DR BRIGID MONDA advises on remedial measures when you have three or fewer bowel movements in a week or if your stool is hard, dry, pellet like, painful or difficult to pass

Constipation is simply the inability to have a normal bowel movement. You may have constipation if you have three or fewer bowel movements in a week or if stool is hard, dry, pellet-like, painful or difficult to pass. Constipation is a sign of an underlying problem. It is not an illness.

Passing one or more soft, bulky stools every day is what many people consider normal. But bowel habits are different for everyone and the foods you eat, how much you exercise, and other factors can affect your bowel habits.

Constipation is most often caused by disturbance of how the intestines work. When food you have chewed and swallowed reaches the stomach, it churns it to a liquid and starts digesting the food.

This near-liquid food then enters the small intestines, which extract nutrients like calories, minerals and vitamins and pass the rest on to the large intestines or colon. The colon is five to six feet long and its main function is to withdraw water from the liquid stool, so that by the time it reaches the rectum, it is a soft-formed stool. If an excessive amount of water is extracted, the stool becomes hard and difficult to expel causing constipation.

Lazy colon

This will happen if the colon is ‘lazy’ and does not contract properly and so fails to move the stool to the rectum, or if the colon becomes spastic and remains contracted for a prolonged time and the stool is again unable to move along.

Both these situations mean that too much water is absorbed from the liquid stool and it forms hard pellets, causing constipation. Constipation can also be due to a mechanical obstruction, such as a large swelling in the lower part of the abdomen, which can distort and narrow the lower part of the colon. Other causes of a sluggish, poorly contracting bowel are a low fibre diet full of processed foods, pregnancy, anal fissures and hemorrhoids, certain drugs, thyroid disease, the abuse of laxatives, travel and stress.

Pregnancy

Constipation may also be caused by other factors like pain medications, sedatives, antidepressants, eating mostly soft or liquid foods that are low in fibre, and being physically inactive.

It is also a common problem in pregnancy and the culprits are the pressure of your growing uterus on your rectum, along with pregnancy hormones, which slow the transit of food through your digestive tract. Iron supplements can make constipation worse.

Constipation may cause anal fissures, which are tears in the skin around the anus caused when hard stool stretches the sphincter muscle.

These cause pain and bleeding with bright red streaks on the surface of the stool.

Sometimes straining causes a rectal prolapse where a small amount of intestinal lining is pushed out from the anal opening and causes secretion of mucus from the anus.

If it persists, see your doctor because there may be other underlying problems.