CONSTIPATION

It is passage of firm or hard pellet like stools at infrequent and long intervals with difficulty to
expel. In constipation there may be less than 3 motions per week or painful defecation.
Infrequent or insufficient emptying of the bowel may lead to:
Malaise
Headache
Coated tongue
Foul breath
Lack of appetite.
These symptoms usually disappear after satisfactory evacuation has taken place.

TYPES
Atonic Constipation- It is the most common type of constipation. The intestinal walls lack
muscular tone so that peristaltic action is impaired. The food mass thus cannot move at normal rate
down the tract.
The chief causes of atonic constipation are:
Selection of foods low in bulk
Insufficient fluids
Poor personal hygiene
Lack of exercise
Chronic illness
Pregnancy
Excessive use of enemas.
Spastic constipation - The contractions throughout the tract act in a spasmodic manner, causing
the movement of food mass to be very irregular. Spasmodic movements cause acute pain.
Spastic constipation may be caused by
Irritation of the intestinal mucosa through the excessive use of alcohol, spices, tea, coffee, bran or
laxatives.
Highly, nervous people are more frequently affected by this type of constipation than bythe atonic
type
Temporary or chronic constipation can be due to any one of the number of factors such as
inadequate diet.
Failure to establish regular times for eating, adequate rest and elimination.
Faulty dietary habits, such as inadequate fluid and fibre intake or use of highly refined and
concentrated foods that leave little residue in the colon.
Interference with the urge to defecate brought on by poor personal hygiene or injury to the
nervous mechanism.
Changes in one's usual routine brought on by illness, nervous tension, or a trip away fromhome.
Chronic use of laxatives.
Difficult or painful defecation due to hemorrhoids or fissures.
DIETARY MANAGEMENT
Cause should be determined.
Correction of constipation depends on establishing regularity in habits -eating, rest, exercise and
elimination.
The diet should contain sufficient fiber to induce peristalsis and to contribute bulk to the intestine.
A regular diet with an abundance of raw and cooked fruits and vegetables should be provided.
Calories and Proteins: As per usual requirement.
Fats: Fat containing foods such as butter, oil etc are useful for some because of the stimulating
effect of the fatty acids on the mucous membranes. Excessive use should be avoided.
Carbohydrates: Whole grain cereals should be substituted for refined ones. Bran is useful for
some patients but excess should be avoided as it may act as an irritant to sensitive intestinal tracts.
Adequate bulk can be supplied in the form of vegetables and whole fruits which are rich in
insoluble cellulose.
Dried fruits like prunes, figs, raisins, dates, apricots provide fiber and are useful adjuncts.
Fruits and vegetables should be increased to 400gms to stimulate the intestinal motility.
Fiber: Both soluble and insoluble fiber should be incorporated in the diet. High fiber foods like
whole grains cereals, green leafy vegetables and other fibrous vegetables should be incorporated in
the diet.
Fluid: A fluid intake of 8-10 glasses a day is useful in keeping the intestinal contents in a semi-
solid state for easier passage along the tract.
1 or 2 glasses of hot or cold water plain or with lemon are helpful in initiating peristalsis when
taken before breakfast.