A number of times people find difficulty passing stool, but have you ever wondered about what the cause could be? According to Dr Private Kamanzi, a nutritionist at Amazon Nutrition Cabinet Remera, Kigali, this is a result of a constipation disorder where a person cannot pass stool or where they can but with much force.

When someone gets complications in the lower abdominal parts and lower back pain, it could be a sign of constipation, explains Kamanzi.

He adds that in a situation where someone loses their appetite yet they are not sick, or experience pain in the stomach which causes grumbling, it could be an indicator of constipation.

For Dr Ian Shyaka, a general practitioner at Rwanda Military Hospital, constipation is a common problem that makes it hard for someone to have bowel movements, that is to say, one’s bowel movement might be too hard, too small or hard to get out.

"The slower the movement of food through the digestion tract, the more the water in the intestines will be absorbed from it. Consequently, the faeces become dry and hard. When this happens, defecation can become very painful,” he says.

Shyaka adds that when someone observes blood stains in the stool or even on the toilet paper after having a bowel movement, then that indicates that such a person could be having constipation. "General body weakness, fever and weight loss signify constipation.”

Causes

Kamanzi says poor dieting such as lack of fibre that helps to absorb the food in the body makes some food remain in the large intestines, hence causing constipation.

He recommends foods such as beans, peas, sweet potatoes, carrots, onions, vegetables like dodo, cabbages, broccoli, whole grains like brown rice, oats and fruits like oranges, avocados, passion fruits, blackberries, strawberries, cherries, guavas, yellow bananas, pears, mangoes, pineapples, and grapes to prevent difficulties in passing stool.

"Diet that is high in refined or processed oils like chips, pancakes and most fried foods as well as refined cereals like white bread lose nutrients like fibre, yet without this fibre, the movement of food is slowed,” explains Kamanzi.

He emphasises that poor lifestyle habits like sleeping immediately after eating are a serious cause of constipation since it complicates the movement of food in the gastro-intestinal tract.

"Fluid consumption is also another cause that cannot be underestimated. For example, some people do not drink fluids like water, juice and tea before and after eating food which makes digestion of food slow, thus causing constipation,” says Kamanzi.

He also says it is risky not to do physical exercises because, without exercises, the movement of food becomes hard which can result in constipation.

Kamanzi adds that stress is another cause of constipation.

According to Shyaka, pregnancy can be associated with constipation largely because of the hormonal changes that come along with it, causing slow intestinal activity.

"Also, the pregnant uterus exertinging pressure on the intestines, thus slowing the passage of food can lead to constipation. This constipation usually gets resolved after child-birth but it can continue due to lifestyle changes,” he adds. Effects of constipation

Kamanzi says constipation leads to internal and external hemorrhoids where the veins in the rectum and the region of the anus swell. Hemorrhoids can cause itching and pain and, sometimes, it might need surgical intervention.

"Due to constipation, the large intestines can get infected due to the remaining food particles that stick on its walls,” he says.

Shyaka says constipation leads to bleeding during a bowel movement and it can also cause development of tears around the anus which can be very painful when passing stool.

Kamanzi ads that lower back pain, loss of appetite and colon cancer can be as a result of constipation. Colon cancer develops when the small non-cancerous (benign tumors) called adenomatous polyps form on the inner walls of the large intestines.

Treatment

"People should improve on their vegetable intake, and avoid eating food with refined oils like chapatti, chips and refined cereals since they complicate digestion,” notes Kamanzi.

Shyaka says medicines for constipation should only be used as last resort and only when prescribed by a medical personnel.

"Sometimes treating constipation depends on what the cause is. For example, the doctor might recommend eating more fibre and drinking more water, but if there is no improvement, then they should go ahead and prescribe medication,” he says.

Shyaka adds that a doctor can also give treatment called enema where they squirt water into the rectum or use a thin tool to help break up faeces that are still inside.

"People should eat foods rich in fibre to ease bowel movement. They should avoid high-fat foods like cheese, meat and eggs because they are associated with high risk of constipation,” he says.

Shyaka says lifestyle changes that can help reduce or overcome constipation include eating foods that have a lot of fibre, eating cereals, taking enough fruits and plenty of water and other fruit juices.

"Before you start eating more fibre, the belly might feel bloated or you might experience gas and cramps. So all this can be avoided by adding fibre to your diet. When you feel like urinating, do so because when you hold it, it might cause more water to be absorbed from the stool, thus causing more hardening of the stool,” he explains.

Kamanzi urges people to always go to bed between 30 minutes to one hour after a meal. He says they can keep themselves busy by watching TV or ironing clothes because sleeping instantly after eating does not give your body time to digest the food.

He adds that people should exercise more often for regular bowel movement.