Complications of constipation

Complications of constipation

Constipation, the painful effort to pass the hard stool can have may complications physical and psychological, directly and indirectly on individual or close relatives of individual like parents in case of child. Here let us discuss the complications of constipation. 

We will try to focus the 

  • Complications of constipation.
  • Effects of complications of constipation
  • Management of effects of complications of constipation.
  • Prevention of complications of constipation.

Physical complications constipation:

  • Hard painful passage of stool causes injury to the anal region. This can cause local ulceration or laceration in case of severe lesion. This injury can be very painful. It pains when patients tries to defecate next time or even sits on a surface. This become annoying in day to day life.
  • Hypertrophy of the external anal sphincter: is the complication of chronic constipation. On physical examination there in increased bulkiness and tone of the anal sphincter. The anus may fail to relax while passing stool which may lead to retention of stool which makes constipation worse.
  • Passage of blood in stool: With pain of local injury patient also suffers the blood loss in stool. This blood loss may be minor to major amount. Over the period this blood loss can cause decreased hemoglobin by iron deficiency causing anemia. The function of hemoglobin is to carry oxygen to various organs of the body. Anemia symptoms of fatigue, decreased capacity to do physical work and if present chronically leads to heart failure.
  • Anal fissure: Anal fissure is a complication of repeated trauma because of constipation at anus. The anal fissure is very painful chronic condition which produces great amount of discomfort and pain to patients and affects very badly psychologically too. It is allowed to continue it may heal with stenosis and fibrosis decreasing the size of the anal opening and making the constipation worse.
  • Peri-anal abscess: Peri-anal abscess is complication of infection of tissues around the peri-anal region. The infection can spread from anus to the peri-anal region. There is pain every time patient tries to pass stool and also when sits. This condition needs surgical treatment along with antibiotics to treat the infection.
  • Patient with hemorrhoids can bleed profusely if suffers from constipation and severe blood loss may lead to shock and death, if not managed swiftly.
  • The food intake in infants is reduced if they suffer constipation and effect is seen on growth in form of growth failure. Malnourished children usually suffer constipation and constipation makes malnutrition severe enough. After treating constipation underweight patients gain weight to normal with enhanced feeling of betterment in health.
  • Extreme form of constipation may lead to intestinal obstruction which is very painful condition associated with abdominal cramps and vomiting, may lead to intestinal necrosis and rupture of small intestine which may cause sudden death also.
  • Intestinal necrosis: Intestinal necrosis occurs when there is stool impaction in the lumen of the intestine which creates excess pressure in the lumen and intestinal wall. Under such pressure the blood supply to intestine may get affected and it can cause necrosis of the intestine.
  • Volvulus: Volvulus is acute mal-rotation of intestine usually the sigmoid portion of the colon. This causes extreme pain abdomen and symptoms similar to the intestinal obstruction. The condition is diagnosed on radiograph and sonography of abdomen.
  • Chronic constipation can lead to increased intra-abdominal pressure and can cause hernia, the protrusion of intra-abdominal contents outside the muscular layer of the abdomen.
  • Intestinal Intussusception: This a condition in which one segment of the intestine telescopes inside of another, causing an intistinal obstruction. Although intussusception can occur anywhere in the intestine it usually occurs at the junction of the small and large intestines.
  • Intestinal rupture: In this condition the wall of intestine is ruptured and the contents inside the lumen are thrown in the peritoneal cavity. This condition presents with severe tenderness in abdomen with cramps, sudden deterioration in general condition of patient with drop in blood pressure. The extreme form of constipation can lead to this condition which can be rapidly life threatening.
  • Encopresis: This condition can occur as complication of chronic constipation. It is basically loss of control over bowel so that patient can pass stool at unwanted location. This gives a great discomfort to patients and their family members.
  • Constipation also causes retention of urine making patients prone to the urinary tract infection. So with painful hard stool they also have pain while passing urine.

Psychological complications of Constipation:

  • Constipation not only have physical injury but also affects psychologically too. Constipation is outcome of psychological disorder vise versa.
  • Many patients who have mental impairment suffer from the constipation. As this is very painful it makes the condition worse.
  • Many patients with cerebral palsy can suffer constipation this makes them prone to physical as well as psychological trauma of the constipation.
  • With painful hard stool children especially toddlers and infants develop increasing phobia to go to toilet. They try to hold stool because of this phobia and the stool becomes more harder.
  • School going children may feel stigmatized with this problem of constipation as it becomes difficult for them to suffer pain in toilets in school. They may become self blemish and may feel low in confidence.
  • Patient with constipation may have encopresis which makes people uncomfortable and people start avoiding such person. They may feel stigmatized and isolated and depressed.
  • Chronic painful problem with seemingly no relief patient becomes depressed and hopeless and sleepless. They may stop going out and may become introvert.
  • The parents of child with constipation may feel sad when they look the child in pain. Many OPD and ER visits in pediatric are for problem of constipation.
  • The nature of problem is such that some people may feel ashamed and hesitated to seek medical advise. This may aggravate the problem rather than finding any solution to it.

Financial complications of constipation:

  • There may be absence from work and office may strain the financial budget of the families.
  • The person suffering constipation may report repeated absence from the constipation. This may affect his/her job prospectus and progress in job.
  • If patient does not seek or get proper medical advice or does not follow medical advice may lead to complications which may need major surgical intervention and adds additional financial burden on the families.
  • The school going children may report frequent absence from the school due to ongoing health condition.

Management of effects of complications:

  • Physical complications of the constipation are treated depending upon the nature of the constipation.
  • Acute impaction of the stool may need emema or manual removal.
  • The local injuries around anus are treated with stool softners.
  • Local injuries like anal fissure may need surgical intervention.
  • If patient has acute blood loss he/she may need admission and blood transfusion.
  • If patient has perianal abscess may need surgical intervention with antibiotics to treat it.
  • Patients with hemorrhoids may need surgical intervention. 
  • Intestinal intussusception may need therapeutic enema and sometimes open laparotomy.
  • Intestinal obstruction, volvulus and rupture, necrosis these all conditions may need surgical intervention.
  • Psychological complications of constipation may need to be addressed with the help of the psychiatrist.
  • Children with toilet phobias may need to visit pediatrician and child guidance clinic.
  • Urinary tract infection if present it should be treated with antibiotics.

Prevention of complications:

  • Treatment of constipation itself is the only prevention of complications of the constipation.
  • Seeking medical professional advice as soon as possible and medical advice and follow ups as suggested is needed to get treated itself for constipation and avoid the complication.

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