Constipation

Causes of constipation

Slower intestinal transit resulting in constipation can be caused by an underlying condition, which is why it is important to have it investigated. Causes of constipation include:

• Fear of pain during bowel movements due to anal fissures or haemorrhoids
• Pelvic floor disorders
• Spinal cord injury or neurological diseases
• Gluten intolerance (coeliac disease)
• Food allergies
  An allergy is often not considered when stools are too hard, yet a food, soy or cow’s milk allergy can be the cause. Lactose, wheat, onions and sorbitol contain sugars that are poorly absorbed and can therefore contribute to symptoms.
• Infection with intestinal parasites
  Constipation alternating with diarrhoea may indicate an intestinal parasite infection, such as Dientamoeba fragilis and Blastocystis hominis
• Colon cancer
  A changing bowel pattern can occur with colon cancer
• Pregnancy
  During pregnancy, about one quarter of women experience constipation
• An underactive thyroid:
• Age
  By around the age of eighty, more than seventy percent of people have very slow bowel function.
• Work-related factors
  Holding in stool for too long can slow intestinal transit, particularly in occupations such as drivers and teachers.
• Overweight and diabetes
  Constipation is one of the most common complaints associated with overweight and diabetes, and emptying of the bowel takes twice as long. Diabetes can cause neurological problems and may play a role in bowel emptying. High methane production in the intestine can also cause constipation, and people who are overweight appear to produce on average four times as much methane.
• Depression and stress
  A bloated abdomen, gas or constipation often occur together with depressive feelings. The intestines send signals to the brain through the blood and nerve pathways, and our behaviour and moods are influenced by signals originating in the gut. Gut bacteria and inflammatory substances present in the intestine have a major influence on the brain. The intestinal wall, for example, produces serotonin, which affects intestinal peristalsis. Toxic by-products of gut bacteria that enter the bloodstream also affect the brain.
• Medication use
  Painkillers and medicines that can cause constipation include:
  • Codeine (including cough syrup containing codeine)
  • Morphine
  • Antidepressants
  • Some anti-inflammatory medicines
  • Blood pressure-lowering medicines
  • Antihistamines
  • Iron supplements
  • Antacids
  • Long-term use of laxatives
• Hirschsprung’s disease or cystic fibrosis
  These conditions are present from birth or develop in the first weeks of life and can manifest as constipation. Narrow, ribbon-like stools may indicate a malformation of the anus. Weakness of the lower limbs, delayed motor development or problems with toilet training can cause slow bowel movements. In young children, a milk allergy is common and can cause severe constipation.