Constipation

constipation; constipated; faeces; feces; poo; bowel; motion; fibre; stool;

Contents

• Poo, faeces, bowel motion or what?
• What is poo?
• What is constipation?
• What does our gut do?
• What causes constipation?
• How will you know if you are constipated?
• What are the effects of constipation?
• Managing constipation
• Resources
• References

Can't drop your friends off at the pool? Finding it hard to have an Eartha Kitt? We might joke, but constipation can be a real problem - but one that you can solve.

Constipation is not a topic that we regularly talk about with our friends, in the schoolyard, at work, in the middle of a deep and meaningful conversation, and certainly not over dinner!

But if you have it, you might need to take some action.

Note: If you notice any blood or mucus with your poo, see your doctor as soon as possible.

Poo, faeces, bowel motion or what?

There are many words used for what are medically called faeces. In some communities, there is not even an acceptable polite word for it at all.

In this topic we are calling it 'poo' because that seems to be the most common polite word used in Australia. Sometimes poo is also called a 'bowel motion' or a 'stool'.

Some other words used here include:

• Anus - the opening through which poo is passed
• Bowel - the part of the gut from the bottom of the stomach to the anus
• Small intestine - the upper part of the bowel (it is longer than the large intestine, but thinner)
• Large intestine - the lower part of the bowel (including the colon, appendix and rectum)
• Rectum - the part of the large intestine just inside the anus.

What is poo?

Poo is mostly made up of water, bacteria (dead and alive), dead cells from the lining of the gut (millions are made and lost every day), undigested food (such as fibre and sometimes pieces of vegetables, seeds, nuts), and waste products (things that the body is getting rid of).

What is constipation?

People often mean different things when they use the word 'constipation', but what we are talking about here is:

• when it is harder than usual to do a poo,
• when the poo itself is harder than usual,
• and when a person passes poo less often than usual (for that person!)

What is 'usual' or 'normal' differs between people.

• Some people do poo much more often than others do, so they may feel uncomfortable and 'constipated' if they only do poo every other day.
• For some people, it is normal for them to only do a poo once a week.
• Some people do poo several times every day.

Generally, the word 'constipated' is only used if the poo is hard and dry.

Sometimes it may seem a person has diarrhoea (runny poo) even when he is constipated.

• This is because only liquid poo is able to get out around a large hard lump of poo.
• This runny poo can leak out without the person being aware that it is leaking, soiling their underwear.

What does our gut do?

This next bit may seem like a biology lesson, but knowing what all the bits do makes it easier to understand why some bits go wrong, and what to do about it. You can skip it if you like.

• The food that we eat gets mixed up in the stomach with acid which starts to break it down so that it can be absorbed (the start of the digestive process).
• The food passes out of the stomach into the small intestine (the upper part of the bowel) where it is mixed with enzymes, and is broken into smaller bits until it can be absorbed through the wall of the intestine.
• Bits that cannot be absorbed (such as some fibre) pass into the large bowel. Here there are bacteria which get to work and some more nutrients (energy, vitamins, water, etc.) can be absorbed. The action of the bacteria also makes various gases, such as methane and other smelly ones!
• What is left is held in the last part of the bowel (the rectum) until we are ready to let it out.
• As the rectum fills up, messages go from the rectum to the brain (via nerves) to let us know that it is time to 'do a poo'.
• The anus has a ring of muscle which holds the poo in until we consciously let go and push it out.
• There are muscles in the wall of the whole length of the gut pushing the food and poo along towards the anus.

Water (a large part of both food and poo) gets into the gut in what we eat and drink, and it also comes through the wall of the gut. Much of it is also absorbed back through the wall.

How soft poo is (how much water is in it) depends on:

• how much we drink
• what type of food we eat
• whether the wall of the gut is healthy (infections like gastro damage the wall of the gut, allowing much more water to leak into the gut)
• how long poo stays in the gut.

If food and poo pass through the gut fast, the poo will have a lot of water in it and be soft. If poo moves through slowly, most of the water in it will be absorbed, drying the poo out.
 

What causes constipation?

There are many causes of constipation. Some causes have to do with what we eat and drink, and others with how well the muscles of the gut are working. Causes include:

• not getting enough fibre or bulk in your diet
• not drinking enough fluids (getting dehydrated)
• not exercising enough (travelling can cause constipation if you sit still for a long time)
• not eating enough food (such as with an eating disorder)
• being sick (this can cause diarrhoea as well)
• taking some medicines, such as painkillers with codeine in them
• not going to the toilet when you need to - some people ignore the message to go to the toilet (maybe they don't want to use the toilet where they are), and the poo in their rectum gets drier and harder, and is not as easy to push out.

Also, for reasons that are not well understood, some people get constipated really easily, while others rarely get constipated. Being constipated seems to 'run' in some families (we just can't help making jokes about poo, can we?)

How will you know if you are constipated?

• If you can't go to the toilet and do a poo easily when you want to, and when you do it is hard, dry and painful, then you have constipation.
• If poo leaks onto your underclothes without you noticing, you might have constipation.
• You may also have some cramping pains in the tummy and feel bloated.

What are the effects of constipation?

• Constipation does not cause health problems. No 'toxins' or poisons are absorbed from the large bowel.
• However, constipation can feel uncomfortable - passing a hard poo hurts, and also can tear the skin of the anus, causing bleeding.

Important: If you have any blood after a poo or mixed in with the poo, make sure you check with your doctor, as sometimes blood in poo can be a sign of more serious problems such as bowel cancer (this can occur in young people - but not often).

Managing constipation

First of all, try to work out what might have caused your constipation.

• If you only rarely get constipated, it may have been because you were sick or travelling, and not much needs to change.
• You might need to increase the fibre in your diet. Fruit and vegetables, cereals and bread are all good sources of fibre. Check out the topic Healthy eating.
• Increased exercise often helps too. More walking is often enough - exercise does not need to be hard exercise. Check out the topic Exercise.
• Drink more water. Getting even a little bit dehydrated through forgetting to have drinks can cause constipation for some people.
• Taking medicines such as laxatives for more than a couple of days is usually not a good idea.
• They may be fine just once or twice, but using them all of the time does not get to the cause of the problem, and sometimes they can change the way muscles in the bowel work, so that there is more trouble with constipation when you stop using them.
• There are different types of laxatives. If you do choose to use them, try ones that increase fibre in the gut.

If poo is leaking out, the mass of poo may be so hard that it will not come out without extra help.

• Sometimes a small enema is needed (an enema is a liquid that is put up into the rectum through the anus - sounds unpleasant, but the modern ones are usually not too bad).

Check with your doctor if:

• you are getting constipated often
• poo is leaking out
• there is any blood in the poo or on toilet paper after you have done a poo
• you have concerns that still cause you worry.

Other ideas

Some people find that massage helps them when they are constipated.

• Massage the tummy in a circle starting from the right groin, up around under the rib cage then down to the left groin. This is the same direction as the poo moves through the bowel.
• Massaging the soles of the feet in the same direction is claimed to help too.

Resources

South Australia

• The Second Story Youth Health Service (TSS)
  - Central: 57 Hyde St, Adelaide
  - South: 50a Beach Rd, Christies Beach
  - North: 6 Gillingham Rd, Elizabeth
  - West: 51 Bower St, Woodville
  Contact TSS via the Youth Health line on 1300 13 17 19, 
  or for mobile phone callers (08) 8303 1691 - normal rates apply.
• General Practitioner.
• Local Community Health Centre.

References

Garfunkel LC, Kaczorowski J, Christy C (Ed). 'Mosby's Pediatric Clinical Advisor'. Mosby 2002.

Gastroenterological Society of Australia. 'Facts about constipation':
http://www.gesa.org.au/leaflets/constipation.cfm 

The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Youth Healthline on 1300 13 17 19 (local call cost from anywhere in South Australia).