When Is Constipation An Emergency and What To Do About It?

A person is said to have Constipation when he or she does not have bowel movements for more than three days or finds it very hard to pass bowels. There are basically three types of constipation namely Normal Transit Constipation, Slow Transit Constipation, and Outlet Defecation Syndrome. Normal Transit and Slow Transit constipation come under the category of motility dysfunction whereas outlet defecation syndrome is a type of chronic constipation where a person finds it very hard to pass stools at least one day of the week for six months or more. Motility disorders are conditions which affect the muscles of the gastrointestinal system that make the passage of food through the intestines slow.[1,2,3]

Mild constipation is quite common and everyone once in a while has it. Certain food habits or change in food can cause the person to have constipation. However, sometimes constipation can become very severe to an extent that daily life becomes a challenge for the individual. It is also accompanied by various other symptoms that make constipation a medical emergency including blood in the stools and severe and persistent abdominal pain. [1,2,3]

Constipation usually becomes an emergency if it is caused by certain medical condition like appendicitis, intestinal bleeding, strangulated hernia and fecal impaction. In such cases, the person may have to be taken to the emergency room for treatment.[1,2,3] The article below gives details of when constipation becomes an emergency and what can be done about it.

When Is Constipation An Emergency?

Mild constipation is something which everyone has at one time or the other and is not a cause of worry. They can be easily treated with medications and changes in dietary habits. A person is said to be constipated if he or she has no more than two to three bowel movements in a week. The stools that are passed will be very hard and dry. The person will also experience severe pain when passing stools.[3]

However, there are times when constipation becomes a medical emergency. There are some warning signs that should not be overlooked in a person with constipation and urgent medical attention is required. These signs include:[3]

Blood in Stool: A person will have dark or tarry stools for a variety of reasons. The most common is intestinal bleeding. The bleeding is usually high up in the digestive tract as the blood has enough time to travel through the digestive system before being eliminated through the rectum. During this time the blood loses lot of oxygen making it dark and tarry.[3] If someone passes bright red blood in the stool then it is indicative of a bleeding much lower in the digestive tract. Intestinal bleeding can occur due to bowel inflammation, damage to the tissue of the intestines, or a bleeding ulcer. Bleeding intestines at times also indicate the presence of a tumor in the digestive tract suggestive of bowel cancer.[3] Thus if a person notices blood in the stool then it is best to go to the emergency room to get it checked out. Once a cause is identified then treatment can be started for it. This is important as conditions like bowel cancer require early detection and treatment for a better prognosis.[3] Another common condition that causes bleeding is hemorrhoids. This is a condition that is specific to people to have chronic constipation. This is because they tend to strain a lot during bowel movements resulting in a build-up of small pocket of tissues around the lower gastrointestinal tract that starts to bleed. Bleeding hemorrhoids also is an emergent condition and requires a trip to the emergency room, especially if the bleeding is significant.[3]

When Is Constipation An Emergency and What To Do About It?

Severe Abdominal Pain: A person with constipation who additionally has excruciating abdominal pain also needs to go to the emergency room to get to the bottom of the cause and start treatment for it. In some cases, even surgery may be required as a mode of treatment. Some of the conditions that cause constipation along with severe abdominal pain include.[3]

Appendicitis: This is a condition in which the appendix becomes infected and inflamed. Other symptoms aside from constipation and severe abdominal pain include appetite loss and fever. It is an emergent medical condition and requires urgent surgery to remove the appendix. This procedure is medically termed as appendectomy.[3]

Diverticulitis: This is an emergent medical condition in which the diverticula which are small pouches in the intestines get inflamed or infected. Aside from constipation and severe left lower quadrant pain, the person with diverticulitis will also experience fever, nausea and vomiting.[3]

Strangulated Hernia: This is also an emergent medical condition that requires immediate attention. A strangulated hernia causes lack of adequate blood supply to the bowels resulting in constipation and severe abdominal pain. A person with these symptoms should immediately go to the emergency room to get treated.[3]

Vomiting Bile or Stool: if a person has frequent bouts of vomiting that smells like stool and is dark brown in color then it indicates that the person has bowel obstruction. This is a medical emergency and requires immediate treatment. In cases of vomiting bile, the vomitus will be yellow in color with a greenish tinge to it. Bowel obstruction requires immediate decompression of the stomach. An NG tube will be inserted to remove all the contents of the stomach. This generally relieves the pain and discomfort that the person may be having.[3]

Fecal Impaction: This emergent medical condition is usually seen in people with chronic constipation. As people find it tough to defecate, stools accumulate and become hard and make it even tougher for other stool to pass through. A person with fecal impaction will always have the urge to pass bowel movements but will be unable to push anything out.[3] Fecal Impaction is a painful condition. Some people also have vomiting along with it. This condition requires immediate medical attention for which a trip to the emergency room is required. During treatment, a disimpaction will be done which will involve complete removal of the blockage of the rectum after which in most cases the person starts having normal bowel movements.[3]

Sporadic Bowel Movements: If a person has less than three bowel movements in a week then he or she is termed as constipated and the cause of it is generally quite severe. This is especially if the person is eating regularly and still is not having normal bowel movements. This causes stool to accumulate. This generally happens when there is some sort of blockage such as a tumor or scarring taking up the area and not allowing stools to pass through. This is medically termed as bowel obstruction which is a medical emergency as explained in detail above.[3] In cases of children, constipation is quite common but even they sometimes need a trip to the emergency room, especially toddlers. This is because they are at an age where they are learning or have just learned how to use the bathroom and when to go. Sometimes, especially when playing or in a classroom toddlers tend to withhold their bowels and do not go to the bathroom. This may occur due to embarrassment or not wanting to stop playing.[3]

If a child has had pain previously during a bowel movement then also he may hesitate to go to the bathroom for fear that there will be pain again. Withholding stool often at times leads to encopresis in which a small amount of stool leaks out. A visit to the physician is recommended if parents feel that their child is withholding stools frequently or they suspect that the child may have encopresis.[3]

It is also important to teach children to drink plenty of water and give them food rich in fiber so that they have regular bowel movements. In case if a toddler has constipation it is best to take him to the physician and get it treated to prevent any unwanted complications that may require emergent treatment.[3]

What Can Be Done About Constipation Accompanied By Serious Symptoms?

Constipation becomes an emergency if the person has severe abdominal pain or bleeding while passing stools. Even if there are no severe symptoms, constipation is a condition that needs to be treated and a consultation is a must with the physician to identify a cause and start treatment. In most cases, over the counter stool softeners may be enough to normalize bowel movements.

Additionally, there are also certain lifestyle changes that can be made to treat or avoid constipation. These include staying hydrated by drinking plenty of water especially after lunch and dinner. It is also recommended to eat a diet rich in fiber as this makes the stools soft and easy to pass through the intestines. Physical activity and exercise is a must to prevent constipation.

In conclusion, constipation is something that everybody has at one time or the other. However, there are times when constipation becomes a medical emergency. This usually happens when a person notices bleeding when passing bowels or there is severe abdominal pain. This usually suggests that there is a problem with the digestive tract. Sometimes, excessive straining during bowel movements in people with constipation results in hemorrhoids which can bleed resulting in a medical emergency.[1,2,3]

A person with chronic constipation needs to consult with a physician to identify a cause for it and start treatment. In instances where dietary habits are a cause for constipation then changing the food and taking over the counter laxatives is enough to get rid of constipation. In cases where intestinal blocking, tumor, or hemorrhoids are believed to be the cause of constipation then more aggressive treatment will be needed, which may even require a stay in the hospital.[1,2,3]

It is recommended for people who have constipation and additionally have severe abdominal pain to go straight to the emergency room for treatment to prevent any unwanted complications that may arise due to conditions that make constipation an emergency.[1,2,3]

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