appointment to understand that the symptoms persist for more than 30 days without improvement.
Also watch out for warning signs: constipation began after 40 years, blood in the stool; weight loss; hardening of the abdomen or fecal seals (hardening of the stool). If you notice any of these situations, immediately make an appointment for evaluation by a gastroenterologist or proctologist.
Among children, parents should see their pediatrician when symptoms persist for more than 2 weeks or gradually increase soon after birth.
How to make a diagnosis?
The doctor will collect data from your medical history, your lifestyle, personal and family history, as well as conduct a physical and proctological examination. Additional examinations can be requested not only to find out your general health condition, but also to identify any diseases associated with your complaint.
Depending on each case, the most important are contrast x-ray of the colon (opaque enema), the time it takes to go through the colon, blood tests and colonoscopy (if any), rectal biopsy and anorectal manometry to assess blood pressure. muscles of the anal area.
Among older people, in addition to age characteristics, it is necessary to study colorectal tumors.
How is the treatment carried out?
Once the diagnosis is determined, the therapeutic approach is always personalized. Gastroenterologist Sandra Beatrice Marion, a professor of medicine at PUC-PR (Pontifical Catholic University of Paraná), explains that in most cases, therapy involves lifestyle changes.
Patients receive recommendations on nutrition, hydration and physical activity, as well as strategies for establishing a new bowel routine. Natural fiber based medications can also be helpful and can be used continuously.
“The first thing you need to know is that there is no miracle cure that makes the intestines work for life,” says the doctor. “If there is no partnership with the patient, if he does not realize the importance of such necessary assistance, he will not achieve the desired result,” he adds.
For people who do not respond to this strategy, there are a number of medications available, such as those that moisturize stools (osmotic laxatives) or make them fatter (emollients). There are also medications that work to balance the intestinal type of serotonin.
The latter options irritate laxatives, namely those that people use primarily in self-medication. Very powerful, they have an immediate effect, but with prolonged use, they damage the nerves of the intestines (myenteric). As a result, constipation only worsens.
Therapy for more complicated cases
When constipation is more severe, especially among women, and the cause is not known, besides all the possibilities described above, treatment may have a surgical solution with removal of the colon or general colectomy (removal of the colon).
Later sacral neuromodulation, a pacemaker in the lumbar region that emits electrical stimuli in modular nerves, was used.
Learn how to set up a diet.
Proper intake of soluble fiber is associated with the proper formation of a fecal bolus with softer and larger stools, while insoluble fiber speeds up intestinal transit. Their daily intake is 25 g / day. And it makes no sense to eat 5 lettuce leaves and 1 tomato per day! These elements have 0.9 g and 1.5 g of fiber, respectively.
Add the appropriate water intake to the fiber (it should be calculated according to its weight: 0.35 ml per kilogram) and avoid a sedentary lifestyle. Even the introduction of probiotics and prebiotics into the diet can be useful and necessary.
A guide from a nutritionist is welcome. This is because “not everyone responds to the same diet and, therefore, must be evaluated individually, always taking into account their habits, limitations and dietary preferences, in order to ensure the best result,” explains nutritionist Camila Naegeli Caverni, a clinical nutritionist and undergraduate EPM. -Unifesp (Paulista School of Medicine, Federal University of São Paulo).
Please note that for some people, changing eating habits helps a lot, but doesn't completely solve the problem. In this case, the gastroenterologist and nutritionist must work together to provide better results.
How to collaborate with treatment
It is not always possible to prevent constipation. However, careful consumption of fiber should become a habit for life. In addition, always eat well with water and exercise regularly.
You can also take the following steps to avoid crisis discomfort or collaborate with therapy:
- Arrange a suitable time to go to the bathroom, preferably in the morning after breakfast or after eating;
- Go to the bathroom when you feel the need to evacuate. Avoid putting off this urgency;
- I prefer natural and whole foods;
- Drink at least 1 liter and 1/2 liquid per day;
- Learn how to read the label of the foods you consume to determine their fiber content;
- Avoid processed and ultra-processed foods such as white rice, refined wheat flour, corn flour, flour;
- Priority at the table: 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 FiluProfessor of Gastroenterology at FMUSP (Faculty of Medicine, University of São Paulo) and Member of the Board of FBG (Brazilian Federation of Gastroenterology); Jose Joaquim Ribeiro da RochaProfessor, Department of Coloproctology, Department of Surgery and Anatomy, Hospital Clinic Hospital, FMRP-USP (University of São Paulo at the Ribeiran-Preto School of Medicine) and the doctor responsible for the proctogastroclinic Ribeiran-Preto; Sandra Beatrice MarionProfessor of the medical course PUC-PR (Pontifical Catholic University of Paraná), specialist in gastroenterology and qualified endoscopist; Camila Naegeli CaverniClinical nutritionist at the Headache Center in Brazil and a graduate student at EPM-Unifesp (Paulista School of Medicine, Federal University of São Paulo). Technical Review: Sandra Beatrice Marion,
References: Ministry of Health care; ACG (American College of Gastroenterology); Maria Vasquez Roque, Ernest P. Buras. Epidemiology and treatment of chronic constipation in elderly patients. Wedge Interval Aging. 2015; Treating constipation: a review of systematic reviews. Rapid Response Report: A critical review summary. Ottawa (ON): Canadian Agency for Drugs and Technology in Health; 2014.