What is constipation? Obviously it concerns frequency and consistency of bowel movements and degree of difficulty in passing stools. Consistency is more important than frequency.
Based on British studies the normal range is usually taken to be from three bowel movements per day to three per week. That range includes about 99% of the population. Clearly some individuals within the range will prove to be constipated when consistency and difficulty in passing stools are taken into account, while others lying outside the range will be seen to have normal bowel function. However, the correlation between stool softness and frequency is high.
The record for rectal continence is held by a man whose feat was reported in a 1902 article entitled “Unprecedented case of constipation”. After 368 days without a bowel movement the unfortunate subject passed his first pailful of feces. Although he was described as being extremely weak, there was, in the author’s words, “much rejoicing in the family”.
In assessing a constipated patient the following questions need to be asked:
1. Is there a change in bowel habit?
2. Are there fewer than three bowel movements per week?
3. Are stools hard or difficult to pass?
4. Is there pain with bowel movements?
5. Is there bleeding?
If the answer is no to all these, the health professional’s job becomes one of helping the patient understand that his or her bowel function is normal and that no treatment is required.
Food intake should be assessed. So-called constipation may simply be decreased stool volume. In the words of a British author, patients “may need to be reminded that one cannot make bricks without straw”.
A large number of symptoms have been attributed to constipation including headache, anorexia, nausea, bad taste, abdominal distension, borborygmi, foul breath, insomnia, irritability, furred tongue and flatulence. Although some of these symptoms may be psychological in origin, most are generally seen as being due to distension and mechanical irritation of the rectum and have been reproduced by packing volunteers’ rectums with cotton wool. They are not due to absorption of toxins produced in the colon, as was once believed.