“We are talking about constipation as soon as we have less than three spontaneous evacuations per week, but also in the event of difficulty going to the saddle, even if the rhythm of evacuation is daily,” explains Dr. Carole Prothe, gastroenterologist and proctologist at Paris Saint-Joseph hospital. “It can be hard stools, a feeling of incomplete evacuation or a need to push to achieve it. As for the concept of chronicity, it applies when these disorders have persisted for more than three to six months. “According to Dr. Prothe,” in 90 % of cases, there is no underlying disease: we then speak of idiopathic constipation. It is often linked to poor diet, lack of physical activity, stress or unusual situations (such as a trip). Certain pathologies can however be involved, such as hypothyroidism, diabetes, proctological, neurological pathologies …, hence the interest of consulting at least once to verify the thyroid function for example, if your doctor deems it necessary. »»
More vulnerable populations
If everyone can concern, this digestive disorder more severely affects certain populations. The elderly, first. “They often move less, drink little, have several pathologies and take many drugs, some of which promote constipation: antidepressants, analgesics, antiparkinsonians … In women, constipation is twice as frequent as in men. They are sometimes more sensitive to these disorders, even if no medical cause is identified. »»
In general, according to Dr. Parades, “the way of life plays a major role: many people no longer listen to their need to go to the saddle, because they do not have time, or because the toilets are unsuitable, to work or elsewhere. Result: the stool accumulates, harden, and the feeling of need disappears. »»
Hygieno-dietetic rules as the first treatment
Before considering any drug treatment, constipation is primarily taken care of by simple measures, but often neglected “physical activity is essential: no need to do intense sport, walking is more than,” says Dr. Prothe. “You must also drink enough – at least 1.5 liters per day – and favor waters rich in magnesium. Then, it is advisable to consume more fibers, found in pulses, full grain products and seeds (chia seeds, oat sound, etc.). Please note, it is better to gradually increase the fibers and promote soluble fibers to avoid bloating. »»
What if that is not enough?
When physical activity, hydration and suitable food do not allow a return to normal transit, drug treatment can be envisaged. “There are four large families of laxatives: mucilage (psyllium seeds which absorb up their volume in water up to 8 times), which act as dietary fibers and which I often recommend as first intention. The osmotic laxatives, which bring water to the colon to soften the stool. They are effective when the mucilage is not enough. Then come the lubricants and stimulants, which are not used on the first line of treatment. »»
Zoom on effervescent suppositories
Used in a targeted way, effervescent suppositories have a very specific role. “They are particularly useful in the event of terminal constipation, that is to say when the stools are blocked in the rectum. The suppository gives off gas, increases the local volume, stimulates the contraction of the rectum and triggers the desire. It is also very useful especially after menopause or after several deliveries. Some women can indeed present a relaxation of the perineum, causing a rectocele (a kind of “pocket” in which the stool stagnates). These women can develop incontinence because their rectum remains full. The suppositories then make it possible to empty the rectum and to avoid these leaks, considerably improving their quality of life. “For Dr. Parades,” it is a local treatment that works well, especially in terminal constipation. In addition, effervescent suppositories are one of the rare treatments for constipation to have been evaluated by randomized trials, with higher results. Do not hesitate to talk to your pharmacist.
What to do in case of brutal constipation?
According to Dr. Prothe, constipation of sudden appearance, accompanied by abdominal pain or blood in the stool, must evoke an organic cause. “There may then be an indication to make a colonoscopy to search for a polyp or a tumor. It is up to the doctor to judge, but you have to consult, because some colon cancers can start with constipation linked to transit blocking. »»
Saint-Joseph, in the heart of French proctology
At the Paris Saint-Joseph hospital, the medico-surgical proctology department is one of the most active in France. National reference, it combines clinical expertise, sustained surgical activity and high -level training. “Faced with received ideas and too general advice, the Saint-Joseph team defends a personalized, concrete and without detour approach. A way to open dialogue … and to relieve patients permanently, ”concludes Dr. Parades
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