Many people think that not being displaced every day is a sign of constipation. But according to the American College of Gastroenterology (CAG), this is a myth. If your intestines work up to 3 times a week, or even 3 times a day, relax because everything is fine. In constipation, it doesn't mean much to you "to be a small watch": what defines it is the presence of hard stools, small volume, and incomplete evacuation sensations.
Constipation or constipation is considered a fairly common complaint affecting around 16% of the world's population. Women are the most affected by the problem, which can manifest at any age, from childhood to adulthood, when its prevalence increases among individuals over 65 years.
Some of this group will still suffer from bowel movements and the stomach will also experience distension.
Most live with constipation for many years, therefore, chronically, but difficulties in evacuation can appear suddenly, especially at times when changes in diet, travel, or between patients lying in bed. In this case, the intestine moves more slowly due to lack of physical activity or use of drugs.
Why this happened?
For 8 out of 10 people, the problem is related to poor lifestyle habits, namely inadequate eating patterns, lack of physical activity, and poor hydration.
"Another very common cause, especially in women, is the so-called functional constipation: no physical origin has been identified for this disease," explained Joaquim Prado P. Moraes Filho, professor of gastroenterology at FMUSP (Faculty of Medicine, University of Sao Paulo). and board member of the FBG (Brazilian Gastroenterology Federation).
Know other causes, some rarely, some more often:
Structural or anal structural disease (outlet obstruction)
- Anti-inflammatory drug
- Calcium medicine
- Emotional or psychological problems
- Among the elderly, loss of abdominal muscle strength, use of drugs and degenerative diseases (Alzheimer's and Parkinson's)
- In children, the cause is the same as adults, especially eating errors and psychogenic factors, in addition to Hirschsprung's disease.
- Hormonal changes and metabolism
How to recognize the symptoms
Besides difficulties in evacuation, you can also see the following signs:
- Stomach cramps;
- Difficulty in removing gas;
- Abdominal distension;
- Anal pain due to fecal dryness and enlarged bolus faeces, which causes anal fissures that may bleed.
When is it time to seek help?
José Joaquim Ribeiro da Rocha, professor of the Coloproctology Division of the das Clínicas Hospital of FMRP-USP (São Paulo University at Ribeirão Preto Medical School) reports that people generally "hang out" with homemade solutions or self-medication. , and can be for years without seeking medical attention. What these people do not know is that "self-medication is inaccurate, does not address the cause of constipation, and even worsens the picture," he said.
According to experts, the ideal is to make a promise to realize that symptoms persist for more than 30 days without improvement.
Also watch out for warning signs: Constipation starts after age 40, there is blood in the stool; weight loss; hardening of the stomach or stool (hardening of stool). If you notice one of these situations, immediately make an appointment for evaluation by a gastroenterologist or proctologist.
Among children, parents must see their pediatrician when symptoms persist for more than 2 weeks or increase immediately after birth.
How is the diagnosis made?
Your doctor will collect data on your clinical history, your lifestyle and personal and family history, and will also undergo a physical and proctological examination. Complementary examinations can be requested not only to ensure your general health, but also to detect any diseases related to your complaint.
Depending on each case, the most important tests are contrast radiography of the large intestine (Opaque Enema), colonic transit time, blood tests and colonoscopy (if any), rectal biopsy and anorectal manoror – to assess blood pressure. from the muscles of the anal area.
Among parents, besides age uniqueness, it is necessary to investigate colorectal tumors.
How is the treatment done?
After the diagnosis is established, the therapeutic approach is always personalized. Gastroenterologist Sandra Beatriz Marion, professor of medicine at PUC-PR (Pontaranal Catholic University of Paraná), explains that, in many cases, therapy consists of lifestyle changes.
Patients receive guidance on diet, hydration and physical activity, as well as strategies for establishing new bowel movements. Natural fiber-based medicines can also help and can be used continuously.
"The first thing you need to know is that there is no magic drug that makes the intestine work for a lifetime," the doctor said. "If there is no patient partnership, if he does not realize the importance of this important treatment, he will not achieve the results he wants," he added.
For people who don't respond to this strategy, there are a number of drugs available, such as those that wet the stool (osmotic laxative) or make it more oily (emollient). There are also drugs that work to balance the type of intestinal serotonin.
The last option is an interfering laxative, which is precisely the first person used in self-medication. Very strong, they have a direct effect, but if used for a long time they damage the intestinal nerve (myenteric). The result is constipation getting worse.
Therapy for more complex cases
When constipation is more severe, especially among women, and the cause is unknown, beyond all the possibilities described above, treatment may have a surgical solution with total colectomy (removal of the large intestine).
Recently sacral neuromodulation has been used, a pacemaker in the lumbar region that emits electrical stimulation in the modular nerve.
Learn how to set a diet
The correct consumption of soluble fiber is related to proper fusion of bolus formation, with softer and larger stools, while insoluble fiber accelerates intestinal transit. The indicated daily consumption is 25 g / day. And it's no use eating 5 lettuce and 1 tomato a day! These items each have 0.9g and 1.5g fibers.
For fiber, add the appropriate water consumption (must be calculated according to weight: 0.35ml per kilo) and avoid sedentary lifestyles. Even inserting probiotics and prebiotics into food may be beneficial and necessary.
Guidance from a nutritionist is welcomed. This is because "not everyone responds to the same diet and, therefore, must be evaluated individually, always considering their dietary habits, limitations and preferences, to ensure better results," explains nutritionist Camila Naegeli Caverni, clinical nutritionist and student EPM master-Unifesp (Paulista School of Medicine, Federal University of São Paulo).
Note that for some people, changing eating habits is very helpful, but that doesn't completely solve the problem. In this case, a gastroenterologist and a nutritionist must work together to ensure better results.
How to collaborate with treatment
It is not always possible to prevent constipation. However, careful consumption of fiber must be a lifelong habit. Also, always be well hydrated and do regular physical activity.
You can also take the following steps to avoid discomfort from the crisis or collaborate with therapy:
- Set the right 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 delaying this urgency;
- Prefer natural and whole foods;
- Drink at least 1 liter and 1/2 liquid a day;
- Learn how to read the product labels that you consume to identify the fiber content;
- Avoid consumption of processed and ultra-processed foods such as white rice, processed flour, corn flour, flour;
- Prioritize on the table: beans, lentils, peas, brown rice, flaxseeds, wheat, corn, wheat flour, vegetables (all), fruits (all);
- Maintain satisfactory physical activity – 30 minutes, 4 times a week.
Source: Joaquim Prado P. Moraes FilhoProfessor of Gastroenterology at FMUSP (Faculty of Medicine, University of São Paulo) and board member of the FBG (Brazilian Gastroenterology Federation); Jose Joaquim Ribeiro da Rocha, professor of the Coloproctology Division of the Department of Surgery and Anatomy, Hospital das Clínicas, FMRP-USP (University of São Paulo at Ribeirão Preto Medical School), and doctors in charge of Proctogastroclinics Ribeirão Preto; Sandra Beatriz Marion, Professor of Medical Courses at PUC-PR (Pontifical Catholic University of Paraná), Gastroenterology specialist and qualified endoscopist; Camila Naegeli Caverni, clinical nutritionist at the Brazilian Headache Center, and master students at EPM-Unifesp (Paulista Medical School, Federal University of São Paulo). Technical Review: Sandra Beatriz Marion.
Reference: Ministry of Health; ACG (American College of Gastroenterology); Maria Vazquez Roque, Ernest P. Bouras. Epidemiology and management of chronic constipation in elderly patients. Clin Interv Aging. 2015; Treatments for Constipation: A Review of Systematic Reviews. Quick Response Report: Summary with Critical Assessment. Ottawa (ON): Canadian Agency for Drugs and Technology in Health; 2014