Am I constipated? (Explained in a way only your pharmacist can…)
Am I Constipated? Do I have Irritable bowel with constipation? Am I impacted?
Pathophysiology of constipation. “Pathophysiology” is just a fancy medical term that means the study of abnormal changes in body functions that are the causes or consequences of the disease.
Constipation is usually defined as hitting the washroom (defecating) fewer than 3 times a week with other symptoms that can include hard stools; feeling of incomplete evacuation (“Still feeling something”); too much forcing/straining ; a feeling of a block in the rectum; and abdominal uneasiness/pain and bloating.
You might incorrectly believe that a daily trip to the bathroom is important and that anything less means “Oh no, I’m constipated”. Actually, the typical number of bowel movements for an adult and for kids 3 years and older varies from 3 daily to once every 3 days. The would be typical for someone on a Western diet. What you eat and drink matters- obviously!
Constipation occurring chronically (regularly) is termed functional or chronic idiopathic constipation. This assumes that your cause of constipation is not the result of a drug side effect or that there is something physically wrong with your bowel.
If your constipation is a side effect of a chronic drug you are taking or a disease- and you do not seek to treat it this may cause serious complications! You can see complications like obstruction, anal fissures (cracks), hemorrhoids, abnormal dilation (swelling) and twisting of the colon and pelvic organ prolapse (a drop) in women.
A comprehensive document called the Rome IV
is a useful tool for used by medical professionals. It lays out the criteria for diagnosing all functional GI disorders.
If you are curious to deepen your official knowledge of constipation criteria here are the Rome IV criteria for chronic and opioid (narcotic drugs) constipation
What can make you at risk for chronic or acute constipation (Also known as your “risk factors”)
- Female
- Non-Caucasian
- Ignoring the urge
- Living in rural, northern or mountainous areas in North America
- Over 65 years of age
- Fewer years of formal education and lower socioeconomic status
- Low caloric intake
- A large number of daily meds
- Physical and sexual abuse
- Sedentary lifestyle and travelling
What about IBS (Irritable Bowel Syndrome) – can it cause constipation?
There is growing information revealing an overlap between functional constipation and irritable bowel syndrome with a predominant constipation side (IBS-C). It is difficult to categorically diagnose IBS-C even if investigated with physiological testing, an abnormal balloon evacuation test, imaging etc…. If you have bloating and or pain with an average of 1 painful constipation episode per week over the past 3 months, you may well be suffering from Irritable bower syndrome with constipation (IBS-C). Constipation with bloating and/or pain, are not main features of functional constipation so chances are it’s IBS-C
What about Fecal impaction? Could it be it?
Well Fecal impaction is the inability to pass a hard collection of stool. Symptoms that you may be experiencing is rectal discomfort, nausea, vomiting, abdominal pain, increase need to urinate- you can even see urinary and fecal incontinence.
Watch out for it in physically or mentally incapacitated persons and the elderly. This group of people are at particular risk of fecal impaction, as are those who require long-term use of medications associated with constipation as a side effect.
Can your medication constipate you?
Here is a pretty long list of medications that can constipate you. Send me a message if you have any specific questions on your medicines! alexyourpharmacist@gmail.com
Antiepileptics: Gabapentin Phenytoin (Dilantin®) Pregabalin
Antihistamines: Diphenhydramine Hydroxyzine
Antihypertensives: Clonidine Nifedipine Verapamil
Antinauseants: Dimenhydrinate (Gravol®) Prochlorperazine Promethazine Scopolamine
Antiparkinsonian agents (Sinemet®) Benztropine Bromocriptine
Levodopa Pramipexole Ropinirole
Antiplatelets: Clopidogrel
Antipsychotics: Clozapine
Antispasmodics: Dicyclomine
Cat-lon-containlng agents: Aluminum Barium Bismuth (Pepto Bismol)® Calcium Iron supplements
Diuretics: (Like Hydrochlorothiazide)
NSAIDs (like Advil® and Aleve®)
Opioids (Narcotic pain killers)
Resins (use for cholesterol reduction) Cholestyramine Sodium polystyrene sulfonate
Vinca alkaloids (Cancer treatment drugs) vinblastine, vinorelbine, vincristine, and vindesine
Conditions
Endocrine/metabolic disorders
Autonomic neuropathy
Cystic fibrosis
Chronic renal failure/uremia
Diabetes
Gastro lntestinal motor disorders (like: gastroparesis)
Hirschsprung disease (congenital aganglionic megacolon) -occurs when some of your baby’s intestinal nerve cells (ganglion cells) don’t develop properly, delaying the progression of stool through the intestines.
Hyper/hypocalcemia
Hyperparathyroidism
Hypokalemia (Low Potassium levels)
Hypomagnesemia
Hypothyroidism
Intestinal pseudo-obstruction
Irritable bowel syndrome (IBS)
Megarectum and megacolon (distented colon)
Multiple sclerosis
Neurogenic disorders
Panhypopituitarism
Parkinson disease
Pelvic floor dysfunction
Porphyria
Rectoceles (prolapse of the vaginal wall)
Spinal cord injury
Stroke
Systemic sclerosis
Uremia
Older age
Pain
Secondary to anal fissures,
Hemorrhoids
Pregnancy
Psychiatric disorders
Abuse, anxiety, brain injury,
depression, eating disorders,
sleep disorder
Anatomic obstructions (Actual blockage)
Diverticulosis
Post-surgical abnormalities
Stricture (Narrowing)
Cancer
Chemotherapy-induced
Dehydration
Direct intestinal radiation
Hormonal changes
Hypercalcemia (too much calcium)
Tumor compression of large intestine
Tumor interference with colonic nerve endings
Assessing Constipation
Take a proper look at your diet, level of exercise and relevant social or psychological problems. What has changed in your life that can be improved that may contribute to the constipation ?
At first, review prescription and non-prescription medications to rule out drug-induced
causes. Are you taking any of the drugs on the list above?
Also look at the natural health products since their overuse could cause gut dysfunction and constipation.
Signs and symptoms of constipation include:
■ Infrequent defecation
■ Abdominal distention
■ Nausea
■ Vomiting
■ Anorexia
■ Early satiety
■ Stools that are small, hard and/or difficult to evacuate
Which ones are the most troublesome?
What past laxative have you used and failed- this will to help maximize adherence and reduce possible side effects. Keep in mind that if you are suffering from opioid induced constipation, up to 28% of patients do not take the prescribed laxatives by their doctor while 25% of those patients use laxatives only intermittently!
Did you know there is an official chart about the different forms of observed formed of feces called The Bristol Stool Form Scale (BSFS)? It is tool to help describe bowel patterns in a way that is more useful for diagnosis and evaluation of treatment- I wish I could tell you how this visual chart was conceived and how agreement was reached but it’s a real thing! Check it out!