Constipation

 

Passing stool is a very important part of our life and daily routine, if someone doesn’t pass stool in their routine they always feel discomfort and disturb their routine and mind too.
Constipation means hardening of stool and because of hardening of stool there is difficulty in emptying of bowel usually associated with painful defecation. Constipation is a condition of the digestive system where an individual has hard feces that are difficult to expel. So constipation is a symptom not a disease. Constipation may be acute (recent onset) or chronic(long duration).

Symptoms
Patient may have:
 Few bowel movements
 Trouble having a bowel movement (straining to go)/painful defecation
 Hard or small stools
 A sense of incomplete emptying.
Belly bloating/nauseous
Abdominal cramps
 Losing appetite
Pathology behind Constipation
Slower digestion of food will lead to slower movement through digestive tract and will lead to increase water absorption from the food which causes hardening of stool.

Causes of constipation

1. Decreased water intake
A healthy adult needs to drink at least 2-3 liters of water a day, but decreased intake of water will lead to decreased food digestion process and less hydrated body will make the feces hard, so we should keep hydrated in order to have good digestion and normal feces formation.
2. Physical inactivity
Physical activity keeps metabolism high, so less physical activity will slower metabolic rate and physical inactivity will lead to very slow metabolism.
Physical inactivity also causes constipation, because during physical activity our body muscles including abdominal muscles contract and relaxes which causes intestinal stimulant for contraction and relaxation.
People with sedentary lifestyle, older people, and bed ridden patients usually suffer from constipation.
3. Decreased intake of fibers
Fibers help in digestion and they promote bowel movements, low fiber diet will lead to constipation. It is very important to consume fiber rich diet like salads, fruits, multigrain flour should be part of our diet.
4. Medicines
Some medicines that doctors prescribe to treat other health problems can cause constipation. Medicines that can cause constipation include
Antacids—used to neutralize stomach acid—that contain aluminum and calcium
Anticholinergics—used to treat muscle spasms in the intestines
Anticonvulsants-phenytoin (Dilantin) and carbamazepine (Tegretol) iron supplements—used to decrease abnormal electrical activity in the brain to prevent seizures
Antispasmodics—used to reduce muscle spasms in the intestines
Calcium channel blockers diltiazem (Cardizem) and nifedipine (Procardia)—used to treat high blood pressure and heart disease
Diuretics—used to help the kidneys remove fluid from the blood
Iron supplements—used to build up higher iron levels in the blood
Medicines used to treat Parkinson’s disease
Narcotics—used to treat severe pain
Antidepressants (amitriptyline and Imipramine)
5. Life change from daily routine;
Sometimes because of travel , or any change from your daily routine habits eg; irregular meal time or sleep time, during pregnancy and change in food habits may also cause constipation.
6. Ignoring the urge to have a bowel movements
If individuals ignore the urge to have a bowel movement, the urge can gradually go away until the individual no longer feels the need to go. The longer it is delayed, the drier and harder the stool will become. In kids this is the most common cause of constipation.
7. Overuse of laxative
Some people believe a person should go to the toilet at least once a day – this is not true. However, to make sure this happens, some people self-medicate with laxatives. Using them regularly allows the body to get used to their action and gradually the dose needs to increase to get the same effect. Laxatives can be habit-forming. When a person becomes dependent on them, there is a significant risk of constipation when they are stopped.
8. Certain health problems
Diseases that tend to slow down the movement of feces through the colon, rectum, or anus can cause constipation eg Thyroid disorders (hypothyroidism), Diabetes, some neurological disorders, gastrointestinal disorders like diverticulitis or inflammatory bowel diseases and in certain cancers.
9.Aging
As a person gets older, the metabolism slows down, resulting in less intestinal activity. The muscles in the digestive tract do not work as well as they used to.

Diagnosis of Constipation
Diagnosis of constipation in patient made by full medical, surgical history, family history, complete dietary history, physical examination and by performing some diagnostic tests if need. For example, if defecation is painful, the doctor knows to look for anal problems such as a narrowed anal sphincter or an anal fissure. If small stools are the problem, eating foods low in fiber may be the cause. If the patient is experiencing significant straining, then pelvic floor dysfunction is likely. Depending upon the medical history and symptoms doctor may order for different tests

Blood tests – for thyroid hormones or calcium, or if blood loss from feces then CBC.
Abdominal X ray
Large amounts of material in the colon usually can be visualized on simple X-ray films of the abdomen, and the more severe the constipation, the more visualized on X-ray.
Barium enema
A barium enema (lower gastrointestinal [GI] series) is an X-ray study in which liquid barium is inserted through the anus to fill the rectum and colon. The barium outlines the colon on the X-rays and defines the normal or abnormal anatomy of the bowel and rectum. Tumors and narrowing (strictures) are among the abnormalities that can be detected with this test.
Flexible sigmoidoscopy or colonoscopy.
Anorectal Studies
Anal Manometry– for this test, a health care professional puts a thin tube that has pressure sensors and a balloon on its tip into your anus. Once the balloon reaches your rectum and the pressure sensors are in your anus, the health care professional slowly pulls the tube out to measure muscle tone and contractions. The test takes about 30 minutes.
Balloon expulsion tests consist of a health care professional filling a balloon with different amounts of water after he or she places it into your rectum. The health care professional will give you a stopwatch and instructions to go to the restroom and measure the amount of time it takes you to push the balloon out. If you can’t push out a balloon filled with less than 150 milliliters of water, or it takes longer than 1 minute to push the balloon out, you may have a problem pushing out stool.
Defecography -emptying of the rectum can be tested in the laboratory or with special x-rays.
Sometimes depending upon the condition and other results doctor may order for CT scan or MRI too.

Treatment
In the majority of cases, constipation resolves itself without any treatment or risk to health.
The goal of treatment in constipation should not to have bowel movement every day, but one every two to three days without difficulty (without straining).
Treatment for constipation depends on
• The cause of constipation
• how bad your constipation is
• how long you’ve been constipated means it is acute or chronic
Treatment of constipation should be start with natural remedies
1. Change of dietary habits which include eating more fibers, fruits and vegetables.
2. Intake of water should be increased. Try warm liquids, especially in the morning.
3. Prune juice, act as natural laxative.
4. Lifestyle changes and increasing physical activity. Exercising every day may help prevent and relieve constipation.
5. Flax seed oil as a natural lubricant and laxative.
6. Use of Probiotics/yogurt/buttermilk.
7. Don’t ignore the urge to have a bowel movement.
OTC Laxative
Use of laxative should be as a last resort.
Stimulants: These make the muscles in the intestines contract rhythmically. These include Correctol, Dulcolax, and Senokot.
Lubricants: These help the stool move down the colon more easily. These include mineral oil and Fleet.
Stool softeners: These moisten the stool. Stool softeners include Colace and Surfak.
Fiber supplements: These are perhaps the safest laxatives. They are also called bulk laxatives. They include FiberCon, Metamucil, Konsyl, Serutan, and Citrucel and should be taken with plenty of water.
Osmotics: These facilitate the movement of fluids through the colon. These include Cephulac, Sorbitol, and Miralax.
Saline laxatives: These draw water into the colon.
Chloride channel activators: These require a prescription and include lubiprostone (Amitiza).
5-HT-4 agonists: They increase the secretion of fluid in the intestines and speed up the rate at which food passes through the colon. They include Prucalopride.
If the constipation does not respond to any treatment, as a last resort, surgery to remove part of the colon may be undertaken. In the procedure, the segment of the anal sphincter or rectum that causes the constipation is removed.

Complications
Constipation on its own can be uncomfortable but not life-threatening. However, severe constipation can develop into more serious conditions, including:
1. rectal bleeding after continually straining to pass stools
2. anal fissure, or a small tear around the anus
3. hemorrhoids, or swollen, inflamed blood vessels of veins in the rectum
4. fecal impaction, in which dried stools collect in the anus and rectum, leading to an obstruction in the path stool would take to leave the body
5. Dealing with constipation before it becomes one of these conditions can prevent further discomfort.

Please note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.
Content source –https://www.medicalnewstoday.com/articles/150322.php,  https://www.niddk.nih.gov/health-information/digestive-diseases/constipation, https://www.webmd.com/digestive-disorders/digestive-diseases-constipation#1

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Hyperthyroidism

The term hyperthyroidism refers to any condition in which there is increased thyroid hormone produced in the body means the thyroid gland is overactive. Another term for this problem is thyrotoxicosis, which refers to high thyroid hormone levels in the blood stream, irrespective of their source.
Symptoms

  • Poor concentration
  • Fatigue/tiredness
  • Frequent bowel movements/Diarrhea
  • Goiter (enlarged thyroid gland) or thyroid nodules
  • Hair loss
  • Hand tremor
  • Heat intolerance
  • Increased appetite
  • Increased sweating
  • Irregular menstrual periods in women
  • Nervousness
  • Pounding or racing heart beat (palpitations)
  • Restlessness
  • Sleep problems
  • Weight loss despite a good appetite

Hyperthyroidism usually begins slowly but in some young patients these changes can be very abrupt. At first, the symptoms may be mistaken for simple nervousness due to stress.

Causes
The most common cause is overproduction of thyroid hormone by the entire thyroid gland. This condition is also known as Graves’ disease(autoimmune disorder). Graves’ disease is caused by antibodies in the blood that turn on the thyroid and cause it to grow and secrete too much thyroid hormone. This type of hyperthyroidism tends to run in families and it occurs more often in young women.
Other common causes include:

  • Thyroiditis-Inflammation of the thyroid due to viral infections, some medicines, or after pregnancy .
  • Taking too much thyroid hormone can cause thyrotoxicosis.
  • Nodules or lumps in the thyroid that may gradually grow and increase their activity so that the total output of thyroid hormone into the blood is greater than normal. This condition is known as toxic nodular or multinodular goiter.
  • Some tumors of the testes or ovaries (rare)
  • Getting medical imaging tests with contrast dye that has iodine (rare, and only if there is a problem with the thyroid).

Thyroid hormone regulation
The thyroid itself is regulated by another gland located in the brain, called the pituitary. In turn, the pituitary is regulated in part by thyroid hormone that is circulating in the blood (a “feedback” effect of thyroid hormone on the pituitary gland) and in part by another gland called the hypothalamus, also a part of the brain.The hypothalamus releases a hormone called thyrotropin releasing hormone (TRH), which sends a signal to the pituitary to release thyroid stimulating hormone (TSH). In turn, TSH sends a signal to the thyroid to release thyroid hormones. The rate of thyroid hormone production is controlled by the pituitary gland. If there is an insufficient amount of thyroid hormone circulating in the body to allow for normal functioning, the release of TSH is increased by the pituitary and TSH stimulates the thyroid to produce more thyroid hormone. In contrast, when there is an excessive amount of circulating thyroid hormone, the release of TSH is reduced as the pituitary attempts to decrease the production of thyroid hormone.

Diagnosis
Physician will ask questions about your symptoms, do a physical exam with reflexes, medical history, family history and order medical tests to diagnose hyperthyroidism.
Blood tests – to measure your thyroid hormones TSH, T3, and T4. A high level of thyroid hormone in the blood plus a low-level of TSH is common with an overactive thyroid gland.
Imaging tests of the thyroid-If blood tests show that your thyroid is overactive, your doctor may ask for
•   Radioactive iodine uptake and scan
•   Thyroid ultrasound

Treatment
No single treatment is best for all patients with hyperthyroidism. The appropriate choice of treatment will be influenced by your age, the type of hyperthyroidism that you have, the severity of your hyperthyroidism, other medical conditions that may be affecting your health and your own preference.

Antithyroid drugs
Methimazole , Propylthiouracil (PTU)
Methimazole is usually preferred one due to less severe side-effects. These drugs work well to control the overactive thyroid, bring quick control of hyperthyroidism and do not cause permanent damage to the thyroid gland.
Side effects – allergic reactions, red skin rashes, hives, fever and joint pain. Rare but serious condition called Agranulocytosis (decrease number of WBCs). If you are taking one of these drugs and get an infection such as a fever or sore throat, you should stop the drug immediately and check for a white blood cell count that day. Even if the drug has lowered your white blood cell count, the count will return to normal if the drug is stopped immediately. Liver damage is another very rare side effect. You should stop either methimazole or PTU and call your doctor if you develop yellow eyes, dark urine, severe fatigue, or abdominal pain.

Radioactive iodine
Another way to treat hyperthyroidism is to damage or destroy the thyroid cells that make thyroid hormone .The radioactive iodine taken just once by mouth in liquid or capsule form. Once swallowed, the radioactive iodine gets into your blood stream and quickly is taken up by the overactive thyroid cells. The response to treatment can take from 6 to 18 weeks, during which time drug treatment may be used to control hyperthyroid symptoms, radioactive iodine destroys the cells that have taken it up. The result is that the thyroid or thyroid nodules shrink in size, and the level of thyroid hormone in the blood returns to normal. Radioactive iodine is often recommended if you have Graves’ disease and are older than 50, or if you have thyroid nodules (toxic multinodular goiter) that are releasing too much thyroid hormone. Radioactive iodine is contraindicated if:
a. You are pregnant or you want to become pregnant within 6 months of treatment.
b. You are breast-feeding.
c. You have thyroiditis or another kind of hyperthyroidism that is often temporary.
Side effects – side effects of radioactive iodine treatment is for short-term, neck tenderness, swelling, nausea , vomiting, swelling and tenderness of the salivary glands, dry mouth, taste changes.

Beta-blockers
Beta-blocker drugs, such as atenolol or propranolol, do not block the production of thyroid hormone. Instead, they use for symptomatic control of hyperthyroidism, especially rapid heart rate, trembling, anxiety, and the high amount of heat the body produces.

Surgery
Removal of the thyroid gland is another permanent solution, but is often the last option. This procedure must be performed by a highly skilled and experienced thyroid surgeon because of complications include the risk of damage to nerves around the larynx (voice box) and to the nearby parathyroid glands, which control calcium metabolism in the body. Surgery is recommended when there is an enlarged thyroid gland that makes breathing difficult or when antithyroid drugs are not working, or when there are reasons not to take radioactive iodine. It may also be used in people who also have thyroid nodules, especially when the nodules may be cancerous.
Another important thing that after surgical removal of thyroid the source of your hyperthyroidism is gone and you will likely become hypothyroid. As with hypothyroidism that develops after radioiodine treatment, your thyroid hormone levels can be restored to normal by treatment once a day with a thyroid hormone supplement. So the patient will need to be monitored regularly for adequate thyroid hormone levels in the blood.

If left untreated, hyperthyroidism can lead to other health problems including congestive heart failure, abnormal heartbeat, and loss of bone mineral (osteoporosis).

Food to avoid
To increase the effectiveness of your radioactive iodine therapy, you may be prescribed a low iodine diet. The highest sources (and those to be avoided) are iodized salt, grains and cereals, some breads, fish from the sea, shellfish, beef, poultry, pudding mixes, milk and milk products.
Avoid restaurant foods
Consult your doctor before discontinuing or taking any medication.

Want To Know About Your Thyroid???

The thyroid gland is a butterfly shaped endocrine gland that is normally located in the lower front of the neck. The function of thyroid gland is to make thyroid hormones, which are secreted in to the blood and then carried to every tissue in the body. Thyroid hormone plays a very important role in the body as use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should. They help in regulation of growth and metabolism in the body. Thyroid hormones also help children grow and develop.
The thyroid’s hormones regulate vital body functions, including: Continue reading