Constipation vs. Obstructive Defecation
Constipation is a common complaint, affecting millions worldwide. It simply refers to infrequent bowel movements or difficulty passing stool. However, there’s a more specific condition called obstructive defecation that can mimic some constipation symptoms.
Causes of Constipation
This condition often arises due to problems with stool consistency or movement through the digestive tract. Here are some common causes:
- Low fibre intake: Fibre bulks up stool and aids its passage. A lack of fibre leads to hard, dry stools that are difficult to expel.
- Dehydration: Not drinking enough fluids can harden stool, making it harder to pass.
- Certain medications: Some medications, like opioids or antidepressants, can cause constipation as a side effect.
- Medical conditions: Conditions like thyroid disorders, diabetes, and neurological diseases can also contribute to constipation.
- Lifestyle factors: Lack of exercise, ignoring the urge to have a bowel movement, and changes in routine can all lead to constipation.
Criteria for Constipation:
According to the ROME III criteria this condition is defined as:
1) At least 2 symptoms below must be present for at least 3 months
- < 3 bowel motions per week
- Straining of stool at least 25% of defecation
- Hard stools occurring at least 25% of the time
- Sensation of anorectal obstruction at least 25% of defecations
- Incomplete evacuation at least 25% of defecations
- Digital evacuation at least 25% of defecations
2) There should be no loose stools without laxatives
3) Exclusion of constipation predominant irritable bowel syndrome (IBS)
Obstructive Defecation
Obstructive defecation (OD) is a type of chronic constipation where there’s a physical or functional obstacle hindering stool passage. It can feel similar to constipation, but the underlying cause is different. Here are some reasons for OD:
- Structural problems: This can include conditions like rectal prolapse (where the rectum pushes through the anus) and rectocele (weakening of the pelvic floor muscles)
- Muscle incoordination: Issues with coordinating the muscles involved in defecation can lead to difficulty pushing stool out. This can be due to nerve damage or weakened pelvic floor muscles.
Symptoms of Obstructive Defecation
- Straining during bowel movements
- Incomplete bowel evacuation
- Feeling of a blockage in the rectum
- Need for digital maneuver (using fingers) to assist bowel movement
- Frequent urge to have a bowel movement, but passing little stool
Treatment Options
Treatment for both constipation and OD depends on the cause. Some common approaches include:
- Dietary changes: Increasing fiber intake and staying hydrated are essential for both conditions.
- Laxatives: These can help soften stool and make it easier to pass. However, overuse is not recommended.
- Pelvic floor muscle therapy: This can help strengthen and coordinate the muscles involved in defecation, particularly beneficial for OD.
- Surgery: In some cases, surgery might be necessary to address structural abnormalities causing OD.
