CONSTIPATION: definition, causes, solutions, different laxatives

In this video and in this health and wellness blog post you will find:

- The definition of real constipation

- The functioning of the digestive system

- The different stages of digestion

- The anatomy of the digestive tract simplified

- What can cause constipation?

- Complications of constipation

- How to unblock constipation?

- The different types of laxatives

- Recommendations and contraindications to the use of laxatives

- How to avoid constipation?

Constipation is a problem that affects many people, it can be very embarrassing and unpleasant if it lasts too long.

I'll give you a little reminder about digestion and intestinal transit.

When we eat food and drink beverages, these different substances mix with saliva in our mouths during chewing.

These substances then travel down a tube called the esophagus to the stomach where they are broken down into nutrients (carbohydrates, proteins, fats) and digested in the small and large intestines.

The elements pass to the blood to be distributed to the cells of our different organs to ensure their proper functioning.
The undigested elements arrive at the rectum (end of the large intestine) to be evacuated by the stool.

The intestine is formed by several layers of cells, from the inside to the outside of the intestinal lumen, there is the mucosa, the submucosa, the muscularis and the serosa. Each layer contains different cells that have specific roles.

The mucosa is formed mainly by enterocytes, these cells allow the absorption of different nutrients, they are equipped with cilia called microvilli or brush border, at their upper part. These cilia increase the surface area of exchanges within the intestine, they allow the absorption of different nutrients and their advancement within the intestine).

The submucosa is connected to the nervous system.

The muscularis contains smooth muscle cells, this type of cell can contract involuntarily and rhythmically unlike striated muscle cells. The role of the muscularis cells is to move food through the digestive tract.

The serosa has a protective role.

I would like to inform you that constipation corresponds to a frequency of bowel movements lower than 3 times per week accompanied by bloating, abdominal pain, a feeling of heaviness in the belly and pain when the person tries to evacuate the stools which are often dry and hard.

The causes of constipation are usually dietary and lack of physical activity.
The main cause of constipation is not drinking enough water during the day, i.e. less than 1.5 L per day, but also not eating enough dietary fiber.

These fibers are not digested by the body and help intestinal transit. They increase the volume of stools and make them softer thanks to their ability to retain water in the stool.

For more information on dietary fiber, click here 

Fiber is found mainly in fruits, vegetables and whole grains.

Physical activity promotes the circulation of blood within the body and the movement of the food bolus within the intestine, hence the importance of regular and adapted physical activity.

Other causes of constipation are smoking cessation, stress, age (people over 55 tend to be more constipated), certain diseases that affect the nervous system such as Parkinson's disease. These pathologies can hinder the proper circulation of nerve messages that allow, for example, the contraction of muscles necessary for the proper functioning of intestinal transit.

Hormonal changes can also cause constipation (menstrual cycle, menopause, pregnancy), as well as certain medications such as painkillers of the opiate family (morphine), certain antidepressants, antihistamines (allergy treatment), treatments given to fight against high blood pressure or diabetes, statins given to limit the increase of cholesterol, certain medications prescribed against nausea during chemotherapy...

It is recommended to drink at least 2 liters of water per day when taking these different treatments to limit this side effect.

Apart from the unpleasant sensation, constipation does not lead to major complications, but it can cause hemorrhoidal attacks.

It is important to be careful because if it lasts too long, it can be a warning sign of an intestinal obstruction, which is the fact that a part of the intestine is blocked by an obstacle that prevents the circulation of the food bowl.

In case of constipation, it is advisable to drink a lot of water (2 L), giving preference to mineral water rich in magnesium.

For a better effect, it is recommended to drink 2 to 3 glasses of water one after the other.

It is also recommended to eat foods rich in fiber such as flaxseeds, prunes, kiwi, wheat bran, ... fruits and vegetables,

If constipation is ever accompanied by blood in the stool, nausea, vomiting, abdominal pain, severe bloating or fever, or if it is unusual and lasts more than 3 days, you should consult a doctor.

I would like to draw your attention to dietary supplements and laxative medications, their use must be very punctual and for a very short time. Indeed, some of these products can be irritating for the digestive system if they are used too frequently.

Moreover, laxatives can cause laziness at the level of the intestinal microvilli and thus promote constipation over the long term. They can also cause a significant loss of potassium or sodium.

It is therefore very important to use them as a last resort for a very short period of time.

There are different types of laxatives to relieve constipation: contact laxatives, ballast laxatives, laxatives with a mechanical or osmotic action, and stimulant laxatives.

Firstly, it is preferable to use contact laxatives by rectal route, in the form of glycerine suppository for example, they stimulate the contraction of the rectum and the evacuation of stools. However, they should not be used too frequently, as they can harm the rectal reflex over the long term.

Then there are ballast laxatives which are based on plants rich in fibers or mucilage (seaweed, psyllium seeds, flax seeds, ...).

Laxatives with a mechanical action such as lactose or macroggols, which encourage the arrival of water in the intestine and make the stools softer.

Lubricating laxatives contain fatty substances such as kerosene oil and can reduce the absorption of vitamins A, D, E and K, which are fat-soluble (attracted to fat).

Finally, stimulant laxatives such as bisacodyl, which promote intestinal motricity, are not recommended for pregnant women.

To unblock constipation, it is preferable to follow hygienic and dietetic measures (diet, physical activity) and to use these products only when necessary for a short period (less than 8 days).

Dr. Noura Marashi (doctor of pharmacy, health youtuber, creator of the health and well-being application Pharmaquiz)

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