Constipation is defined in medical terms as fewer than 3 bowel movements per week. Severe constipation is defined as less than one bowel movement per week. The causes of constipation include medications, habit, diet, hormonal disorders, laxative overuse, diseases affecting the colon, central nervous system diseases and pelvis floor dysfunction.
The management of chronic constipation is aimed at treating the underlying cause of the condition. The use of medications as a cause is frequently overlooked, with pain relievers, anti-depressants, anti-convulsants, iron supplements, calcium channel blocking drugs and aluminum-containing antacids being the usual culprits. Usually, discontinuation of the medication may not be necessary if simple measures like increasing dietary fiber are effective. The best way of adding fiber to the diet is increasing the quantity of fruits and vegetables. The most common sources of fiber include fruits and vegetables, wheat or oat bran, and psyllium seed. Psyllium, also known as Isabgol (Plantago ovata), is usually mixed with water, kept for sometime till it absorbs water and swells, and is then swallowed. Increased flatulence is a common side effect of high fiber diets. While large doses of psyllium can definitely increase bulk formation in the stool, it usually reduces the appetite. It is therefore advisable to use a combination of medicines in order to achieve the desired therapeutic effect and minimize the side effects.
Medicines like Amalaki (Emblica officinalis), Haritaki (Terminalia chebula), Behada (Terminalia bellerica), Sunthi (Zinziber officinalis), Marich (Piper nigrum) and Pippali (Piper longum) form the main stay of treatment for chronic constipation. These medicines regulate optimum gastric and intestinal secretions, and normalize bowel movement to bring about a normal defecation. These medicines are combined with other medicines according to the specific disorder involving constipation. Castor oil (Ricinus communis) is a good medicine to treat acute constipation. However, it is not recommended for repeated use since it can damage the nerves and muscles of the colon. This problem is overcome by using products like Gandharva-Haritaki, in which Haritaki is treated with castor oil. Similarly, other medicines like Hingashtak-Churna, Samudradi-Lavan-Churna and Shankh-Vati are used, which improve appetite, increase intestinal motility and soften the stools.
Medicated enemas which contain strong irritants can be used to treat acute constipation. However, to treat chronic constipation, simple enemas of sesame oil (Sesamum indicum) and groundnut oil are used on a long term basis. Medicines like Agnitundi-Vati, Vish-Tinduk-Vati, Ekang-Veer-Ras and Vat-Gajankush-Ras are used to treat diseases of the nerves which supply the colon. Medicines like Trayodashang-Guggulu, Kaishor-Guggulu, and Panch-Tikta-Ghrut-Guggulu can be used to treat pelvic floor dysfunction and diseases of the muscles of the colon. Medicines like Praval-Panchamrut, Panchamrut-Parpati and Suvarna-Parpati are used to treat inflammation in the intestinal tract.
Thus, constipation has to be treated according to the presenting causes and symptoms. A careful history and a detailed physical examination are therefore very important in all patients with constipation. It is important to note that while chronic constipation may not require immediate attention, acute constipation, especially when accompanied by other symptoms, may present as a serious illness and therefore requires urgent medical assessment.Constipation