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Constipation is a common gastrointestinal problem in Malaysia. The ever growing popularity of detoxification programmes and bowel cleansing regimes show that many of us are suffering from this problem.

However, different people have different ideas about constipation. Some think they are constipated if they do not have a bowel movement every day or whenever stools are hard.

For some, constipation means having to strain during bowel movement or passing out insufficient stool or having the feeling that they have not completely emptied the bowel.

Fortunately for most, this problem only occurs occasionally and is easily resolved with an increase in water and fibre intake.

However, if the problem persists, it may be a cause for concern.

Causes of constipation

Our stomach is responsible for churning and mixing food with digestive juices and enzymes so that it can be digested. The digested product, which is in liquid form, is passed into the small bowel for nutrient absorption, and later it is passed into the large bowel.

The large bowel is 90cm to 120cm long; it is responsible for absorbing water from the remnant food.

When the final product enters the rectum, which is the final portion of the colon, the stool becomes soft and formed. The transit of stool from one end to another end is by the contractions of the large bowel muscle.

Constipation occurs when too much of water is absorbed in the colon and when the bowel movement is slow.

A few factors can cause the slowdown of bowel movements:

» Inadequate liquid and fibre intake.

» Lack of physical activity (among elderly people, stroke or Parkinson patients).

» Intake of certain medications such as morphine and anti-depressants.

» Hormone disorders such as inadequate amount of thyroid hormone or diabetes.

» Functional disorder such as irritable bowel syndrome.

» Specific conditions such as pregnancy, travel, stress or chronic abuse of laxatives.

» Colon problem such as tumour or diverticulosis.

Constipation can also be caused by poor coordination between the rectal muscle and anal sphincter. The sphincter is at the lower end of the anus and acts as a guard to prevent leaking of stool.

Whenever we want to open the bowel, the rectal muscle will contract to push the stool down but, at the same time, the sphincter needs to relax to allow the stool to come out.

Poor coordination between the two can happen in elderly people or patients with a history of anal trauma, fissure or piles.

It is said that consumption of coffee, chilli or other ‘hot’ stuff can cause constipation but this has not been proven by scientific studies.

A detailed medical history together with physical examination will help in evaluating the problem.

Many accompanying symptoms and physical signs can offer a clue to the underlying cause.

A blood test may be needed to rule out hormonal disturbances or electrolyte imbalance.

Sometimes, the doctor may ask for abdomen X-ray or CT scan to confirm bowel obstruction or other causes.

You may need a large bowel assessment with endoscopy (colonoscopy), especially if you have the following factors: age 50 and above, recent onset of constipation, stools become slimmer, worsening of constipation, blood in the stool, weight loss or family history of bowel cancer.

By using a flexible scope, the doctor can view the interior of your bowel.

Treatment and Prevention

» Eat a high-fibre diet. Foodstuff with high fibre content include vegetable, fruits, beans and whole grain. Fibre increases the bulk and softness of stool. Each day we should consume at least 20 to 35 grams of fibre.

» Drink plenty of water.

» Exercise regularly or go for walks.

» Train your bowel to open at a fixed time each day and after a glass of water and breakfast. Give yourself plenty of time for the bowel to open naturally.

» Adopt the squatting position instead of sitting position during the bowel opening.

» Try an enema if stool is impacted.

» If none of the above works and if the doctor has concluded that you have no major problem, try laxatives. They are generally safe if they are appropriately used.

» If the problem is related to poor coordination between the rectal muscle and sphincter, a special therapy called biofeedback may help.

When it comes to HIV/AIDS, the bottom line is this: What difference does a 100,000-to-one chance of infection make if you are the one who becomes infected? World AIDS Day, observed every year on Dec 1, is a reminder that the disease is still a threat.

In Germany with its population of 82 million, some 3,000 people became infected with HIV in 2008, nearly double the number registered in 2001, according to the Robert Koch Institute, the federal institution in Germany responsible for disease control and prevention.

“At greatest risk are men who have sex with men,” noted Joerg Litwinschuh, spokesman for Deutsche AIDS-Hilfe (German AIDS Help), an HIV/AIDS self-help association in Berlin. He said that about a third of the approximately 65,000 HIV-infected people in Germany were unaware of their infection and could unwittingly transmit the virus to others.

“You can’t tell outwardly that someone’s infected,” pointed out Elisabeth Pott, director of the Federal Centre for Health Education (BZgA) in Cologne.

So having safe sex means using a condom. Other contraceptives can “prevent pregnancies but not HIV,” Litwinschuh said.

But what constitutes sex? Does sex include petting? It depends, Pott said. “If caressing is what you mean, there’s no risk of infection,” she said. Pott added that a risk existed if ejaculated semen entered the vagina, however.

People in a long-term, mutually monogamous relationship who do not always want to use a condom can be tested for HIV. Anyone can have the test, which is done by doctors and, anonymously, by public health authorities. “One should definitely get counselling first, though,” Pott said.

Someone who has the test needs to know that the body takes about three months after infection with HIV to develop detectable antibodies against the virus. So to be virtually certain that a negative HIV result is true, individuals must avoid unprotected sex for three months before testing.

Those who have an HIV test in order to forgo condoms must be sure that their partner is also sexually faithful, since a partner who has unprotected sex with another person can become infected. Ulrich Gerth, chairman of Germany’s Federal Child Guidance Association (BKE), advised caution: ‘People relying on an HIV test need to be aware that unfaithfulness can occur unexpectedly.”

Condoms, consequently, remain the best defence. Before going out, you should always have one in your wallet or trousers pocket. But how do you tell your boyfriend or girlfriend that you always use a condom during sex?

“For quite a lot of adolescents, condoms are a matter of course nowadays,” Litwinschuh remarked. Gerth was more sceptical, and recommended bringing up the subject beforehand.