Constipation is a common and persistent condition that affects many patients around the world, with an estimated global prevalence of 14% of the population. In addition to infrequent bowel movements, the definition includes, overexertion, feeling of incomplete evacuation, prolonged attempts to defecate, use of maneuvers to evacuate, abdominal bloating, and hard stool consistency.
Types of constipation
Constipation is classified into two types: primary and secondary constipation. Primary constipation is due to disordered regulation of the neuromuscular system within the colon and anorectal, as well as disruption in its corresponding ascending and descending pathways in the brain-gut axis. With the help of criteria based on symptoms and diagnostic tests, primary constipation can be classified into functional disorder of defecation, characterized by slow transit and irritable bowel syndrome with a predominance of constipation.
The secondary one, on the other hand, can result from a multitude of factors, such as metabolic disorders (hypercalcemia, hypothyroidism), medications (e.g., opiates, calcium channel blockers, antipsychotics), neurological disorders (parkinson, lesions, diabetes mellitus), and primary diseases of the colon (stenosis, cancer, cleft, proctitis).
What is constipation, diet and lifestyle
Initial therapeutic approach to primary chronic constipation, regardless of etiology, consists of dietary and lifestyle changes, such as encouraging regular exercise, fluid and fiber intake.. Fiber is a complex and poorly digested carbohydrate that acts by increasing the volume of stool, extracting fluid in waste from stool in the colon as a laxative.
In addition, it undergoes partial fermentation producing short-chain fatty acids, hydrogen, methane and carbon dioxide. Fiber further accelerates colonic transit, increases biomass, and induces changes in colonic pH and gut microbiome, which can, in turn, affect membrane permeability and inflammation.
Fiber can be characterized based on solubility and fermentability. Bloating, bloating, flatulence, and cramping limit the use of insoluble fiber. However, a systemic review found evidence with a recommendation in support of fiber supplementation in chronic constipation. Particularly, mixed fiber supplements with insoluble components.
Clinical practice
The initial therapeutic approach, regardless of etiology, consists of dietary and lifestyle changes. Given this, an adequate intake of fluids and fiber is essential. As well as encouraging the practice of regular physical activities.
referencesBody
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Article:
Constipation
– Sharma A, Rao S. Constipation: pathophysiology and current therapeutic approaches. Handb Exp Pharmacol. 2017;239:59-74. doi:10.1007/164_2016_111
