Constipation is not a disease but a symptom, similar to a fever. Various causes can lead to slow bowel function. The intestines slow down because the waves that drive the contents weaken or occur less frequently. According to the cause of origin, constipation is divided into two groups:

Primary (functional constipation)

Secondary (consequence of illness or taking medication)

Table 2. Constipation classification according to the cause of origin

Primarna (funkcionalna) opstipacijaSekundarna opstipacija
A Normalno tranzitno vrijemeA Posljedica uzimanja lijekova
B Sporo tranzitno vrijemeB Posljedica drugih bolesti
C Poremećaj izbacivanja stolice

Constipation with a normal transit time accounts for 55% of primary constipation. It has not yet been established whether some colon waves are less frequent or weaker. Lifestyle certainly plays a role: prolonged sitting, little movement, skipping breakfast and low fiber foods will negatively affect the motility of the intestine.

Also, if due to discomfort you avoid “nature’s call”, the likelihood of developing constipation increases. It is not good to suppress “when you need to go” because the colon reflex gradually weakens.

Constipation with a slow transit time accounts for 15% of primary constipation. Passage through the colon is slowed here. People with this form of constipation have fewer nerve cells (Cajal cells) that stimulate the intestine muscles to perform the undulating movements. That’s why they have fewer motions in the colon. These people’s colon waves do not enhance after eating or taking laxatives. Their colon is a real slacker.

Defecation disinergia is an official term for fecal incontinence.

The colon works properly. The passage through the colon is not slowed down. All the motions are frequent enough and of sufficient intensity. The stool reaches the end of the colon, but it can not be ejected. At the time of defecation, the colon sphincter and the lower pelvic muscles constrict rather than relax. For this reason, the patients cannot discharge the stool.

Secondary constipation is caused by other diseases or taking certain medication. There are many drugs that slow the colon. They are listed in Table 3. Diseases that slow down bowel movements are listed in Table 4.

Table 3. Medication that causes constipation

Protiv mučnineOndansetron
Protiv bolovaMorfij, fentanil, ibuprofen
Za tlakVerapamil, nifedipin, atenolol
Za mokrenjeFurosemid
Protiv grčeva crijevaMebeverin
Oralni kontraceptiviEstrogen, progesteron
Dodaci prehraniPreparati željeza, kalcija
Za epilepsijuKarbamazepin
Za psihičke bolestiHaloperidol, risperidon, klorpromazin
Za bolesti žučiKolestiramin

Table 4 Diseases that cause constipation

Bolesti crijevaTumor debelog crijeva, priraslice nakon operacija
Bolesti metabolizmaDijabetes, slab rad štitnjače, sniženi kalij u krvi, povišeni kalcij u krvi
Neurološke bolestiStanje nakon moždanog udara, Parkinsonova bolest, multipla skleroza
Psihijatrijske bolestiDepresija
Bubrežne bolestiPovišena urea u krvi

Which tests should be done when I’m constipated?

If you noticed some of the alarming signs, you need to have a colonoscopy.

If you don’t have any alarming symptoms, you don’t need additional tests, just therapy.

The American Gastroenterological Society in its guidelines recommends that in case of constipation you take therapy. Only if therapy does not work should you run tests to see if you may have fecal incontinence or a slow transit through the colon.

When to suspect fecal incontinence?

  • if you sit on the toilet for a long time
  • if you have to strain hard to get the stool out
  • if you have difficulty emptying your bowels even when it is soft
  • if you have to use your fingers to get the stool out

What test should you do when you suspect fecal incontinence?

Anal manometry is a test to determine if you have fecal incontinence. A probe is inserted into the anus to measure how the anal sphincter works. When urinating, the colon sphincter relaxes so that the stool can come out. Fecal incontinence occurs if the sphincter contracts instead of relaxing. In addition to checking the function of the sphincter, the time required for the probe to be expelled from the rectum is also measured. If after three minutes you cannot eject the probe, you have fecal incontinence.

How to detect slow transit through the colon?

Transit time – the time required for the contents to pass through the colon

Measuring transit time in the colon is a simple test. Drink one capsule containing plastic rings marked with barium to be seen on an X-ray. After five days, take an X-ray of the abdomen while standing. If after five days on the abdominal X-ray more than 5 rings are left in the colon – it is a slow transit time.

Image – X-ray of the abdomen five days after taking the capsule

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