Category Archives: Symptoms Of Digestive Disorders

What Are The Causes Of Diarrhea in Adults

Diarrhea is the frequent passing of large volumes of loose stools; it is not a disease, but a symptom caused by some other digestive disorder.

Bowel movements as frequent as three to five times a day may be normal for some people, as is large amount feces in those who consume a lot of vegetables. Rather than the volume of stools or the frequency of passing them, it is the watery consistency of the stool that determines whether it is diarrhea. Diarrhea is often accompanied by stomach cramps, gas and the inability to control or delay the bowel movements. If a toxin or an infection is causing the diarrhea, nausea and vomiting may also be present.

Complications: Dehydration is a major complication of diarrhea as large quantities of fluid is lost with each bowel movement. If vomiting is also present, it can quickly deteriorate to dangerous levels, especially in very young patients, older people and those who are already weak. Along with fluids, essential minerals necessary for normal body functions such as potassium, sodium, magnesium etc. are also lost, causing chemical imbalance in the body. Severe dehydration can result in low blood pressure leading to syncope or fainting. It may cause abnormal heart rhythms and several other disorders which can become dangerous.

Causes

Diarrhea can be considered as either acute or chronic, based on the duration of the abnormal condition; their causes also may be different.

Acute diarrhea which lasts for only a few days may be caused by viral or bacterial infections or other parasitic infestations. The toxins produced by them or other poisonous substances ingested by the patient as well as the use of certain drugs may also cause acute diarrhea.

Chronic diarrhea, on the other hand, continues for over a week or more. It is often caused due to the following:

The treatment for chronic diarrhea is focused on treating the cause which may be chronic as well.

Types of diarrhea

Diarrhea can be classified as rapid transit diarrhea, osmotic diarrhea and secretory diarrhea depending on the reason of its origin. Stool normally contains sixty to ninety percent water when it is eliminated. Once the digestion of food and absorption of nutrients are over, the remaining waste materials become the stool. As the stool passes through the large intestine, excess water is reabsorbed into the body, giving it a solid to semi solid texture. However, stool may remain watery, if enough water is not removed from it. The reason for poor re absorption of water from the stool can vary. It may be because the stool passed too quickly through the intestines or contained substances which impede the absorption of water by the large intestine. When intestines secrete too much water due to some reason, it is excreted as watery stools.

Rapid passage of stool through the last section of the digestive tract often causes frequent diarrhea. Unless the stool remains in the large intestine for a sufficient amount of time for the re absorption of water, its consistency may become too watery. Hyperthyroidism and a condition called Zollinger-Ellison syndrome, resulting from tumor induced overproduction of stomach acids, cause rapid transit of stool. If parts of the digestive tract such as stomach and the intestines have been removed surgically, or bypassed, the stool may move too fast. Ulcerative colitis and such other inflammatory bowel diseases, the use of laxatives, antacids with magnesium compounds, the hormone serotonin and prostaglandins are also reasons for quick passage of the stool, resulting in diarrhea. Generally, highly acidic foods and those with high sugar content can accelerate the bowel movements. Certain specific foods, anxiety and stress also induce diarrhea in some people.

Osmotic diarrhea is watery stools resulting from the presence of some substances which remain unabsorbed by the walls of the colon. The continued presence of these substances leads to diarrhea, due to the retention of excess amounts of water in the colon. Certain food additives such as mannitol, hexitols sorbitol and other chemicals used as a substitute for sugar in products intended for diabetics and dieters cause osmotic diarrhea. Certain types of beans and fruits are also known to result in this condition.

Lactose intolerance is a condition developing in people who lack an enzyme called lactase which breaks down the milk sugar lactose into the simpler sugar glucose and another sugar called galactose, for absorption by the small intestine. In the absence of lactase, the milk sugar lactose remains in the intestine. Use of milk and milk products by lactose intolerant people results in osmotic diarrhea. When people with lactose intolerance stop taking lactose containing foods, their osmotic diarrhea gets resolved eventually.

The presence of blood in the stomach or the intestines also causes osmotic diarrhea. The blood may have come from a leaking ulcer in the stomach or intestine. When the normal bacteria of the digestive tract are destroyed by the use of antibiotics, new types of bacteria take their place and it may be another reason for osmotic diarrhea. Excessive growth of the normal bacteria in the intestine also may cause it.

Secretory diarrhea results from the excess secretion of water and salts like sodium chloride by the intestines. Viral infections, certain bacterial infections by Campylobacter, cholera or parasitic infestations and toxins secreted by certain organisms induce excess secretion by the intestines. Castor oil, strong laxatives and excess bile also irritate the intestines into secreting water and salts. Presence of tumors like vipoma or gastrinoma and polyps also may induce secretory diarrhea.

Inflammatory diarrhea is caused by the inflammation of the tissue lining the walls of the large intestine, resulting from infections like tuberculosis, auto immune conditions such as Crohn’s disease, cancers and tumors such as adenocarcinoma and lymphoma. When the lining of the large intestine is inflamed, it becomes less effective in absorbing water. The inflamed lining of the rectum has an increased sensitivity to stool and it makes the person feel an urgent need for frequent emptying of the rectum, resulting in diarrhea.

Evaluation

Diarrhea is a very common occurrence and not all episodes require immediate medical treatment. However, some cases may require urgent medical attention as there may be a chance of developing severe complications. It is advisable that the person assesses his condition before seeking medical help using the information given below.

 Warning signs: When diarrhea is accompanied by certain other symptoms, it may be necessary to seek medical attention. The following are some of the symptoms to watch out for:

  • Passing of either pus or blood along with stool
  • High body temperature
  • Development of severe dehydration with symptoms such as dryness of mouth, decrease in urine output, extreme lethargy and severe thirst
  • Severe abdominal pain
  • Frequent Diarrhea that continues for over a week
  • Occurrence of diarrhea even at night
  • Recent noticeable weight loss without apparent reason

 When any of the first four symptoms accompanies diarrhea, people should get urgent medical attention. They may have to be admitted in the hospital for immediate treatment and further investigations to detect the cause. Those who have the other warning signs also should see a doctor without much delay. Even without any of these accompanying symptoms, any diarrhea lasting for over three days requires medical attention. If it does not clear up with recommended medications, the doctor may decide whether further testing is necessary.

At the doctor’s clinic, a physical examination of the abdomen as well as the general condition of the patient is done with a view to assess the hydration levels and detect signs of developing complications. The patient may be asked about the previous medical history with emphasis on existing digestive disorders and the drugs used, including recent antibiotic therapy. Details about the severity, frequency and nature of diarrhea as well as the presence of other symptoms may help the doctor decide on the diagnostic tests and treatment required. Doctor may ask the patient about:

  • the specific circumstances in which the diarrhea started such as travels or change in food and water
  • the use of drugs and any recent change in medication as well as recent use of antibiotics
  • the presence of abdominal pain, nausea and vomiting
  • recent changes observed in the color and texture of stool and the presence of mucus, pus and traces of blood
  • loss of appetite or recent weight loss
  • frequency and urgency of bowel movements
  • occurrence of diarrhea in the locality or among the patient’s family and friends

Testing: Based on the physical examination and the previous medical history and other details provided by the patient, doctor may prescribe further testing to determine the cause or initiate general drug therapy. Rehydration measures which are immediately started may be sufficient for acute diarrhea of sudden onset, which is usually of viral origin. Without further testing or treatment, it may clear up in less than four days.

People who have blood in the stool and severe pain in the abdomen may require imaging tests to detect any abnormalities in the stomach and intestines. Stool is tested for the presence of microorganisms such as Giardia, Yersinia, shigella, Cryptosporidium, Campylobacter, amebas etc. Stool culture or specific enzyme tests may be necessary to detect certain microbes. Stool is tested for Clostridium difficile toxin if the patient has been on antibiotic therapy because those particular bacteria multiply when the normal microbes in the digestive tract are destroyed by antibiotics.

When diarrhea persists for more than a week, in addition to the above tests, colonoscopy may be done to detect any abnormality in the colon and rectum, which may be causing the diarrhea. Biopsy of the lining of the rectum may reveal inflammatory bowel disease. Presence of tumors, their size and location may be determined by a CT scan enterography. Pancreatic function and thyroid and adrenal gland functions are also tested, if necessary. Fat globules in the stool point to malabsorption of lipids. Breath analysis for the presence of hydrogen is done, if malabsorption of carbohydrates is suspected.

Treatment Of Diarrhea

Whenever the cause for diarrhea is identified, the cause is treated along with the symptoms. If the diarrhea is caused by any drug the person is taking, it is stopped or substituted with more suitable ones. Infestations are eradicated with appropriate drugs. If any tumor is found to be the cause, it can be surgically removed. Diarrhea due to viral infections clears up in a day or two without any treatment.

Rehydration: One of the major complications of diarrhea is severe dehydration due to the excessive fluid loss through watery stools, and by vomiting, if it is also present. Immediate measures should be taken to replenish the body with not only water but also with adequate amounts of salts and sugars which were also lost. Oral rehydration is possible once the vomiting has stopped. But in severe cases, electrolyte supplements are given intravenously for effective rehydration. Usually, severely dehydrated people are admitted in the hospital for rehydration therapy and for preemptive treatment of possible complications as well as for further diagnostic tests, if necessary.

Drugs: Anti diarrheal drugs like Loperamide and other prescription medication such as diphenoxylate, codeine, and opioid drugs relax the muscles of the intestine and help in slowing down diarrhea. They can be safely used by people who have watery stools but none of the other warning symptoms accompanying their diarrhea. However, these drugs are contraindicated in people with gastroenteritis of bacterial origin, as Shigellosis, Salmonellosis and infection by Clostridium difficile become worse with the use of anti diarrheal drugs.

Certain non-prescription drugs like kaolin-pectin function as adsorbents, adhering to toxins and other harmful chemicals as well as to microorganisms which cause infection. Some of them have the property of altering the texture of stool and firming it up. Bismuth salicylate, often used for treating diarrhea, may turn stools or tongue black, but it is a temporary side effect. Chronic diarrhea is often relieved by the use of methylcellulose and psyllium husk, which are more often used for relieving constipation by adding bulk to the stool.

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What Is Meant By Chronic Abdominal Pain

When pain in the abdomen has been present for a period of three months or more, it is termed as chronic abdominal pain. The pain may be almost continuous or it may be intermittent. It is more frequently encountered in children between the ages five to sixteen and most often in 8-12 year olds. It is more common in girls and women compared to boys and men respectively. Incidence is found to be10 to 15% in children of susceptible age and 2% in adults.

Depending on the underlying condition, several other symptoms may be present along with chronic abdominal pain.

Causes Of Chronic abdominal Pain

The causes of abdominal pain may have been investigated from the time it appeared and appropriate treatments initiated. However, if no particular reason could be identified in spite of tests, the condition is classified as functional abdominal pain. Around 90% of patients having chronic abdominal pain is found to be having functional pain.

When there are no specific disorders such as peptic ulcer present, and if the pain is not due to particular situations such as bowel movements, gas formation after meals or menstrual cramps, it is probably a functional pain. The exact cause of functional pain is not known but it is assumed that the oversensitivity of the nerves of the abdominal tract to normal motions of the stomach and intestines is the reason. Emotional and physical stresses, mental problems, genetic predisposition are all factors known to trigger or worsen functional abdominal pain. Children going through stressful situations such as starting or changing school, birth of a sibling, separation of parents, moving houses etc., may develop chronic abdominal pain which is considered as a need for extra attention. Child abuse in the family or outside may trigger chronic abdominal pain. Functional pain is as real as any other pain and it may be often quite severe.

The other causes of chronic abdominal pain may differ depending on the age of the patient.

In children, the usual causes are gastro esophageal reflux, constipation and an allergic reaction to the lactose sugar in milk, called lactose intolerance.

In younger adults, any of the following may cause chronic abdominal pain.

  • Disorders of the stomach such as peptic ulcer, dyspepsia etc.
  • Allergic reactions to certain drugs including NSAIDs and aspirin and food and food additives such as MSG.
  • Disorders of the liver including hepatitis.
  • Cholecystitis or other disorders of the gall bladder.
  • Pancreatitis or other pancreatic problems.
  • Crohn’s disease and other inflammatory bowel diseases or irritable bowel syndrome.
  • Infestations of parasites and infections by microorganisms such as amoebiasis and giardiasis

In older adults, chronic pain may be due o the development of cancer of the pancreas or stomach. Ovarian cysts, fibroids, uterine and colon cancers also may cause chronic pain.

Evaluation

Since chronic stomach pain is common and it may occur due to minor causes or even no identifiable cause, it is advisable to self evaluate the condition before seeking medical help. Some of the causes may progress to life threatening conditions which require immediate medical help. The following list of warning signs may help in seeking timely medical care.

 Warning signs: these are additional symptoms to watch out for:-

  • Presence of diarrhea, nausea and  vomiting
  • Traces of blood found in urine, stool or vomiting blood.
  • High temperature or continuous low grade fever.
  • Problems with swallowing food.
  • Recent weight loss for no apparent reason.
  • Severe pain which disturbs sleep at night.
  • Signs of jaundice like yellowing of eyes and nails.
  • Swollen abdomen with or without swelling in the legs.
  •  Lack of appetite.

When any of the above additional symptoms, except the last two, appear in people who have chronic abdominal pain, immediate medical attention should be sought. Those who have lack of appetite and swelling of abdomen or legs should also consult a doctor, but in a few days time. When chronic abdominal pain is accompanied by additional symptoms, the chance of it being functional pain is very slim. Hence it is always advisable to get the advice of a doctor and undergo the required tests to rule out serious complications.

Diagnosis and Treatment

Physical examination of the abdominal region is done to check for specific areas of tenderness or pain and to detect enlargement of organs or presence of masses. Rectal examination and pelvic examination for women are done to check for anorectal fissures, abscesses, hemorrhoids and bleeding from rectum or vagina. Signs of jaundice and presence of swellings or rashes are also examined.

Medical history is also very important in reaching a diagnosis. Doctor may particularly ask questions regarding the eating habits and bowel habits of the patient, to see if any connection exists between those and the abdominal pain. If pain is associated with the intake of dairy products, there is a high probability of lactose intolerance which is an allergic reaction to the lactose sugar in the milk. It is very common among blacks. Details of the drugs used regularly as well as any drugs used recently are noted as well as any abdominal surgery undergone by the patient. Family history of abdominal disorders is also taken into account. Presence of other symptoms such as diarrhea, constipation and blood in urine, stool or in the vomit may point to specific causes which can be investigated further. The aim of preliminary examination is not only to detect the cause of the condition but also to determine the diagnostic tests which may be required.

Doctors often ask the patients to keep a record of bowel movements, different types of food eaten and any relation perceived between those and the occurrence pain in the abdomen. Any particular activity or drug triggering the pain should also be recorded. Any remedy which had brought relief also can be included.

Testing:  General tests to check for infections and inflammations include blood test with ESR, urinalysis and stool tests. Depending on the impressions got from physical examination, doctor may prescribe other diagnostic tests such as ultrasound or other imaging tests. CT scan of the abdomen and colonoscopy may also be done for older adults. When any abnormality is found in the tests, further testing is done to pinpoint the exact cause.

Treatment

Once the cause of the chronic abdominal pain is established through physical examination and tests, treatment is initiated to resolve the issue. If constipation is found to be the cause, a diet rich in fiber may help. Laxatives or stool softeners may be given to make the movements easier. People detected to be having lactose intolerance are advised to avoid dairy products.

Functional pain: Since the cause of the functional pain cannot be determined; treatment to cure the condition is also not available. However, various measures can be taken to help the patient take control of the situation using relaxation techniques and mild pain killers such as acetaminophen, when necessary. Patients are reassured that they are not in any physical danger due to their condition and that they can indulge in any normal physical activity without fear of harm. In fact, patients should be encouraged to be active, especially children who may be reluctant to take part in school activities due to the pain.

After a number of tests have clearly established the absence of any disorder, further testing may be unnecessary, but doctors encourage patients to visit the clinic at regular intervals. Continuous monitoring will reassure the patient and will have a positive psychological effect. Trust and rapport between the doctor and the patient is a very important in successful management of the condition. It may have to be explained to the family members of the patient that even though functional pain can be aggravated by emotional stress and it may have a psychosomatic factor in it, the pain is real and not imagined. And often it is as severe as any other abdominal pain which may be caused by a definite disorder.

Certain drugs which prevent muscle spasms are found to be effective in reducing functional pain. They are called antispasmodic drugs.  Antihistamines and drugs that reduce the production of stomach acids have also been tried with some success. Peppermint oil is also helpful. People with anxiety problems may benefit from antidepressants. Several relaxation techniques and self-help measures such as yoga, hypnosis and biofeedback are helpful in managing the pain. A diet rich in fiber or taking supplemental fiber also may be helpful.

Children need the help and support from the doctors as well as the members of the family. The focus should be on helping the child lead a normal, independent life, in spite of the painful condition. Their pain should be treated as real and not imagined, but at the same time, too much attention and sympathy should be avoided. The child should be encouraged to attend school and take part in all physical activities. When the child has an episode in the school, help should be available at the nurse’s office. A short period of rest or a dose of acetaminophen should help the child to return to normal activities. If the child is allowed to call the parents, they should speak to the child over the phone and reassure him and encourage him to stay in school. The child should be rewarded for responsible behavior and independence shown. The child who has functional abdominal pain may need extra attention to sort out his/her stressful situations in life. The required extra attention should definitely be given to the child, but not because the child has stomach pain. Spending quality time with the child and taking him out or enrolling him in extracurricular activities may help remove the focus from stomach pain.  More often than not, the functional pain may resolve by itself after a while.

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Can Digestive Disorders Cause Chest and Back pain?

Many heart disorders and aortic aneurysms can cause chest and back pain between the shoulder blades. But disorders of the digestive system, especially that of the esophagus, such as gastroesophageal reflux disease caused by the back flow of  stomach acids into the esophagus, can cause a feeling of tightness or pain in the middle of the chest. Esophageal spasms are also felt as a squeezing sensation in the chest, very similar to the pain caused by heart disorders.

The burning sensation in the chest, usually referred to as heartburn may have nothing to do with the heart at all. It may be caused by gastro esophageal reflux disease instead. In the US, GERD is the most frequent digestive disorder. The burning sensation usually rises upwards into the chest and it may extend up to the neck and the throat too. It typically occurs following meals, especially while lying down after a meal. On the other hand, pain and discomfort in the chest due to heart attack appear during exertion and gradually disappears on resting. Feeling of a lump in the throat is sometimes associated with heart problem but if the difficulty is felt only when a person is swallowing, it may be resulting from an esophageal disorder.

Since the symptoms of heart disease and digestive disorders like GERD are so very similar, the priority is given to diagnostic tests to detect heart disorders. ECG, x-ray and stress tests may be conducted to rule out heart problems, before considering the possibility of esophageal disorder. Typically, heart disease is treated only after detecting the exact cause by a variety of tests. However, people showing characteristic symptoms of gastro esophageal reflux disease are usually given drugs blocking stomach acid production, while awaiting the test results.

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How To Relieve Constipation

When the cause for the constipation is identified, it is treated with applicable medication. Any drugs known to have the side effect of causing constipation are stopped or substituted by more suitable ones.

Prevention is always better than cure and in the case of constipation; the best way to prevent it is by leading a healthy life style with adequate physical exercise, sufficient intake of water and other liquids and the inclusion of fiber-rich items in the diet. When bed rest is required due to any reason or when a person is taking a drug which precipitates constipation, laxatives, dietary supplements of fiber, and increased fluid intake, should be incorporated to preempt constipation.

 How To Relieve Constipation..The 3-prong approach to relieve constipation includes:

  • Lifestyle changes
  • Use of laxatives
  • Enemas

Life style changes:  they are mainly aimed at preventing constipation rather than curing it. Life style changes which help avoid constipation include changes in the diet, bowel habits and the level of physical activity.

Consumption of at least fifteen to twenty grams of dietary fiber and adequate quantity of water and other liquids help in the formation of bulky and soft stools. Fruits and vegetables are the most common sources of fiber but supplements of fiber taken along with food also may help. Sprinkling unrefined bran on other foods add to the fiber content. It is very important to drink plenty of water while taking extra fiber.

Moving about, as opposed to a sedentary lifestyle, helps avoid constipation. With reduced physical activity, the movements of the digestive tract also become sluggish. Regular exercise is not only good for health but also for avoiding constipation.

Developing the habit of having a bowel movement at the same time and at regular intervals helps in avoiding constipation. Many people have a natural urge to empty their bowels within an hour of breakfast because more food entering the digestive tract stimulates peristalsis. However, the bowels of different people work at different rates and it is not necessary to have motion every day. Frequent use of laxatives because of the obsession to have daily movements interferes with the natural rhythm of a person’s bowel cycle. Laxatives should not be used unless at least three days have passed since the previous defecation.

Laxatives: There are different types of laxatives for preventing constipation and for treating it. Some are safe for prolonged use while others are for occasional use only.

 The following are the different classes of laxatives:

  • Bulking agents
  • Stool softeners
  • Osmotic laxatives
  • Stimulant laxatives

Bulking agents add body and volume to stool by absorbing and retaining water. The bulk induces the intestines to contract and relax moving the stool down the tract. The improved open texture of the stool makes it soft and facilitates smooth movement. The fiber contained in vegetables and which is supplied by bran and psyllium husk act as bulking agents which facilitates regular bowel movements. The use of bulking agents is a safe way to avoid constipation. It is necessary to drink plenty of water while taking the bulking agents as they have the tendency to draw water from the body and retain it, to be eliminated with stool. There are a few side effects though, such as bloating and flatulence or passage of gas. Excess fiber prevents the absorption of certain micronutrients too.

Stool softeners include mineral oil and docusate which are used for softening stools, making them easy to pass. Bulk is also increased resulting in better peristaltic movements which help push the stool along the way. The softened stool, though easy to pass may be disagreeable to some people. However, stool softeners are especially beneficial to avoid straining, in those who have hemorrhoids and those who have undergone abdominal surgery recently.

Osmotic laxatives work by drawing water into the large intestine, softening and making the stool loose. The increased fluid content in the large intestine results in better peristalsis, accelerating the movement of stool along the way. The usual osmotic agents are poorly absorbed sugars and salts such as lactulose, magnesium salts and phosphates. Osmotic laxatives are comparatively safe for use for most people. However, it is contraindicated for people with kidney disease as it causes fluid retention. Those who have heart failure also should avoid them because the phosphate and magnesium content in them gets absorbed into the bloodstream, which is harmful to people who take heart failure drugs such as [ACE] inhibitors, angiotensin II blockers and diuretics which affect kidney function. Rarely, kidney failures have been caused by laxatives containing sodium phosphate, when orally administered prior to colonoscopy or x-rays.

Stimulant laxatives are those which cause irritation to the intestinal walls causing them to contract with force, pushing the contents faster along the way.  Bisacodyl, phenolphthalein and anthraquinones are stimulant laxatives. They may contain irritating substances like cascara and senna.  Stimulant laxatives are beneficial in avoiding constipation when people are taking drugs such as opioids which usually result in constipation. They are also used for quick emptying of the large intestine prior to tests and surgery.

Oral administration of stimulant laxatives become effective in about six to eight hours and often produce a semisolid bowel movement which is usually accompanied by cramping. When used as suppositories, these drugs work much faster, usually in fifteen minutes to an hour. A condition termed melanosis coli, characterized by the deposit of an abnormal dark-colored pigment on the walls of the large intestine, results from extensive use of stimulant laxatives. Excess loss of essential salts from the blood and allergic reactions are other side effects. Lazy bowel syndrome may develop due to the dependency of the large intestine on stimulant laxatives. Hence, they have to be used judiciously and for short periods. Bisacodyl is an effective drug for chronic constipation.

Natural substances which aid in easy bowel movements such as anthraquinones are found in aloe, senna, sagrada, rhubarb and cascara. They are usually incorporated into   many of the herbal laxatives available over-the-counter. The drug lubiprostone is a laxative which is safe for use for prolonged periods and its action is by inducing extra fluid secretion from the large intestine, resulting in smooth passage of stools.

Enemas: They are used to flush out the rectum and sometimes the lower part of the large intestine as well. Usually, slightly warmed plain water is used. It is pushed into the rectum via the anus using a squeeze ball. Ready- made squeeze bottles with a fixed volume, usually five to ten fluid ounces or 150 to 300ml, are available at pharmacies. But for older people with enlarged rectum, it may not be sufficient, in which case, an enema bag is used to administer larger volumes. Enemas should be administered gently and cautiously, as forceful pumping can be dangerous. The water flushes out the stool, in a bowel movement that would soon follow the enema.

Addition of certain substances to the enema water is a common practice but whether it increases the effectiveness of enema, is doubtful. Soapsuds enema contains soap which is supposed to have the effect of a stimulant laxative. Mineral oils, phosphates and other salts are often added to commercially available enemas.

Colonic enemas are rarely used when people have a condition called obstipation, which is a very severe form of constipation. A large volume of enema is administered to flush out the contents even from the last part of large intestine called colon. It is not a general medical practice but it is often used in alternative medicine. Additives such as tea or coffee are also included in the enema solution but whether it is dangerous or beneficial, is still not proven.

The use of laxatives and enema can cause cramps, dehydration, diarrhea and eventually an addiction to the laxatives. People with inflammatory bowel disorders, gastrointestinal bleeding and obstructions in the intestines should not use laxatives or enemas.

Fecal impaction: This condition does not improve with any of the general measures such as increasing the fiber content in the diet, administering oral laxatives or using suppositories. The initial treatment is with warm water enema; it may be followed by medicated enemas. If these measures do not give the desired results, the hard stool causing obstruction requires to be removed manually with a gloved finger. This is generally performed under local anesthesia or sedation. An enema afterwards helps to clear the rectum of all the accumulated waste.

Essentials for Older People

Enlargement of rectum is a common occurrence as the years go by, and the larger size of the rectum in older people result in greater volume of stool being collected there, before the urge to defecate is felt. This increased collection of stool becomes hard on compaction and makes bowel movements difficult. Many of the drugs used by older people for the common age-related ailments have the side effect of slowing down bowel movements. Reduction in physical activity, diets low in fiber content, greater incidence of diabetes and Parkinson’s disease, all contribute to increased constipation among older people. Misuse of laxatives is also rampant among the old because of the misconceptions regarding bowel movements.

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What Is Constipation

When bowel movements are infrequent and difficult or when there is incomplete emptying of the rectum, it is referred to as constipation. It is not a disease but an underlying symptom of some other disorder.

Constipation is classified as acute and chronic depending on the nature and duration of the condition. When there is a sudden development of severe constipation, it is termed acute constipation.  A gradually developed constipation, which continues over a period of time ranging from months to years, is called chronic constipation.

Some people have the misconception that at least one bowel movement a day is necessary and if they fail to have it, they consider it as constipation. The frequency of bowel movements varies from person to person and normally it may range from three movements a day to three a week. More than the frequency, it is the regularity of bowel movements that is important, and what should be considered abnormal is a sudden change in the usual pattern. The consistency, color and quantity of stool also may vary between individuals depending on the quantity and type of foods they consume and also on their body nature. Usually, many abdominal symptoms such as nausea, gas and lack of appetite are blamed on constipation. But, constipation is not the disease which causes those symptoms but it is just another symptom caused by an underlying disease. Overusing laxatives, suppositories and enemas, to ensure daily bowel movements, is an extremely unhealthy practice. The aim should not be daily motions but regularity and ease of bowel movements. Including plenty of fruits and vegetables and unpolished cereals in the diet is a healthier option to avoid constipation.

Complications: Even though constipation is not a disease, it gives rise to many complications which may eventually become disorders of the digestive system.

The following are some of the complications precipitated by frequent constipation:

People who have constipation may develop a complete blockage in the movement of stool due to hard stools in the rectum or in the lower part of the large intestine. This condition is called fecal impaction. It is very common in older people and in those who have been bed ridden for a long time and also in pregnant women. Lack of physical activity and barium based imaging tests are also known to cause this condition. It may result in pain and cramping of the rectum. When mucus and stool in liquid form leak from around the blockage, it would seem as the person is having diarrhea instead of constipation. Such a condition is called paradoxic diarrhea. The person still feels as if the rectum is full, in spite of the diarrhea and the repeated efforts at complete voiding.

When stools are hard and difficult to pass, people tend to strain excessively to bring about a bowel movement. This forceful straining raises the pressure in the veins lining the anus, leading to their enlargement and development of hemorrhoids.

The passage of very hard or very large stool may injure the walls of the anus and may result in cuts called annual fissure.

Sometimes, due to repeated straining, the rectum may get dislocated from its normal position and it may prolapse in to the anus; this condition is called rectal prolapse.

The large intestine may have to use additional force to push hardened stool, especially when it is small too. This weakens the intestinal wall, particularly of the colon, and causes it to bulge outwards and form balloon-like projections called diverticula which can get filled with fecal matter and may start bleeding. If diverticula rupture, a serious condition called peritonitis results.

Complications of constipation being painful, it may induce people to delay or postpone the emptying of bowels, worsening the condition. Laxatives or stool softeners may be required to break this vicious cycle. However, such measures should be resorted to with caution and moderation. Overuse of these substances may interfere with the normal movements of the digestive tract, resulting in chronic constipation.

Several misconceptions about bowel movements often result in the abuse of laxatives. Some cultural and social conditioning dictates these false theories:

  • It is necessary to have daily bowel movements
  • Stool is an unclean material which should not remain in the body
  • All ills of the body stem from accumulation of stool
  • Daily habit of emptying the bowels is a cure for all ailments

People with these beliefs spend large amounts of time in the toilet, overstrain themselves and misuse laxatives and enema.

Causes Of Constipation

Constipation can be precipitated by the following:

  • Alterations in food habits
  • Medications which have the side effect of slowing down bowel movements
  • Irregularity in bowel movements
  • Overuse or abuse of laxatives

Most of the reasons for constipation can be found in the dietary habits of people. Dehydration due to insufficient intake of water and other liquids is a major cause of constipation. To preserve sufficient volume of water in the body, the water content in the digested food may be reabsorbed into the body while the waste products are passing through the large intestine, making the stool very hard. The fiber contained in fruits, vegetables and unpolished cereals, absorbs and retains large amounts of water. They act as bulking agents, which gives stool a light texture making it easy to move down the intestines with the natural peristaltic movements. If sufficient quantity of fiber is not present in the diet, the stools become compacted and small, making it hard for the intestinal walls to push them forward. Thus, people who eat less vegetables and fruits and more of processed foods tend to have constipation.

Constipation may be caused by certain drugs such as iron supplements, anticholinergic drugs such as certain antidepressants and antihistamines. Opioids, sedatives, antihypertensive drugs, antacids containing aluminum hydroxide and bismuth subsalicylate often cause constipation.

Some people may find it difficult to make a bowel movement, in spite of having the urge to do so. Their stools may not be hard but still it is difficult to pass, probably because the muscles in the rectum or the anus that help in moving the stools do not contract or relax properly.  This condition is called dyschezia or disordered defecation. Those who have the abnormal condition called IBS or irritable bowel syndrome often have dyschezia.

Frequent use of laxatives or enemas become addictive and people may find that they are constipated and unable to have a bowel movement without the aid of those substances, which leads to increased use of laxatives, creating a vicious cycle.

There are several other reasons for constipation which may have neurological or metabolic origin. Physical obstructions in the intestines also may result in constipation. When people are recuperating from serious illnesses, prolonged inactivity and decrease in the quantity of food taken may cause constipation. It may be due to the sluggish movement of the intestines resulting from the lessened physical activity or from the lack of bulk in the intestines which makes it harder to push the stool forward.

Obstructions in the intestines may lead to constipation. People who have had surgery of the small intestines are prone to develop scar tissue and adhesions in those areas which can obstruct the smooth passage of stool down the intestines. Large tumors, either cancerous or benign, may block the large intestines, especially in the lower portion called colon, impeding the movement of the stool, resulting in constipation.

Hypothyroidism caused by the decreased production of hormones by the thyroid glands may result in constipation. High levels of calcium in the blood called hypercalcemia also may cause constipation. Certain neurological problems like diabetic neuropathy, Parkinson’s disease and spinal cord injury may affect the nerves of the intestines, causing them to slow down their normal movements, resulting in constipation.

Evaluation

Since constipation is the most common complaint associated with the digestive system and not all kinds of constipation may have serious causes or complications, people should evaluate their condition and look for other symptoms which may necessitate a visit to the doctor

Warning signs: When certain other symptoms are present along with constipation, it may be necessary to consult a doctor as soon as possible. Some of the warning signs given below, when accompanied by constipation, calls for a visit to the doctor right away.

  • Swelling up of the abdomen
  • Traces of blood in the stool
  • Vomiting without any other reason
  • Sudden or steadily worsening  constipation, especially in older people
  • Recent noticeable weight loss without any apparent cause

When to see a doctor: If vomiting, blood in the stool or distention of abdomen are not present, the patient may call the doctor first, before making a visit to the clinic. Taking into account the symptoms present, and the medical history of the patient, doctor may decide whether a visit is necessary. General measures to improve bowel movements, including laxatives, may be prescribed for a trial period which may be enough to clear out the bowels.

When the patient visits the doctor with the complaint of constipation, a physical examination is conducted. Previous medical history, drugs taken, food habits and activities of the patient are all noted. Based on these factors and the physical examination, doctor may decide on further tests and treatment.

Physical examination includes checking the abdomen for signs of distention and the presence of masses in the intestines. Rectum may be manually or visually checked for bleeding, fissures, hemorrhoids and other growths. Body is generally checked for evidence of other diseases and the signs of cachexia, which is muscle and fat tissue atrophy due to severe weight loss.

Doctors frequently ask these questions to ascertain the cause and severity of constipation.

  • The usual frequency of bowel movements and the consistency of stool.
  • The need or habit of straining to pass stools and whether there is practice of pressing the perineal area to aid defecation.
  • Level of satisfaction after a bowel movement, whether there is a feeling of fullness even after defecation.
  • The use of laxatives, suppositories and enema.
  • Usual diet and the level of physical activity and any recent change in them.
  • The drugs which are currently in use and any recent change in the medication.
  • neurologic and metabolic disorders such as Parkinson’s disease, diabetes and injury to spinal cord

Testing: When the reason for the constipation is straight forward and clear, further testing may be unnecessary, and measures to relieve the constipation are initiated immediately. But in the absence of any such obvious causes like drug use, physical inactivity or injury, doctors may advice certain tests. If warning signs which often indicate an underlying disorder are present, tests are necessary to identify the exact cause. When constipation is not resolved in a day or two with general measures and the use of laxatives, tests have to be conducted to detect fecal impaction or obstructions in the intestines.

X-rays of the abdomen and ultrasound or CT scans are tests used to detect obstructions in the intestines. Colonoscopy and sigmoidoscopy are done to detect the presence of cancers, diverticula and hemorrhoids. Blood tests to check thyroid function, and the presence of excess calcium levels in the blood, are also conducted.

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What Is Acute abdominal Pain (Sudden Severe Abdominal Pain)

Pain in the abdomen, commonly called a stomach ache, which is frequently encountered in children and younger adults, is not generally a cause of concern. However, a sudden, severe Acute Abdominal pain is often an indication of a serious problem which requires immediate medical attention. Occasionally, severe abdominal pain appearing suddenly may be the only symptom of a condition requiring urgent surgery.

People with immune deficiency diseases, or those who take immunosuppressant drugs are particularly prone to abdominal pains, so are very old people. Children and younger adults usually feel more severe stomach pains for the same disorders which may cause a lesser sensation of pain in the older adults.  Infants and young babies also get abdominal pain and they may express it by crying and crankiness, as they cannot express it in words.

Types of Acute Abdominal Pain

Abdominal pains are differentiated based on the location of their origin.

Visceral pain originates in the organs inside the abdomen, viscera being the collective name for all the organs and structures inside the abdominal cavity. The visceral nerves respond to the stimuli of stretching but not to tearing or cutting. Stretching of the stomach or intestine with gas accumulation is registered as pain which is dull and vague and difficult to pinpoint to a particular area. Disorders of liver, stomach, pancreas and the first part of the small intestine often precipitate a pain in the upper abdominal area. Pain around the navel or the mid section of the abdomen may result from problems affecting portions of the small intestine. Pain due to inflammation of the appendix is usually felt on the right side of the navel. Infections or other disorders affecting genital and urinary structures and the lowest part of the digestive system may result in lower abdominal pain.

Somatic pain is often a sharp pain which is easy to locate. It originates in the lining of the abdomen called peritoneum. It may be caused by an infection or inflammation of the peritoneal membranes or by irritation caused to them by blood or chemical irritants in the abdominal cavity.

Referred pain refers to pain which is felt in places elsewhere, than the actual location of the disorder causing the pain. For example, pain due to kidney stones is often felt in the groin and pain due to an inflamed diaphragm is usually felt as shoulder pain.

Peritonitis

Peritonitis is a serious, potentially fatal inflammation of the cavity between the layers of peritoneum. It may be caused by the infection of any of the visceral organs such as pancreas or appendix.  When body fluids such as blood or stomach contents spill into the abdominal cavity as in the rupture of the fallopian tube during Ectopic pregnancy or perforation of intestine, they may leak into the peritoneal cavity. These substances may cause irritation and result in peritonitis. An injury to the abdominal area also may cause peritonitis.

Inflammation of the peritoneal cavity causes the peritoneal fluid to leak into the abdominal cavity after a few hours, and it may result in dehydration, and may eventually lead to shock. It may also release many toxic substances formed by the inflammation, which may affect other organs adversely. It may result in liver and kidney failure or severe inflammation of the lungs. It may have a fatal outcome, if not treated urgently.

Causes of Abdominal Pain

Abdominal pain can result from various causes; some of them are gastric ulcers, infections and inflammations of various organs, ruptures, perforations and obstructions in the intestines, blockage in the abdominal blood vessels and muscle spasms.

Potentially fatal conditions which require immediate surgical interventions are:-

  • Abdominal aortic aneurysm that has ruptured
  • Perforations resulting from ulcers in the intestine or stomach
  • Mesenteric ischemia caused by a blockage in the blood supply to the intestines
  • Ectopic pregnancy which has ruptured, spilling the contents into the abdominal cavity

Other Serious conditions which require urgent medical attention are:-

Abdominal pain may also result from several other disorders unrelated to the abdomen such as pneumonia or heart attack. Diabetic ketoacidosis, testicular torsion, porphyria, certain venoms (scorpion and spider bites) and poisons, sickle cell anemia, methanol poisoning etc., are some other less frequent reasons. In infants and newborns, abdominal pain may have entirely different causes unique to them.

Evaluation

Since stomach pain is a common complaint and often the cause may not be serious and may resolve on its own, the patient may self-evaluate the symptoms to assess the need for urgent medical attention.

 Warning signsPeople who have the following symptoms should seek immediate medical intervention.

  • Excruciating pain in the abdomen
  • Presence of symptoms associated with shock such as low blood pressure, fast heart rate, confusion and sweating.
  •  Steadily worsening pain; slightest touch or movement increasing it, which may be a symptom of peritonitis.
  • Enlargement of the abdomen

Those who have abdominal pain, but not the above mentioned warning signs, also may have to consult a doctor as soon as they can.

Diagnosis

Physical examination of the patient may include thorough examination of the abdominal area by touching, tapping and pressing various points in the abdomen. Doctor may ask about the nature of the pain, whether it is intermittent or constant or whether it worsens with touch or movement. Severity or sharpness of the pain may be assessed by the patient’s reactions as well as by the general appearance such as anxiousness, sweating and paleness. Previous medical history of similar pain or surgical procedures undergone, drugs being used including illicit stimulants and alcohol and even details about the food eaten recently are gathered and analyzed for possible causes.

When doctors examine the abdomen, they look for particular sensations and reactions from the patients. Stiffness can be felt by the fingers and tenderness may be detected from the patient’s expression. Guarding is a reflex reaction, of contracting the abdominal muscles by the patient, when an area is touched by the doctor. Rigidity would mean the muscles remaining in a contracted state even in the absence of any external stimuli. Flinching when the doctor suddenly withdraws his hand is termed as rebound. Peritonitis is diagnosed from the above mentioned reactions.

Anus and rectum may be examined for signs of bleeding, tenderness, bulging or masses. Women and girls of reproductive age are asked about the possibility of pregnancy and any existing disorders of the genital system. Pelvic examination may be done to detect vaginal bleeding.

Accompanying symptoms such as nausea and vomiting; blood in sputum, stool or urine; abnormalities in bowel movements such as constipation or diarrhea; weight loss or fatigue may help the doctor in deciding on the further investigations required.

Testing

Testing may be necessary to detect the exact cause of the condition. But, when characteristic symptoms point to certain conditions which requires immediate surgery, doctors may proceed with preparations of surgery without waiting for the test results.

  • Pregnancy is always ruled out in girls and women before further tests or procedures are done.
  • X-rays, ultrasound scans and other imaging tests are done to detect the cause.
  • Urine analysis may be done to rule out urinary tract infections.
  • Blood tests also may be done to look for other possible reasons for the stomach pain.

A  CT scan of the abdomen may give a clear picture of the visceral organs which may have any disorder that can result in abdominal pain but it may not be able to identify all the possible causes

Treatment

When the cause of the abdominal pain is detected, it can be treated with medication, or surgery if necessary. The pain may be relieved by taking appropriate pain relievers. But aspirin is never given as it may worsen abdominal bleeding, if present.

Earlier, doctors were reluctant to prescribe pain killers before the diagnosis was made as there was a chance of them masking the symptoms, but now, with improved diagnostic tests, subjective assessment has become unnecessary.

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Do You Have Digestive Symptoms

Digestive disorders usually become apparent by the symptoms they precipitate. Irregular bowel movements such as constipation and diarrhea, severe abdominal pain, as well as upper abdominal difficulties like nausea, vomiting, gas formation and burning sensation, regurgitation etc., commonly called as indigestion, all indicate some underlying digestive disorder. Loss of appetite, difficulty in swallowing, globus sensation (which is the feeling of having a lump in the throat), abdominal pain and bleeding also may be caused by certain disorders of the digestive system.

Most symptoms of digestive system disorders are usually referred to as indigestion which can be very misleading. Their underlying causes may be entirely different.

Regularity in bowel movements is often considered a sign of digestive health. But there can be variations in the bowel movements between persons and in the same person at different times. It is influenced by the diet of the person, stress levels, drugs taken and certain diseases that may be present. Cultural and social conditioning also influences the frequency of bowel movements. However, most people feel an urge to empty their bowels half an hour to one hour after their first meal in the morning. Two to three bowel movements a day to two to three per week are often considered normal in most communities in the west.

 More than the frequency of bowel movements, it is a noticeable change in the frequency in a person, for no apparent reason, that is important, as it may indicate the development of some digestive disorders. Also, any change in the consistency of stools, or the presence of pus, blood, mucus or oiliness may be an indication of underlying disorders.

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