Understanding Obstipation : Causes, Symptoms, and Effective Solutions

1. What is Obstipation?

   Obstipation is a term used to describe severe constipation or the condition of being persistently constipation. It is a state where an individual experiences significant difficulty in passing stool, resulting in prolonged retention of feces in the colon and rectum.⁽¹⁾

   Unlike common constipation, obstipation implies a more severe and persistent blockage of the bowel, leading to the accumulation of hardened stool and causing considerable discomfort and difficulty in bowel movements.

   The condition may be associated with various underlying factors including physical obstructions, neurological disorders, or dysfunction in the pelvic floor muscle.

2. Prevalence of Obstipation

   The prevalence of obstipation varies across different populations and age groups. It is important to understand the frequency of this condition for healthcare professionals to develop effective preventive measures and interventions. 

   • Obstipation is less common than mild and occasional conditions. A small percentage of the general population may experience obstipation at some point in their lives.
   • The prevalence of obstipation is rare in infants, but it can also occur due to congenital anomalies.
   • The prevalence of obstipation increases with age.
   • Risk of obstipation increases with the incidence of medical conditions.
   • Obstipation is not gender bias and may affect both males and females.
   • Obstipation may be more prevalent in hospitalized patients especially those with prolonged bed rest, postoperative recovery, or serious medical conditions. 

   The prevalence of obstipation may be influenced by an individual’s health condition, lifestyle factors, and cultural conditions. Anyone with persistent and severe constipation should consult a healthcare professional for proper diagnosis and appropriate management.

Obstipation or severe constipation is long-lasting constipation that does not resolve and can have various causes.⁽²⁾ Some of these include:⁽³⁾

• Low-Fiber Intake: A low-fiber diet can cause constipation. Fiber adds bulk to stool and helps it in moving through the digestive system more easily. Insufficient fiber can lead to hard, dry stool that may be difficult to pass.
• Inadequate Fluid Intake: Dehydration contributes to constipation. Good fluid intake helps keep stool soft and facilitates its passage through the digestive tract.
• Lack of Physical Activity: Staying physically inactive can slow down the digestive system, making it harder for stool to move through the intestine. Regular exercise stimulates bowel movement.
• Certain Medications: Medications such as antacids and painkillers containing calcium and aluminium, certain antidepressants, and certain antiparkinsonian drugs can lead to constipation.^(4,5)
• Neurological conditions: Disorders of the nervous system such as multiple sclerosis or Parkinson’s disease can affect the functioning of the muscles of the digestive tract and lead to constipation.
• Hormonal Changes: Hormonal fluctuation, particularly in females during pregnancy and menstruation can affect bowel movements and contribute to constipation.
• Structural Abnormalities: Conditions causing structural abnormalities in the gastrointestinal tract including strictures, tumors, or blockages can lead to obstipation.⁽⁴⁾
• Functional Gastrointestinal Disorders: Irritable bowel syndrome and pelvic floor dysfunction can cause chronic constipation and obstipation.⁽⁴⁾
• Psychological Factors: Stress and anxiety are known to affect the functioning of the digestive system and contribute to constipation.
• Ignoring Urge to Defecate: Suppressing the urge to have a bowel movement can lead to a build-up of stool in the intestine, making it harder to pass.

Obstipation can be a result of a combination of these factors and the underlying cause may vary from person to person.

Obstipation is characterized by a range of symptoms that indicate difficulty in passing stool or infrequent bowel movements. Some of the symptoms of obstipation include: 

• There may be a significant reduction in the frequency of bowel movements. The bowel movements in obstipation may be less frequent than usual resulting in several days and even longer between movements.
• The stool may be difficult to pass as it would be hard and dry. There may be straining during bowel movements and the passage of stool may be painful.
• Obstipation may cause abdominal discomfort in some individuals. This may be due to the accumulation of hard stool in the intestines causing distention and pressure.
• Abdomen may feel full and bloated. The build-up of gas and stool in the intestine may contribute to this sensation.
• Individuals with obstipation may experience pain and discomfort in the rectal region, which may be due to the strain of trying to pass a hard stool.
• There may be incomplete evacuation of the bowels.
• Some people may experience nausea which could be due to the build-up of stool and gas in the intestines.
• Some individuals may also experience loss of appetite.
• Obstipation may sometimes be accompanied by a headache. It may be due to dehydration or overall discomfort.
• The general discomfort and strain associated with obstipation may contribute to feelings of fatigue and lethargy.

It is important to know that these symptoms may be indicative of obstipation and can also occur due to other gastrointestinal and systemic conditions. Anyone experiencing persistent and severe symptoms should seek medical attention for proper diagnosis and treatment.

Diagnosis of obstipation involves a comprehensive evaluation by a healthcare professional. 

• A detailed medical history is taken by the doctor about the bowel habits of an individual, diet, lifestyle, and underlying medical condition. The onset and duration of symptoms, any associated pain and discomfort, and associated factors are enquired about.
• The abdomen and rectal areas are examined to assess for signs of abdominal distention, tenderness, or presence of impacted stool.⁽⁶⁾ A digital rectal examination may also be performed to assess the rectum and anal canal.
• Blood tests including thyroid function, electrolyte levels, and markers of inflammation may be conducted to check for any underlying medical condition.
• X-rays and CT scans of the abdomen and pelvis may be ordered to identify impacted stool, blockages, or other abnormalities.
• A colonoscopy or sigmoidoscopy may be recommended if any structural abnormality, inflammatory bowel disease, or colorectal cancer is suspected. The procedure may involve inserting a flexible tube with a camera into the rectum to examine the colon.
• Anorectal manometry is a test done to measure the pressure and function of the muscles in the rectum and anus. It provides information about how well the muscles are working during bowel movements.
• Colonic transit study, a test involving tracking the movement of markers through the digestive tract to assess the transit time of stool. It can help identify delays in stool passage through the colon.
• If pelvic floor dysfunction is suspected, specialized s such as defecography or magnetic resonance defecography may be performed to assess the function of the pelvic muscles during defecation.

 The treatment option for obstipation depends on the underlying cause and the severity.

• Lifestyle and Dietary Changes: Consuming a diet rich in fiber helps add bulk to the stool and promotes regular bowel movements. These include fruits, vegetables, whole grains and legumes.

Drinking an adequate amount of water is essential for maintaining soft and pliable stools.

• Medications: Stool softeners are given for easy passage of stool. Laxatives are prescribed which include bulk-forming, stimulants, osmotics, or lubricant laxatives, based on the specific needs of the individual.⁽³⁾
• Physical Activity: Regular physical activity should be done as it helps stimulate bowel movements and promote overall digestive health.
• Biofeedback and Pelvic Floor Therapy: Individuals with pelvic floor dysfunction are prescribed biofeedback and pelvic floor therapy to help improve muscle coordination and function.
• Prescription medication: In some cases, prescription medication may be recommended to address any underlying condition.
• Enemas or Suppositories: In severe cases of obstipation, healthcare providers may use enemas or suppositories that may help soften and evacuate stool.
• Surgery: In rare cases where other treatments may be ineffective or in cases of anatomical issues, surgery may be considered.⁽⁷⁾
• Treatment of Underlying Condition: If obstipation is due to any underlying medical condition, treating it may help in easing the symptoms.

Self-medication and prolonged use of laxatives without medical supervision are not recommended as they may lead to dependency and other complications.

Obstipation is a chronic type of constipation and occurs when hard and dry stool remains in the rectum. The person is therefore unable to pass stool or gas. The prevalence of obstipation may vary and may be influenced by factors such as age, diet, lifestyle, and underlying health conditions. Having an understanding of the symptoms, causes, and diagnostic approaches is crucial for effective management.

Treatment strategies include lifestyle changes, dietary modifications, increased fiber intake, hydration, regular exercise, medications, biofeedback, pelvic floor exercise, and surgery in some cases.

People with severe constipation need to seek medical attention for a comprehensive evaluation and personalized treatment plan. Self-management and overuse of certain medications can be harmful and should be avoided. Early intervention and appropriate management can help improve symptoms and prevent complications associated with obstipation.