Constipation

The constipation (French of the 14th century according to the Latin Co : " avec" + stipare : " to make stiff, compact") consist of the difficulty with déféquer, i.e. to evacuate the Excrément S out of the organization, generally because of a too great hardness of the saddles. The constipation is affirmed by a number of saddles lower than 3 per week.

The fear of the constipation is the Apopathodiaphulatophobie.

Who is concerned?

It is estimated that the constipation reached up to 20% of the population of the Western countries. It is particularly frequent at the woman (hormonal causes: the Prostaglandine S have a role on the reduction in the activity of the smooth muscle, involving a less good mobility of the digestive tract) and the elderly (because of frequent dehydration, of a mode unbalanced and low in fibers, lack of activity).

Diagnostic orientation

The main issue vis-a-vis a constipation is to differentiate benign constipation (functional) and constipation related to an organic pathology engraves (in particular cancer colic). If a serious cause is suspectée, certain examinations must be prescribed: Coloscopie, search for blood in the saddles, Hémogramme,… In the event of suspicion of anomaly of the tonicity of the anal sphincter, one will be able to carry out a manometry anorectale (examination of the pressure of the anal sphincter at rest and to the defecation).

Leading causes of constipation

  • primitive Constipation (or functional ):

    • Anomaly of the contents of the saddles: when they are not rich enough in fiber water nor in particular.
    • Reduction in digestive motricity: dependant on an insufficiency of physical exercise, an excessive catch of Laxative S, a irritable Colon.
    • Anomaly of the evacuation: dependant on an excess of the tonicity sphinctérien, whose relaxation is not obtained during the defecation.
    • psychogenic Causes: one often finds a stress related to the defecation, readily related to a problematic training of cleanliness (abusive mother), but also Maltraitance, sexual abuses in childhood.
    • Stress of the daily life due has a génant environment, or with a change of this one.
    • Stress of the lack of Hygiene of the Toilette S, which block the defecation.

Treatment

  • In the event of functional constipation:

    • Hygiene of life:

      • To go to the saddle to fixed hour and never to retain themselves,
      • Food rich in fibers (green vegetables, its, brown rice, fruits),
      • to hydrate itself Well (2 liters of water per day),
      • Physical exercise,
      • Relieving.
      • Rehabilitation by a kinesitherapist specialist

    • Laxative S not irritants (by oral or rectal way)

  • In the event of organic constipation: treatment of causal pathology.

Constipation in the child

  • the new-born babies expel the Méconium during the first two days of the life. Then they have approximately a saddle after each tétée to decrease then and to stabilize themselves towards 3-4 years with 3 saddles per day to 3 saddles per week. In the event of breast-feeding the saddles are liquid, friable or very soft. In the event of bottle-feeding the saddles are more compact.

  • the constipation in the child is defined by a reduction in the frequency of the saddles (2 to 3 times per week), by saddles compact and/or difficult to evacuate, or by a retention of the saddles.

  • the complications of the constipation are exceptional before two years. The principal complications are the appearance of Fécalome complicated itself of prolapsus rectal, the Encoprésie, the digestive functional disorders (abdominal pains, distensions), the anal cracks and bleedings related to the defecation. Sometimes one finds urinary infections with repetition, psychosocial disorders.

  • Most of the time one does not find any organic cause: the constipation is known as functional calculus. It is related to an unsuited food, a feverish state or a stress. Sometimes it is about a voluntary retention related to the education of cleanliness. Many drugs can also involve a constipation. Among the rare causes: Lead poisoning, Botulism, the congenital mégacolon (Disease of Hirschsprung).

  • the principal treatment is of a nonmedicamentous nature: mode rich in fibers (vegetables, fruits, complete cereals), use of not very mineral-bearing water (volvic). Occasionally a medicamentous treatment is necessary. In first intention, specific use of a Laxative by rectal way like the glycerin . If a repeated use is to be considered, not to cause anal irritation, an osmotic laxative or lubricant can be made. The laxatives of ballast are an alternative, especially when the fiber contribution is insuffisant.

are contra-indicated: stimulative laxatives before the twelve years age (because of the many undesirable effects and medicamentous interactions), the rectal injections in hypertonic solution before the three years age (risks of hydro-electrolytic disorders serious).
the paraffin of repeated use exposes to anal irritations and with the seepage, the laxatives by rectal way or the rectal injections can block the normal reflex of defecation. Certain laxative herb teas contain anthracene derivatives (Bourdaine, senna for examples) and can lead to the same risks as the stimulative laxatives.
In the long run, all the laxatives can disturb the absorption of other drugs.

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