|
From: Medicine.net
What causes
constipation
Theoretically, constipation can be caused by the slow
passage of digesting food through any part of the intestine.
More than 95% of the time, however, the slowing occurs in the
colon.
Medications: A frequently over-looked cause of constipation
is medications. The most common offending medications
include:
Narcotic pain medications such as codeine (e.g., Tylenol
#3), oxycodone (e.g., Percocet), and hydromorphone
(Dilaudid);
Antidepressants such as amitriptylene (Elavil) and imipramine
(Tofranil) . Anticonvulsants such as phenytoin (Dilantin) and
carbamazepine (Tegretol). Iron supplements
Calcium channel blocking drugs such as diltiazem (Cardizem) and
nifedipine (Procardia).
Aluminum-containing antacids such as Amphojel and
Basaljel
In addition to the medications listed above, there are many
others that can cause constipation. Simple measures (e.g.,
increasing dietary fiber) for treating the constipation caused
by medications often are effective, and discontinuing the
medication is not necessary. If simple measures don't work, it
may be possible to substitute a less constipating medication.
For example, a non-steroidal anti-inflammatory drug (e.g.,
ibuprofen) may be
substituted for narcotic pain medications. Additionally, one of
the newer and less constipating anti-depressant medications
(e.g., fluoxetine or Prozac) may be substituted for
amitriptylene and imipramine.
Habit: Bowel movements are under voluntary control. This
means
that the normal urge people feel when they need to have a bowel
movement can be suppressed. Although occasionally it is
appropriate to suppress an urge to defecate (e.g., when a
bathroom is not available), doing this too frequently can lead
to a disappearance of urges and result in constipation.
Diet: Fiber is important in maintaining a soft, bulky stool.
Diets that are low in fiber can, therefore, cause constipation.
The best natural sources of fiber are fruits, vegetables, and
whole grains.
Laxatives: One suspected cause of severe constipation is the
over-use of stimulant laxatives (e.g., senna, castor oil, and
certain herbs). An association has been shown between the
chronic use of stimulanat laxatives and damage to the nerves
and muscles of the colon, and it is believed that the damage is
responsible for the constipation. It is not clear, however,
whether the laxatives have caused the damage or whether the
damage existed prior to the
use of laxatives and, indeed, has caused the laxatives to be
used. Nevertheless, because of the possibility that stimulant
laxatives can damage the colon, most experts recommend that
stimulant laxatives be used as a last resort after
non-stimulant treatments have failed.
Hormonal disorders: Hormones can affect bowel movements. For
example, too little thyroid hormone (hypothyroidism) and too
much parathyroid hormone (by raising the calcium levels in the
blood) can cause constipation. At the time of a woman's
menstrual periods, estrogen and progesterone levels are high
and may cause constipation. However, this is rarely a prolonged
problem.
High levels of estrogen and progesterone during pregnancy also
can cause constipation.
Diseases that affect the colon: There are many diseases that
can affect the function of the muscles and/or nerves of the
colon. These include diabetes, scleroderma, intestinal
pseudo-obstruction, Hirschsprung's disease, and Chagas disease.
Cancer or narrowing (stricture) of the colon that blocks the
colon likewise can cause a decrease in the flow of stool.
Central nervous system diseases: A few diseases of the brain
and spinal cord may cause constipation, including Parkinson's
disease, multiple sclerosis, and spinal cord injuries.
Colonic inertia: Colonic inertia is a condition in which the
nerves and/or muscles of the colon do not work normally. As a
result, the contents of the colon are not propelled through the
colon normally. The cause of colonic inertia is unclear. In
some cases, the muscles or nerves of the colon are diseased.
Colonic inertia can also be the result of the chronic use of
stimulant laxatives. In most cases, however, there is no clear
cause.
Pelvic floor dysfunction: Pelvic floor dysfunction
(also known as outlet obstruction or outlet delay) refers to a
condition in which the muscles of the lower pelvis that
surround the rectum (the pelvic floor muscles) do not work
normally.
These muscles are critical for defecation (bowel movement).
It is not known why these muscles fail to work properly in some
people, but they can make the passage of stools difficult
even when everything else is normal.
|