Constipation is generally defined as a condition in which a person is able to pass stools at a frequency of less than three times per week. In constipation, the stool itself is hard in consistency. Moreover, considerable straining is required to pass the hard stools out of the body.
Constipation is a fairly common condition, but it is not considered to be a medically serious situation. However, severe and long-term constipation can cause complications that may be serious, and even life-threatening. For this reason, one must promptly seek treatment in case of severe constipation, regardless of whether it is acute or chronic.
What Happens in Severe and Untreated Constipation?
The following are some of the possible complications that may arise due to severe or untreated constipation.
The slow bowel movements in constipation lead to accumulation of stool within the large intestine. This provides an opportunity for the intestinal bacteria to act on the fiber present within the stool, leading to production of gas.
Accumulation of gas in constipated individuals may result in abdominal bloating, especially in the lower left abdominal region. This area of the abdomen may also be tender to touch, and can cause severe pain.
Read more on bloating and gas.
A lazy colon refers to an abnormally low frequency of bowel movements that usually afflicts individuals with chronic and severe constipation. In the case of a lazy colon, even the presence of stool within the colon is unable to stimulate the urge for a bowel movement. These cases are commonly attributed to:
- chronic laxative abuse
- prolonged bed rest
- holding off bowel movements for prolonged periods
Lazy colon does not reflect a permanent colon impairment. Elimination of all possible causes of constipation, maintaining a healthy diet, and leading a physically active life can provide relief from the symptoms of lazy colon.
Fecal impaction refers to the accumulation of hard stools that cannot be passed out through natural straining. Elderly, bedridden individuals are more commonly affected by this condition. Both children and adults can get affected by fecal impaction, especially when suffering from chronic constipation.
Taking methadone or opiates can also cause fecal impaction. Dietary causes of fecal impaction include lack of adequate fluid intake, especially after consuming large amounts of cereals. Symptoms of fecal impaction include abdominal discomfort, sensation of fullness in abdomen, abdominal cramps, strong urge to defecate, pain in rectum, nausea, and frequent urge to urinate.
Fecal impaction can be treated by water irrigation (with a sigmoidoscope) and enema (using phosphate, arachis oil and glycerin suppositories). A doctor may also give an oral solution of polyethylene glycol in case of high fecal impaction. The stool may sometimes be removed piece-by-piece under local or general anesthesia.
Surgical removal of stools is generally not required. Forceful expulsion of compacted stool is not recommended since it can cause anal tears. Fiber-containing laxatives (such as metamucil) may be used to prevent fecal impaction.
Obstipation refers to constipation that is caused by an intestinal obstruction. The obstruction in the intestine can be partial or complete, and acute or chronic. Intestinal obstruction can be caused by a variety of conditions, including cancer, polyps, post-surgical scar tissue formation, twisting of the intestine upon itself (volvulus), telescoping of a part of the intestine into an adjacent part (intussusception), gallstones, hernia, and presence of foreign bodies.
Read more on blocked colon.
Diseases such as amyloidosis, lupus, and scleroderma can also affect colonic motility. Excessive stool within the intestine can be detected through ultrasound. Obstipation requires prompt treatment in order to avoid serious complications such as bleeding, bowel perforation and infection.
Rectal prolapse refers to a condition in which a part of the rectum protrudes through the anal opening during a bowel movement. Elderly people who have weak pelvic floor muscles, and constantly strain during bowel movements, are more prone to suffer from a rectal prolapse. Use of stool softeners and bulking laxatives can prevent aggravation of rectal prolapse. Surgical treatment may be required in some cases.
Rectocele is a condition that affects women, and is characterized by a bulging of the rectum into the vagina. The rectal bulge may contain trapped stool. Rectocele may occur due to constant lifting of heavy weights or a heavy vaginal delivery. The rectal bulge in rectocele can be detected by a doctor during a vaginal or a rectal examination.
In mild cases, strengthening of the muscles of the pelvic floor through Kegel exercises may help. However, surgical correction may be necessary if the rectocele protrusion into the vagina is significant.
Anal fissures refer to tears in the anal mucosa that are usually a result of forceful expulsion of hard stools during constipation. Severe pain that lasts of several hours is usually felt after a tear in the anal mucosa. The stools may also contain fresh blood. Bowel movements become very painful.
Bleeding and pain during bowel movements can persist for several weeks. Local analgesic creams and warm sitz baths can provide relief from pain and soothe the anal muscles. Stool softeners can also be used to smoothen the passage of stools. Anal fissures usually heal on their own within a few weeks. However, surgical treatment may be required if spontaneous healing does notoccur.
Chronic constipation commonly results in hemorrhoids (or piles), which refer to inflamed and swollen veins within the rectum and the anus. Pain in the anus is a common symptom of hemorrhoids.
Read more on hemorrhoids.
Treatments for hemorrhoids include consumption of fiber-rich diet, use of analgesic and anti-hemorrhoidal creams, and frequent sitz baths. When blood clots occur within the anal veins (thrombosed hemorrhoids), they become bluish and cause extreme anal pain. Prompt surgical removal of blood clot is essential in such cases.
Constipation can also causes complications outside the intestines. For example, incomplete urination, urinary incontinence, and urinary tract infections are often associated with the presence of hard stools in the rectum. Stroke and heart attacks can also be triggered by straining during bowel movements.
Blood is prevented from reaching the heart when the pressure within the chest cavity increases during intense straining and breath-holding. Upon release of the breath, the pressure within the chest drops suddenly and the blood trapped in the veins rushes into the heart. This causes a sudden rise in the heart rate and blood pressure. The heart rate then slows down reflexively. This sequence of events can precipitate a heart attack in susceptible individuals.
A similar increase and decrease in blood flow within the brain can also cause transient ischemic attack or stroke. In old people who suffer from atherosclerosis, deaths due to stroke can occur in the toilet while straining to pass stools. The need to strain during a bowel movement can be greatly reduced by adopting a squatting position while defecating.