Looking for relief

Just about everyone has been there, you need to defecate but after all the huffing and puffing nothing has been presented and you rise defeated, but not deflated.

Constipation isn’t just an inconvenience, it has also been associated with cognitive impairment and even cardiovascular disease.

There are over-the-counter remedies aplenty that will often get things moving again, but for some these have side effects while the situation can persist for months or even years. For this unlucky few, the consequences can have a villainous impact on quality of life, and lead to conditions such as anal fissures, haemorrhoids, impacted bowels and even in thankfully rare cases death.

People become constipated for a variety of reasons. In children the main cause is withholding faeces during potty training. Some two-thirds of adults with constipation are women, with reproductive hormones suppressing bowel mobility, while childbirth can damage the muscles in the pelvic floor, including those that control rectum contraction.

The condition also becomes more common with age. Sensory nerve decline in the rectum means older people are sometimes not so aware of the need to “go”, with the build-up and hardening of faeces in the lower bowel that is harder to pass.

Some medical conditions such as hypothyroidism and neurological conditions like Parkinson’s can contribute to the onset of constipation, as can many drugs such as codeine and other opiates. Then there are lifestyle choices such as too little dietary fibre, inactivity and dehydration which are thought to account for some one-third of cases.

But is constipation a symptom or a cause? The thinking is shifting.

Back in 2016 a team from Tohoku University School of Public Health established that a lower frequency of defecation went with an increased risk of mortality due to cardiovascular diseases in older women. But this was a small study. At the University of Tennessee shortly after, a team decided to look deeper into the matter. They perused the records of more than 3.3 million US veterans and found that deaths from all causes were significantly higher among those who were recorded as having suffered from constipation, with strokes and CHD occurrence being particularly noted as higher. Further studies have confirmed this phenomenon, including a study at the University of Melbourne which showed that those with chronic constipation were more likely to suffer a cardiac event. It has also long been known that people with kidney disease have been prone to constipation, while a study in South Korea revealed that chronic constipation often came before the development of kidney disease. This causal effect is not yet been proven, but there is a plausible mechanism for such a link.

Constipation can usually be resolved, but what can you do if you find yourself backed up? The standard medical advice is to consume more fluids and raise your fibre intake. Exercise can also have an impact, with even gentle exertion such as walking being shown to have an effect. Abdominal massage has also been found to help things along, and down, while taking up a different posture on the toilet such as leaning forward can help align things and ease passage.

New treatments are ongoing with trials of probiotics to manipulate the gut microbiome. Caffeine is also a (tasty) candidate, possibly because it stimulates bowel muscles. People with a high caffeine intake were found to have lower rates of constipation. Coffee anyone?