Types 12 indicate constipation, with 3 and 4 being the ideal stools (especially

the latter), as they are easy to defecatewhile not containing any excess liquid, and
5, 6 and 7 tending towards diarrhea.

Constipation (also known as costiveness
[1]
or dyschezia
[2]
) refers to bowel
movements that are infrequent or hard to pass.
[2]
Constipation is a common cause of
painful defecation. Severe constipation includes obstipation (failure to pass stools or
gas) andfecal impaction, which can progress to bowel obstruction and become life-
threatening.
Constipation is a symptom with many causes. These causes are of two
types: obstructed defecation and colonic slow transit (or hypomobility). About 50% of
patients evaluated for constipation at tertiary referral hospitals have obstructed
defecation.
[3]
This type of constipation has mechanical and functional causes. Causes of
colonic slow transit constipation include diet, hormonal disorderssuch
as hypothyroidism, side effects of medications, and rarely heavy metal toxicity. Because
constipation is a symptom, not a disease, effective treatment of constipation may
require first determining the cause. Treatments include changes in dietary
habits,laxatives, enemas, biofeedback, and in particular situations surgery may be
required.
Constipation is common; in the general population incidence of constipation varies from
2 to 30%.
[3]

The definition of constipation includes the following:
[4][5][6][7]

infrequent bowel movements (typically three times or fewer per week)
difficulty during defecation (straining during more than 25% of bowel movements or
a subjective sensation of hard stools), or
the sensation of incomplete bowel evacuation.
The Rome III criteria are widely used to diagnose chronic constipation, and are helpful
in separating cases of chronic functional constipation from less-serious instances.
[8]

The causes of constipation can be divided into congenital, primary, and
secondary.
[2]
The most common cause is primary and not life-threatening.
[12]
In the
elderly, causes include: insufficient dietary fiber intake, inadequate fluid intake,
decreased physical activity, side effects of medications, hypothyroidism, and obstruction
by colorectal cancer.
[13]

Constipation with no known organic cause, i.e. no medical explanation,
exhibits gender differences in prevalence: females are more often affected than
males.
[14]

Primary
Primary or functional constipation is ongoing symptoms for greater than six months not
due to any underlying cause such as medication side effects or an underlying medical
condition.
[2][15]
It is not associated with abdominal pain, thus distinguishing it
from irritable bowel syndrome.
[2]
It is the most common cause of constipation.
[2]

Diet
Constipation can be caused or exacerbated by a low fiber diet, low liquid intake, or
dieting.
[5][6]

Medication
Many medications have constipation as a side effect. Some include (but are not limited
to); opioids (e.g. common pain
killers), diuretics, antidepressants, antihistamines,antispasmodics, anticonvulsants, and
aluminum antacids.
[5][8]

Metabolic and muscular
Metabolic and endocrine problems which may lead to constipation
include: hypercalcemia, hypothyroidism, diabetes mellitus, cystic fibrosis, and celiac
disease.
[5][12]
Constipation is also common in individuals with muscular and myotonic
dystrophy.
[5]

Structural and functional abnormalities
Constipation has a number of structural (mechanical, morphological, anatomical)
causes, including: spinal cord lesions, Parkinsons, colon cancer, anal fissures, proctitis,
andpelvic floor dysfunction.
[12]

Constipation also has functional (neurological) causes, including anismus, descending
perineum syndrome, and Hirschsprung's disease.
[3]
In infants, Hirschsprung's disease is
the most common medical disorder associated with constipation. Anismus occurs in a
small minority of persons with chronic constipation or obstructed defecation.
[16]

Psychological
Voluntary withholding of the stool is a common cause of constipation.
[5]
The choice to
withhold can be due to factors such as fear of pain, fear of public restrooms, or
laziness.
[5]
When a child holds in the stool a combination of encouragement, fluids, fiber,
and laxatives may be useful to overcome the problem.
[17]

Diagnosis
The diagnosis is essentially made from the patient's description of the symptoms. Bowel
movements that are difficult to pass, very firm, or made up of small hard pellets (like
those excreted by rabbits) qualify as constipation, even if they occur every day. Other
symptoms related to constipation can include bloating, distension, abdominal pain,
headaches, a feeling of fatigue and nervous exhaustion, or a sense of incomplete
emptying.
[18]

Inquiring about dietary habits will often reveal a low intake of dietary fiber, inadequate
amounts of fluids, poor ambulation or immobility, or medications that are associated
with constipation.
[5][6]

During physical examination, scybala
[19]
(manually palpable lumps of stool) may be
detected on palpation of the abdomen. Rectal examination gives an impression of the
anal sphincter tone and whether the lower rectum contains any feces or not. Rectal
examination also gives information on the consistency of the stool, presence
of hemorrhoids, admixture of blood and whether any tumors, polyps or abnormalities
are present. Physical examination may be done manually by the physician, or by using
a colonoscope. X-raysof the abdomen, generally only performed if bowel obstruction is
suspected, may reveal extensive impacted fecal matter in the colon, and confirm or rule
out other causes of similar symptoms.
[5][6]

Chronic constipation (symptoms present at least three days per month for more than
three months) associated with abdominal discomfort is often diagnosed as irritable
bowel syndrome (IBS) when no obvious cause is found.
[20]

Colonic propagating pressure wave sequences (PSs) are responsible for discrete
movements of the bowel contents and are vital for normal defecation. Deficiencies in PS
frequency, amplitude and extent of propagation are all implicated in severe defecatory
dysfunction (SDD). Mechanisms that can normalise these aberrant motor patterns may
help rectify the problem. Recently the novel therapy of sacral nerve stimulation (SNS)
has been utilized for the treatment of severe constipation.
[21]

MARAMING tao ang hindi makarumi nang regular. Ang tawag dito ay constipation o
pagtitibi. Ang pagtitibi ay puwedeng magpalala ng sakit sa puso, luslos at hemorrhoids.
Ang mga buntis, kababaihan at may edad ay madalas hirap makarumi. Hindi namin
pinapayo ang pag-inom ng gamot o herbal tea para makarumi. Sa katagalan ay
makasasama ito.
May mga prutas na mabisang lunas para sa hindi makadumi. Subukan niyo ang apat na
prutas na nag-uumpisa sa P.
1. Pakwan Ang pakwan ay may taglay na 92% alkaline water. Mataas ito sa vitamin A,
Vitamin B, Vitamin C, lycopene at potassium. Ang pagkain ng dalawang hiwa ng
pakwan sa maghapon ay puwede nang magpalambot ng dumi. May benepisyo rin ang
pakwan para sa bibig, sikmura at bituka. Makatutulong ito sa may si-ngaw at mabaho
ang hininga.
2. Papaya Ang papaya ay napakabisang prutas para sa hindi makarumi. Kapag
kumain ka ng isa o dalawang hiwa ng papaya ay siguradong lalambot ang iyong dumi.
Kapag matamis ang papaya ay mas mabisa ito. May sangkap na papain ang papaya,
isang enzyme na nakatutulong sa paglambot ng dumi. Mataas din sa vitamin C ang
papaya kaya masustansya ito. Huwag lang sosobrahan ang pagkain at baka magtae ka
naman.
3. Peras Ang peras ay mayaman sa fiber at sorbitol na makatutulong sa pagdumi.
Ang fiber ay nagbibigay ng hugis (o bulk) sa dumi. Ang sorbitol naman ay nagbibigay ng
tamis sa peras at naghahatak ng tubig sa loob ng bituka para lumambot ang dumi. Ayon
kay Dr. Jay Hoecker ng Mayo Clinic, puwedeng bigyan ng peras ang mga sanggol at
bata na hindi makarumi. Ang dalawa hanggang apat na ounce ng katas ng peras ay
maaaring makatulong sa pagdumi ng bata.
4. Prunes Sa Pi-lipinas, makabibili tayo ng prune juice at dried prunes sa mga
supermarkets. Ang prunes ay matagal nang lunas para sa pagtitibi. Tulad ng peras,
may taglay na fiber, sorbitol at antioxidants ang prunes. Sa bawat kalahating baso ng
prune juice (100 ml) may sangkap itong 6.1 grams ng sorbitol. Dahil dito,
napapalambot ng prunes ang dumi. Ayon sa mga eksperto, may tulong din ang prunes
sa buto at sa pag-iwas sa osteoporosis.
Kaya tandaan natin ang apat na prutas na nabanggit para maiwasan ang pagtitibi at
maging malusog ang ating katawan.
Marami ang nakararanas ng pagtitibi. Sa kabutihang palad, kalimitang ito ay walang
pagbabanta sa buhay ng isang tao.