"Constipation is the one universal problem we all have with or without the presence of Hepatitis. These articles are very informative. Information on where these articles and many more can be obtained will be shown at the bottom of each article."
Constipation is the infrequent and difficult passage of stool. The frequency of bowel movements among healthy people varies greatly, ranging from three movements a day to three a week. As a rule, if more than three days pass without a bowel movement, the intestinal contents may harden, and a person may have difficulty or even pain during elimination. Stool may harden and be painful to pass, however, even after shorter intervals between bowel movements. Straining during bowel movements or the feeling of incomplete evacuation may also be reported as constipation.
What are Some Common Misconceptions About Constipation?
Many false beliefs exist concerning proper bowel habits. One of these is that a bowel movement every day is necessary. Another common fallacy is that wastes stored in the body are absorbed and are dangerous to health or shorten the life span. These misconceptions have led to a marked overuse and abuse of laxatives. Every year, Americans spend $725 million on laxatives. Many are not needed and some are harmful.
What are Some of the Causes of Constipation?
Constipation is a symptom, not a disease. Like a fever, constipation can be caused by many different conditions. Most people have experienced an occasional brief bout of constipation that has corrected itself with diet and time. The following is a list of some of the most common causes of constipation:
· Poor Diet - A main cause of constipation may be a diet high in animal fats (meats, dairy products, eggs) and refined sugar (rich desserts and other sweets), but low in fiber (vegetables, fruits, whole grains). Some studies have suggested that high fiber diets result in larger stools, more frequent bowel movements, and therefore less constipation.
· Imaginary Constipation - This is very common and results from misconceptions about what is normal and what is not. If recognized early enough, this type of constipation can be cured by informing the sufferer that the frequency of his or her bowel movements is normal.
· Irritable Bowel Syndrome (IBS) - Also known as spastic colon, IBS is one of the most common causes of constipation in the United States. Some people develop spasms of the colon that delay the speed with which the contents of the intestine move through the digestive tract, leading to constipation.
· Poor Bowel Habits - A person can initiate a cycle of constipation by ignoring the urge to have a bowel movement. Some people do this to avoid using public toilets, others because they are too busy. After a period of time a person may stop feeling the urge. This leads to progressive constipation.
· Laxative Abuse - People who habitually take laxatives become dependent upon them and may require increasing dosages until, finally, the intestine becomes insensitive and fails to work properly.
· Travel - People often experience constipation when traveling long distances, which may relate to changes in lifestyle, schedule, diet, and drinking water.
· Hormonal Disturbances - Certain hormonal disturbances, such as an under active thyroid gland, can produce constipation.
· Pregnancy - Pregnancy is another common cause of constipation. The reason may be partly mechanical, in that the pressure of the heavy womb compresses the intestine, and may be partly due to hormonal changes during pregnancy.
· Fissures and Hemorrhoids - Painful conditions of the anus can produce a spasm of the anal sphincter muscle, which can delay a bowel movement.
· Specific Diseases -Many diseases that affect the body tissues, such as scleroderma or lupus, and certain neurological or muscular diseases, such as multiple sclerosis, Parkinson's disease, and stroke, can be responsible for constipation.
· Loss of Body Salts - The loss of body salts through the kidneys or through vomiting or diarrhea is another cause of constipation.
· Mechanical Compression - Scarring, inflammation around diverticula, tumors, and cancer can produce mechanical compression of the intestine and result in constipation
· Nerve Damage - Injuries to the spinal cord and tumors pressing on the spinal cord can produce constipation by affecting the nerves that lead to the intestine.
· Medications - Many medications can cause constipation. These include pain medications (especially narcotics), antacids that contain aluminum, antispasmodic drugs, antidepressant drugs, tranquilizers, iron supplements, anticonvulsants for epilepsy, anti-parkinsonism drugs, and antihypertensive calcium channel blockers.
· Colonic Motility Disorders - The peristaltic activity of the intestine may be ineffective resulting in colonic inertia or outlet obstruction.
What Causes Constipation in Older Adults?
Older adults are five times more likely than younger adults to report problems with constipation. Poor diet, insufficient intake of fluids, lack of exercise, the use of certain drugs to treat other conditions and poor bowel habits can result in constipation. Experts agree, however, that too often older people become overly concerned with having a bowel movement and that constipation is frequently an imaginary ailment.
Diet and dietary habits can play a role in developing constipation. Lack of interest in eating - a problem common to many single or widowed older people - may lead to heavy use of convenience foods, which tend to be low in fiber. In addition, loss of teeth may force older people to choose soft, processed foods, which also tend to be low in fiber.
Older people sometimes cut back on fluids, especially if they are not eating regular or balanced meals. Water and other fluids add bulk to stools, making bowel movements softer and easier to pass.
Prolonged bed rest, for example, after an accident or during an illness, and lack of exercise may contribute to constipation. Also, drugs prescribed for other conditions, such as antidepressants, antacids containing aluminum or calcium, antihistamines, diuretics, and anti-parkinsonism drugs, can produce constipation in some people.
The preoccupation with bowel movements sometimes leads older people to depend heavily on laxatives, which can be habit-forming. The bowel begins to rely on laxatives to bring on bowel movements, and over time, the natural mechanisms fail to work without the help of drugs. Habitual use of enemas also can lead to a loss of normal function.What Diagnostic Tests Can Help Determine the Causes of Constipation?
Constipation may be caused by abnormalities or obstructions of the digestive system in some people. A doctor can perform tests to determine if constipation is the symptom of an underlying disorder.
In addition to routine blood, urine, and stool tests, a sigmoidoscopy may help detect problems in the rectum and lower colon. In this procedure, which can be done in the doctor’s office, the doctor inserts a flexible, lighted instrument through the anus to examine the rectum and lower intestine. The doctor may perform a colonoscopy to inspect the entire colon. In colonoscopy, an instrument similar to the sigmoidoscopy, but longer and able to follow the twists and turns of the entire large intestine, is used. A barium enema X-ray will provide similar information. If bleeding is present, a double-contrast barium enema is preferred.
Other highly specialized techniques are available for measuring pressures and movements within the colon and its sphincter muscles, but these are used only in unusual cases.Is Constipation Serious?
Although it may be extremely bothersome, constipation itself usually is not serious. However, it may signal and be the only noticeable symptom of a serious underlying disorder such as cancer. Constipation can lead to complications, such as hemorrhoids caused by extreme straining or fissures caused by the hard stool stretching the sphincters. Bleeding can occur for either of these reasons and appears as bright red streaks on the surface of the stool. Fissures may be quite painful and can aggravate the constipation that originally caused them. Fecal impactions tend to occur in very young children and in older adults and may be accompanied by a loss of control of stool, with liquid stool flowing around the hard impaction.
Occasionally, straining causes a small amount of intestinal lining to push out from the rectal opening. This condition is known as rectal prolapse and may lead to secretion of mucus that may stain underpants. In children, mucus may be a feature of cystic fibrosis.When Is Medical Attention Needed?
The doctor should be notified when symptoms are severe, last longer than three weeks, are disabling, or when any of the complications listed above occur. The doctor should be informed whenever a significant and prolonged change of usual bowel habits occurs.
The symptoms of constipation are key to helping the physician determine a diagnosis and treatment. They include: infrequency of bowel movements, straining, pain, or unsatisfied defecation. In addition, a full record of prescription and over-the-counter medications should be provided to the physician.What Is The Treatment For Constipation?
The first step in treating constipation is to understand that normal frequency varies widely, from three bowel movements a day to three a week. Each person must determine what is normal to avoid becoming dependent on laxatives.
For most people, dietary and lifestyle improvements can lessen the chances of constipation. A well-balanced diet that includes fiber-rich foods, such as unprocessed bran, whole-grain bread, and fresh fruits and vegetables, is recommended. Drinking plenty of fluids and exercising regularly will help to stimulate intestinal activity. Special exercises may be necessary to tone up abdominal muscles after pregnancy or whenever abdominal muscles are lax.
Bowel habits are also important. Sufficient time should be set aside to allow for undisturbed visits to the bathroom. In addition, the urge to have a bowel movement should not be ignored.
If an underlying disorder is causing constipation, treatment will be directed toward the specific cause. For example, if an under active thyroid is causing constipation, the doctor may prescribe thyroid hormone replacement therapy.
In most cases, laxatives should be the last resort and taken only under a doctor’s supervision. A doctor is best qualified to determine when a laxative is needed and which type is best. There are various types of oral laxatives, and they work in different ways.
Above all, it is necessary to recognize that a successful treatment program requires persistent effort and time. Constipation does not occur overnight, and it is not reasonable to expect that constipation can be relieved overnight.Prevention of Constipation
The frequency of bowel movements among healthy people varies from three movements a day to three a week. Individuals must determine what is normal. As a rule, constipation should be suspected if more than three days pass between bowel movements or if there is difficulty or pain when passing a hardened stool. Most people experience occasional short bouts of constipation, but if a laxative is necessary for longer than three weeks, check with a doctor.
Doctors agree that prevention is the best approach to constipation. While there is no way to ensure never experiencing constipation, the following guidelines should help:· Know what is normal and do not rely unnecessarily on laxatives.
· Eat a well-balanced diet that includes unprocessed bran, whole-wheat grains, fresh fruits and vegetables.
· Drink plenty of fluids.
· Exercise regularly.
· Set aside time after breakfast or dinner for undisturbed visits to the toilet.
· Don’t ignore the urge to defecate.
· Whenever there is a significant or prolonged change in bowel habits, check with a doctor.
Additional Reading:
Cummings M. Overuse hazardous: laxatives rarely needed. FDA Consumer. 1991; 25(3): 33-35. Article reprint available from the Food and Drug Administration, 5600 Fishers Lane, Rockville, MD 20857, or in libraries. This article discusses the dangers of the overuse of laxatives and suggests alternative methods for treating constipation.
Diet, Nutrition, & Cancer Prevention: The Good News (NIH Publication No. 87-2878). Pamphlet available from the Cancer Information Service, Office of Cancer Communications, National Cancer Institute, 9000 Rockville Pike, Bethesda, MD 20892, 1-800-4-CANCER. Discusses high-fiber diet and fiber-rich foods.
Larson DE, ed. Mayo Clinic Family Health Book. New York, NY: William Morrow and Company, Inc; 1990. General medical guide that includes a section on constipation. Available in libraries and bookstores.
Marshall JB. Chronic constipation in adults: how far should evaluation and treatment go? Postgrad Med. 1990; 88(3):49-63. This article for primary care physicians offers advice on diagnosis and treatment of constipation.
Murray FE, Bliss CM. Geriatric constipation: brief update on a common problem. Geriatrics. 1991; 46(3): 64-68. This article for health professionals discusses the causes and management of constipation in older adults.The liver weighs about three pounds and is the largest organ in the body. It is located in the upper right side of the abdomen, below the ribs. When chronic diseases cause the liver to become permanently injured and scarred, the condition is called cirrhosis.
The scar tissue that forms in cirrhosis harms the structure of the liver, blocking the flow of blood through the organ. The loss of normal liver tissue slows the processing of nutrients, hormones, drugs, and toxins by the liver. Also slowed is production of proteins and other substances made by the liver.What is the Impact of Cirrhosis?
Cirrhosis is the eleventh leading cause of death by disease in the United States. Almost one-half of these are alcohol related. About 25,000 people die from cirrhosis each year. There also is a great toll in terms of human suffering, hospital costs, and the loss of work by people with cirrhosis.
What are the Major Causes of Cirrhosis
Cirrhosis has many causes. It can result from direct injury to the liver cells (i.e., hepatitis) or from indirect injury via inflammation or obstruction to bile ducts which drain the liver cells of bile. Common causes of direct liver injury include chronic alcoholism (most common cause in the United States), chronic viral hepatitis (types B, C, and D) and auto immune hepatitis. Common causes of indirect injury by way of bile duct damage include primary biliary cirrhosis, primary sclerosing cholangitis and biliary atresia (common cause of cirrhosis in infants).
Less common causes of cirrhosis include direct liver injury from inherited disease such as cystic fibrosis, alpha-1-antitrypsin deficiency, hemochromatosis, Wilson’s disease, galactosemia, and glycogen storage disease.
Two inherited disorders result in the abnormal storage of metals in the liver leading to tissue damage and cirrhosis. People with Wilson’s disease store too much copper in their liver, brain, kidneys, and in the corneas of their eyes.
In another disorder, known as hemochromatosis, too much iron is absorbed, and the excess iron is deposited in the liver and in other organs, such as the pancreas, skin, intestinal lining, heart and endocrine glands.
If a person’s bile duct becomes blocked, this also may cause cirrhosis. The bile ducts carry bile formed in the liver to the intestines, where the bile helps in the digestion of fat.
In babies, the most common cause of cirrhosis due to blocked bile ducts is a disease called biliary atresia. In this case, the bile ducts are absent or injured, causing the bile to back up in the liver. These babies are jaundiced (their skin is yellowed) after their first month of life. Sometimes they can be helped by surgery in which a new duct is formed to allow bile to drain again from the liver.
In adults, the bile ducts may become inflamed, blocked, and scarred due to another liver disease, primary biliary cirrhosis. Another type of biliary cirrhosis also may occur after a patient has gallbladder surgery in which the bile ducts are injured or tied off.
Very rare causes of cirrhosis include: reactions to drugs (e.g., vitamin A, methotrexate, amiodarone) exposure to environmental toxins, and repeated bouts of heart failure with liver congestion.
If after full evaluation of a patient with cirrhosis, the etiology still is not clear, the disease is called "cystogenic cirrhosis." As much as 10 percent of cirrhosis falls into this category.How is Cirrhosis Diagnosed?
The doctor often can diagnose cirrhosis from the patient’s symptoms and from laboratory tests. During a physical exam, for instance, the doctor could notice a change in how your liver feels or how large it is. If the doctor suspects cirrhosis, you will be given blood tests. The purpose of these tests is to find out if liver disease is present. In some cases, other tests that take pictures of the liver are performed such as the computerized axial tomography (CAT) scan, ultrasound, and the radioisotope liver/spleen scan.
The doctor may decide to confirm the diagnosis by putting a needle through the skin (biopsy) to take a sample of tissue from the liver. In some cases, cirrhosis is diagnosed during surgery when the doctor is able to see the entire liver. The liver also can be inspected through a laparoscope, a viewing device that is inserted through a tiny incision in the abdomen.What are the Treatments for Cirrhosis?
Treatment of cirrhosis is aimed to stop the development of scar tissue in the liver and prevent complications. When cirrhosis is due to an identifiable cause, treatment programs may be specific, such as for management of hepatitis B and C, or steroids and immunosuppressive agents for auto-immune chronic active hepatitis.
No matter what the cause of cirrhosis, every patient must avoid all substances, habits, and drugs that may further damage the liver, precipitate complications, or speed the progression to liver failure. Alcohol, in addition to causing cirrhosis, may accelerate the progression of liver scarring due to other causes, such as hepatitis C. All patients with liver disease should not drink alcoholic beverages. Even some non-prescription drugs and vitamins, acetaminophen, in relatively small doses (more than five doses a day) and Vitamin A (more than 25,000 IU/day) may precipitate liver failure. Non-steroidal anti-inflammatory drugs, such as ibuprofen, may precipitate severe bleeding and/or kidney failure.
The cirrhotic patient is at increased risk of contracting other infections that may be more severe than in healthy patients. Immunizations for hepatitis A, B, influenza, and pneumococcal pneumonia are available and should be administered. Raw seafood may contain bacteria that can cause life-threatening infections and therefore should be avoided.How are the Complications of Cirrhosis Treated?
The abnormal accumulation of fluid may cause swelling of the ankles (edema) and abdomen (ascites). Therefore, patients should reduce the amount of fluid and salt in their diet or use drugs called "diuretics" that mobilize and excrete the excess fluid through the kidneys. Occasionally, the ascites may become infected, a condition known as Spontaneous Bacterial Peritonitis, and require treatment with antibiotics.
When the liver does not efficiently function to cleanse the body of toxins and drugs, the mental state of patients may change dramatically and lead to coma, called Hepatic Encephalopathy. Treatment is directed at reducing the protein in the diet, avoiding sedatives and pain medications, and using laxatives and/or antibiotics to decrease the absorption of toxins from the intestines.
Sometimes, bleeding from the esophagus or stomach caused by abnormal veins (varices) may occur and is a life-threatening emergency requiring hospitalization. Variceal bleeding can usually be controlled with the use of a flexible tube (endoscope) that is inserted through the mouth into the esophagus and stomach and used to inject clotting agents into the veins or to rubberband ligate the varices.
Liver failure refers to the end stage of liver disease and cirrhosis when the liver stops working and cannot support life. Liver failure is difficult to treat and survival is limited. Therefore, patients with any complication of cirrhosis are considered to be at risk of developing liver failure.
When complications develop, it may be possible to manage them. When it is likely that liver failure will develop, some patients with cirrhosis are able to undergo liver transplantation. The treating gastroenterologist may recommend liver transplantation when complications of cirrhosis develop in an attempt to avoid liver failure.Additional Reading:
Biliary Atresia.. This fact sheet presents information on biliary atresia and cirrhosis, including discussions of diagnosis, treatment, and complications. Available from the American Liver Foundation. 1428 Pompton Avenue, Cedar Grove, NJ 07009. (201) 256-2550 or (800) 223-0179.
Cirrhosis: Many Causes.. This fact sheet presents general information on cirrhosis of the liver, research, and the work of the American Liver Foundation. Available from the foundation.
Clayman, CB, ed. The American Medical Association Encyclopedia of Medicine.. New York: Random House, 1989. Authoritative reference guide for patients, with sections on cirrhosis, hepatitis, and other disorders affecting the liver. Widely available in libraries and bookstores.
Primary Biliary Cirrhosis. . This fact sheet presents information on PBC and cirrhosis, including discussions of diagnosis, treatment, and liver transplantation.
Available from the American Liver Foundation.
Rosenfeld, I. Second Opinion: Your Comprehensive Guide to Treatment. New York: Bantam Books, 1988. General medical guide with sections on cirrhosis and other disorders affecting the liver. Widely available in libraries and bookstores.Resources
United Network for Organ Sharing, 1100 Boulders Parkway, Suite 500, P.O. Box 13770, Richmond, VA 23225-8770. (804) 330-8500.
