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

Advertisements

Important facts about Nutrition

Nutrition is the most important key related to the health of an individual. Obtaining adequate nutrition is the fundamental requirement of every individual for survival. Recent decade’s people started talking about nutrition and awareness is increasing because overnutrition and undernutrition both causes diseases. Overnutrition gives rise to obesity, cardiovascular diseases, diabetes, cancer and so many diseases.
So here I want to tell you some important facts about nutrition. Quality and quantity both are very important to know about a healthy diet.

Nutrients in the diet can be divided in to two parts:
A. Macronutrients (carbohydrate, protein, and fat)
B. Micronutrients (Vitamins and minerals)

The three macronutrients all have their own specific roles and functions in the body and supply us with calories or energy. For this reason, the body requires these nutrients in relatively large amounts to grow, develop, repair and feel good.
Micronutrients do not contribute to energy balance but need in small amounts because they are not synthesized in our body and help to maintain energy balance, metabolism, cellular, functions, physical and mental health.

Energy balance
With rule of thermodynamics energy intake should be equal to energy output or energy expenditure. Energy intake is regulated by macronutrient content of food. Carbohydrate, fat and protein provide fuel for oxidation in mitochondria to generate energy (ATPs).
In general energy provided by each component differs.
1 g carbohydrates = 4 kcal
1 g of protein = 4 kcal
1 g fat = 9 kcal
Regulation of energy balance is very important for healthy life. Energy intake in the form of food and energy expenditure at various forms first in the form of food metabolism which is called dietary induced thermogenesis (energy required for digestion of food), BMR basal metabolic rate energy expenditure required to maintain metabolic functions in tissues and hence sustain life. Metabolic energy is also required for thermal regulation, and expenditure is higher in cold or hot environments. Another and most important factor is muscular activity which is usually different in all individuals depending upon their occupation and lifestyle.
Regulation of energy balance is coordinated in the hypothalamus, which receives afferent signals that indicate nutritional status in the short term and the long term.

Macronutrients
Carbohydrates
Carbohydrates are basically sugar molecule and based on structure they are divided in to two forms:
Simple carbohydrates and complex carbohydrates.
Simple carbohydrates are monosaccharides and disaccharides, whereas complex carbohydrates are oligosaccharides and polysaccharides.

Carbohydrates broken down to monosaccharides before absorption from the gut and supply energy. Actually carbohydrate should not be considered as an essential nutrient because they can be synthesized in the body from glycerol and protein. However if the available carbohydrate is less than 100 gram per day then increased lipolysis leads to ketosis.
Therefore sugar in original form (intrinsic sugar) as in fruits, vegetables and milk are never restricted but sugar is an extrinsic form should always be restricted.
Starches in cereal foods, root foods and legumes provide the largest proportion of energy in most diets around the world. Starches digested by amylase enzyme which is produced by pancreas and saliva, some starches digested by salivary amylase only and produce rapid delivery of glucose to the blood.
Carbohydrates source
Simple carbohydrates      Intrinsic: fruits, milks, vegetables
Extrinsic (extracted, refined): beet or cane sucrose,high fructose                                                                                                      corn syrup
Complex carbohydrates starch polysaccharides :(Rapidly digestible); cereals,whole                                                                                                     wheat, rice, root vegetables like potato
(Slowly digestible); lentils, legumes(peas,beans)

So bottom lines for carbohydrates are
1. Immediate source of energy or main fuel of body.
2. In case of starvation or going outside without carbohydrates or very less carbs, your body will use Glycogen as a fuel, glycogenolysis starts by using your protein from muscle mass and organs , gluconeogenesis starts (conversion of amino acids to glucose) to maintain normal glucose level in the body and the brain. So In starvation you are losing your muscle mass.
3. Carbs prevent ketosis – Even when fat is used for fuel, the cells need a bit of carbohydrate to completely break it down. Otherwise, the liver produces ketone bodies, which can eventually build up to unsafe levels in the blood causing a condition called ketosis. Ketosis can also cause the blood to become too acidic and the body to become dehydrated.

Fats
Fats are the highest energy density molecule; they provide most calories to the body
Dietary fat has a critical role in the body, one gram of fat provide 9 kcals, excessive consumption of fat may give rise to obesity and several diseases. But wisely use of fat is important to keep our body healthy.
Fats are different types like saturated fatty acid, unsaturated fatty acids (monounsaturated and Polyunsaturated Fatty Acids which is also called as PUFA).
Sources of Saturated fatty acids are animal fats butter, ghee or lard. Because your body can make all the saturated fatty acids it needs, you do not need any in the diet. High intakes of most saturated fatty acids are linked to high levels of LDL (low-density lipoprotein), or bad, cholesterol and reduced insulin sensitivity. Saturated fat and Trans Fat are associated with cardiovascular diseases so intake of these should be less than 2%. And replacing them with PUFA will reduce the risk of cardiovascular disorders.
Monounsaturated fat sources include avocados, nuts, seeds and olives. Peanut, canola and olive oils are additional sources.
PUFA are linoleic acid and Alpha linoleic acid which are essential fatty acids and sources are plant seeds oil. Other PUFAs are omega 3fatty acids and omega 6 fatty acids. Sources of omega 3 fatty acids are bluefish, herring, lake trout, mackerel, salmon, sardines, and tuna. Sources of omega 6 fatty acids are sunflower seeds, Brazil nuts, pecans and pine nuts. Some cooking oils are good sources too, such as corn, sunflower, safflower and sesame oils.
Hydrogenated oils, trans fats and saturated fats are not good for health, so try to reduce the intake of those and replace them with PUFA.

Proteins
Proteins are made up of 20 different amino acids, in which 9 are essential amino acids means they can not be synthesized in the body and we must get them through diet, we require them for our body growth, others are synthesized in the body by transamination. Proteins of animal origin, particularly from eggs, milk and meat, are generally of higher biological value than proteins of vegetable origin. However, when two different vegetable proteins are eaten together (e.g. a cereal and a legume), their amino acid contents are complementary and produce an adequate mix, an important principle in vegan diets.
Proteins in the body are constantly broken down and re-synthesized. Our bodies reuse most of the released amino acids, but a small portion is lost and must be replaced in the diet. The Recommended Dietary Allowance (RDA) for protein for adults is 0.8 g/kg of body weight. Because of their rapid growth, infants have the highest RDA for protein at 1.5 g/kg of body weight. The RDA gradually decreases until adulthood. It increases again during pregnancy and lactation to a level of 1.1 g/kg. The RDA for an adult weighing 140 pounds (63.6 kg) is a mere 51 grams of protein, an amount many of us consume before mid-afternoon. Usually people think that protein rich food is only animal derived, yeah definitely animal origin like meat,salmon, chicken, egg etc are rich in protein but vegetarians also get enough protein through legumes, cereals, beans, lentils, sprouts, nuts, peanut butter, broccoli, multigrain breads, cheese etc. If you eat a variety of foods, you will meet your protein needs.

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 – Davidson’sDavidson’s Principles and Practice of Medicine(22ndedition) http://www.naturalbalancefoods.com/community/dietary-needs/what-are-macronutrients-micronutrients/
http://www.innerbody.com/nutrition/macronutrients