How to prevent piles by taking care of your constipation

Ideal bowel movement to prevent piles

Bowel movements vary from person to person. Usually, we consider less than three evacuations per week as constipation. A constipated person may also have dry and hard stools, painful evacuations, difficulty in passage of stools, feeling of bloating and nausea, stomach cramps, loss of appetite, recurrent infections and may have a feeling of incomplete emptying after an evacuation. A normal frequency can be from three motions a week to three per day and one feels fresh with no urge to go to the toilet again.

The act of evacuation is a complex, multi-step physiological phenomenon. Presence of stools in the rectum is recognised by the sensory receptors there, which then send impulses to the brain. The brain reciprocates by sending impulses to the large intestine to start contracting to propel the stools into the rectum. At the same time, the person contracts his abdominal muscles to increase the abdominal pressure and muscles around the anal canal (sphincters) relax. This leads to passage of stools out of the anus. Dysfunctioning at any of these steps leads to disordered evacuation.

What causes constipation

The feeling of going again to the toilet after an act of evacuation is considered abnormal. This is because of the fact that residual stools in the rectum send impulses to the brain that the person should evacuate. There are many factors that govern our toilet habits. Some of the common causes of constipation are old age that leads to restricted activities, inadequate intake of solid food due to lack of teeth, loss of appetite and so on.

Medical comorbidities like diabetes, liver and kidney diseases, hormonal issues like menopause (low levels of female hormones and weakened pelvic muscle), hypothyroidism, pregnancy, low fibre diet, sedentary occupation and lack of exercises, dehydration (as the climate in our country is mostly hot and hence we sweat a lot which leads to hard and desiccated stools), medication like iron tonics, BP medicines, medicines to treat psychiatric ailments, painkillers, antacids, allergy medicines are among the factors that can cause constipation.

What is irritable bowel syndrome?

Irritable Bowel Syndrome (IBS), a condition where the motility of the intestine is slow, is also another factor apart from laxative abuse. Long-term use of laxatives, especially the herbal ones which are readily available without prescription, are harmful. They lead to colonic atony (exhaustion of the muscles of the bowel, thus leading to failure of stools to progress into the rectum). They also cause pigmentation of the inside of the colon (Melanois coli) which may interfere with colonoscopy. This may be reversible but takes a long time.

What is surgical correction

Diverticulosis (age-related thinning of bowel wall) or neurological diseases can also lead to constipation and some of these conditions may require a surgery to rectify them. These include paralysis, stroke, Alzheimer’s, Parkinson’s, muscular dystrophy , anorectal conditions like fissures, haemorrhoids (maybe the effects than the cause), narrowing of passage (strictures), rectal prolapse and obstruction defecation syndrome (ODS).

What of tumours and cancer

Colon tumours and cancers are less frequent but are among one of the serious causes of constipation. Hence any recent change in bowel movements demands prompt consultation with the specialist. A proper history and clinical examination by a gastroenterologist/gastro surgeon is essential. Appropriate investigations like blood tests, colonoscopy, barium X-Ray and CT/MRI scans may be required. Special situations may require some more elaborate tests like defecography and transit studies.

Treatment and lifestyle correction

Treatment depends upon the cause of constipation. Most cases of constipation can be corrected by very simple measures. Lifestyle changes go a long way in correcting constipation. High fibre food products like whole grain breads, cereals, legumes, vegetables, salads, fruits should be included in your daily diet on a regular basis. Our body usually requires 30 grams of fibre in a day. Reduction of carbohydrates, meat, eggs and dairy products is equally important (beware that those with lactose intolerance may have diarrhoea with milk and milk products). Drinking at least 2.5 to 3 litres of fluids a day avoids dehydration. Avoid drinking excess coffee, caffeine containing products and soft drinks.

Regular bowel habits go a long way in disciplining the body rhythm. Attending the toilet call promptly is very important. Avoid reading newspapers, books and attending to WhatsApp mobile chats in the toilet as the impulses required to initiate the act of evacuation are decreased. Regular exercises like brisk walks are very helpful for those with a sedentary life. Drinking a glass of warm water with honey (for the non-diabetic) or lemon water getting up in the morning helps to stimulate the bowel and initiate the act of evacuation. Maintaining a food diary helps in identifying if any particular food is causing constipation. Modifications in the medicines or stoppage of medications causing constipation is helpful in those who are on medication. Home remedies or counter medications can be used for a few days or weeks.

Which laxative to go for

There are many types of laxatives available in the pharmacy – Osmotic, bulk, stimulants and stool softeners. Doses depend upon the requirements, type and the patient. Stress should be on to use them for as minimum a duration as possible and rely more on lifestyle modifications. One needs to use them as per the medical condition and after consultation with a doctor. In spite of these measures, if the constipation persists, a specialist should be consulted and proper investigations should be carried out to rule out any sinister condition. Constipation, if neglected for a long time, can become chronic and then difficult to treat and so is long-term use of laxatives.