The first clarification that needs to be made is from a purely medical point of view, clarifying immediately that constipation is not a pathology but a symptom and as such is expressed for a very specific cause.
If you do a quick search on the internet, many treatments for constipation are offered and most are symptomatic and do not aim to resolve the real cause or causes.
What is constipation (constipation)
Constipation, or constipation, is a difficulty in carrying out bowel function that can have a significant impact on quality of life. The term “constipation” comes from the Greek styphein, meaning “tight,” reflecting the typical difficulty and impediment in the bowel movement process. Usually, constipation manifests itself with rare and unsatisfactory evacuations, without a real sensation of complete emptying, which require excessive effort to expel stool.
According to a study published in the American Journal of Gastroenterology, chronic constipation affects approximately 15% of the global population, with a higher prevalence in women and older people. In these cases, psychological stress and conditions such as depression can make the situation worse, negatively affecting the frequency and quality of bowel movements. The “normal” frequency of bowel movements varies widely between individuals, but it is believed that ranging between three times a day and three times a week is typical for healthy bowel function.
The alteration of normal intestinal transit is also associated with irritable bowel syndrome (IBS), a functional condition of the intestine that often overlaps its symptoms with constipation. A study in the Journal of Clinical Gastroenterology highlights how up to 25% of IBS patients experience episodes of constipation.
What are the causes of constipation?
We can identify two types of constipation: acute (transient) or chronic.
Transient constipation is common:
Chronic constipation, on the other hand, can be caused by:
Some drugs (e.g. anesthetics, analgesics, antacids, anticholinergics, antidepressants) can also slow down the transit of feces along the intestine.
Often constipation, which in itself does not lead to abdominal pain or bloating, overlaps with irritable bowel syndrome (IBS).
What is it characterized by?
The symptoms reported by those suffering from constipation are varied and often significantly limit daily well-being. Here is a more detailed overview:
- Reduced frequency of bowel movements: constipation generally manifests itself with less frequent bowel movements than average, with less than three bowel movements per week. This irregularity can lead to an accumulation of feces in the intestine, generating discomfort and a feeling of heaviness.
- Hard or “goat” stools: one of the distinctive signs of constipation is the presence of particularly hard and dry stools, often described as “goat” due to their small and round shape. This consistency makes evacuation painful and tiring, contributing to the sense of frustration.
- Excessive and prolonged straining during defecation: Puffing, or straining to pass stool, is common among patients with constipation. This effort can last a long time and generate tension in the pelvic floor, worsening the difficulty in defecating.
- Sensation of anal obstruction or blockage: Many patients describe the sensation of having a physical obstacle in the rectum that prevents normal defecation. This blockage may be due to a buildup of hardened stool or pelvic floor muscle dysfunction, which makes it difficult to relax needed to expel stool.
- Sensation of incomplete evacuation: after having a bowel movement, it is common for those who suffer from constipation to still feel a sense of weight and fullness, as if the evacuation had not been complete. This persistent feeling can lead to further attempts, often inconclusive and accompanied by discomfort.
- Recourse to manual maneuvers or use of aids: to facilitate evacuation, some people resort to manual maneuvers, such as compression of the abdomen or perineum, or use aids such as enemas and suppositories. Although these practices can provide temporary relief, they do not solve the root problem and can, in fact, increase physical and emotional discomfort.
- Abdominal pain and bloating: Constipation may be accompanied by abdominal pain and bloating, especially when stool accumulates in the intestine. This symptom is often more accentuated in cases of constipation associated with irritable bowel syndrome (IBS), worsening the sense of discomfort.
- Nausea and loss of appetite: When the accumulation of feces persists, nausea and a reduction in appetite may occur, resulting from the pressure exerted by the feces on other organs of the abdomen.
Diagnosis
The approach to the patient with constipation is initially based on an accurate anamnesis and clinical examination. The diagnostic procedures used are aimed at identifying the organic or functional cause of constipation and will be chosen by the doctor on the basis of the patient’s symptoms and clinically detected data.
Treatment
In many cases, changes in nutrition, hydration and lifestyle are sufficient to relieve symptoms and manage constipation.
Here are some tips:
The opinion of the physiotherapist
Even in the medical field we often forget that some problems can be muscular in nature and can be solved or improved with physiotherapy.
Constipation is one of these problems, in fact there is a further classification, the functional constipation due to pelvic floor dyssynergia that is, when there is an absence of relaxation of the puborectalis muscle (a muscle that makes up the pelvic floor that connects the pubis to the rectum) during lifting.
What can a physiotherapist do?
A healthy pelvic floor is a pelvic floor that contracts and releases in a physiological way, physiotherapy even in case of constipation is a valid solution and alternative to the use of laxative drugs and certainly helpful combined with a healthy and adequate diet for the problem.
Some useful advice
Ideal posture
Posture is a fundamental thing, even in the bathroom, in fact more and more studies underline the importance of the position we maintain on the toilet to facilitate defecation; the most widespread and with the greatest results is the squatting position, the same one used in a squat toilet.
In this way the puborectalis muscle relaxes which, as mentioned before, could prevent the normal transit of feces.
How can we obtain the squatting position at home, without necessarily using a squat?
We can use a bench or a rigid box as in the image below, positioned under the feet, until we obtain a position in which the knees exceed the hips.
Breathe with your diaphragm
Once the right posture on the toilet has been achieved, all that remains is to relax the pelvic floor and if everything is in normal physiology, defecation should not have any obstacles. Excellent help certainly comes from diaphragmatic breathing, even in the bathroom!
Diaphragmatic breathing represents a sort of massage for muscles and internal organs, it promotes intestinal peristalsis as well as ensuring general psychophysical well-being.
We try to practice it every day, even for 10 minutes while we relax before sleeping, but also while sitting with our back leaning against the back of the chair, we put a hand on our belly and with our eyes closed we begin to concentrate by breathing with our belly instead of our chest. .
Don’t put off the stimulus!
The longer we hold it, the greater the dehydration the feces will undergo in the intestine: they will be increasingly harder and increasingly difficult to expel.
Furthermore, the intestine works well if used to working at the same time every day, if we are precise and habitual our intestine will be too.
Toilet training
A useful practice for those who suffer from constipation is to regularize evacuation through real training which will condition the intestine to always work at the same hours.
How to do it:
A specialized physiotherapist will be able to identify the causes affecting him and resolve the aforementioned problems in a few sessions, and if necessary he will be able to indicate the necessary specialist visits to the patient and send him to the most competent doctor.
Teamwork between doctors, physiotherapists, nutritionists and graduate athletic trainers is the key to solving many problems, including constipation!
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