Constipation is the passage of faeces infrequently and with difficulty. The faeces are usually hard; however, this is not always the case.
The average defecation frequency in healthy people in the age range of 12 to 90 years varies from 3 times per day to once per 2 days.
Objective criteria (the so-called 'Rome criteria') that are used in the literature for constipation are:
a defecation frequency of less than three times per week, and/or
a defecation duration of more than 10 minutes, and/or
for more than 25% of defecations:
o need to strain, and /or
o feeling of incomplete evacuation, and/or
o feeling of anorectal obstruction/blockage, and/or
o need to remove the faeces manually or to support the pelvic floor
Treatment is usually indicated if there is a change in the patient's normal defecation pattern and if this change is accompanied by complaints. Faecal impaction is the situation in which the faeces in the large intestine are so thickened and hardened that spontaneous discharge is no longer possible. In the majority of cases the impaction occurs in the rectosigmoid. An empty rectosigmoid, however, does not exclude faecal impaction. In the case of faecal impaction an intestinal obstruction or perforation may occur.
Constipation may lead to paradoxical or false diarrhoea: leakage of watery faeces past a thickened faecal plug. It is most important to recognise this cause in patients with diarrhoea in order to initiate a treatment that is focused on the treatment of constipation instead of treating diarrhoea.
Other consequences of constipation can be:
abdominal or anorectal pain
bloating
anorexia, nausea and vomiting
flatulence
local complications such as haemorrhoids, anal fissures, perianal abscesses, urine retention
vagal responses during straining
restlessness and confusion
For the patient, constipation often has a considerable impact on the quality of life and Its severity is frequently underestimated. Preventive measures are therefore vital.
