Earlier version of the Rome Criteria focused on four symptoms of constipation, namely: hard and/or lumpy stools, two or less than two bowel movements per week, straining and incomplete evacuation. Later, two symptoms are added: manual maneuver to facilitate defecation and a feeling of anorectal blockage.
Diagnosis of constipation is based on the presence of two or more of the said symptoms for at least one quarter of the bowel movement time over a period of at least three times.
Yeap, perfect stool should look like the shape of a banana, the consistency of a ripe banana. Stools that doesn't look or feel like bananas is a symptom of constipation:
*Too Small/big stools.
The "banana stool" is an illustration used by a registered Chinese physician 李小萍( pinyin Li Xiao Ping ) of Hong Kong Baptist University during a health chat on tv. Look out for 00:55. A guideline more pragmatic than the Bristol stool chart. Not all common folks like us can cope with learning SEVEN types of stools even though we may have seen all of them.
"The popular wisdom that a daily bowel movement is a key to good health causes many people excessive worry and waste effort because habits of elimination vary considerably from one individual to the next." -The New Harvard Guide to Women's Health by Karen J. Carlson, M. D., Stephanie A. Eisenstat, Terra Diane Ziporyn.
Many respectable references state between 3 times/day and 3times/week as normal. So that means < 3 times/week is constipation.
The numerical indication for straining is > 25%. How do we interpret more than 25 per cent of our bowel movement time? Out of four times I sit on the toilet bowl, I start to go this way once....?
Straininggggg one of the classic symptoms of constipation
If you have stitches on the abdomen, heart problem or brain injury, going into labor mode during toilet time can be hazardous i.e. straining exerts extra pressure that can rupture the stitches, increases pressure in the heart and brain respectively. One small tip to reduce pressure is to breathe out through mouth. ( I know it's yucky, but ... ) - Juta's manual of nursing vol 1 by Anne Young, Mataniele Sophie Mogotiane and Nelouise Geyer.
A "hallmark" of IBS, according to sufferers who complained has not get enough attention from doctors. Examples of their grievances:
Disorder of pelvic floor muscles displays symptoms similar to IBS though there is still no research to clearly indicate they are related. For example, many women have the out pouching of the rectum in which stool may be entrapped causing the sense of incomplete emptying.
Other than that, if incomplete evacuation is < 25% of bowel movement ( a figure I let the affected individual to quantify or consult his personal physician ) or does not last more than 3 months. Then it's most likely just constipation
An infant who turns red to have a bowel movement is not constipated. Excessive straining, particularly in an infant who routinely requires parental manipulation to defecate (e.g... manual removal of stool mass), is constipated. - Dr. M. Dr. Kovacs, " Constipation: Easing the Pain in Children"
Other examples: A 33 year old woman diagnosed with pelvic floor in-coordination had to occasionally press around the anal area to evacuate stool as her constipation worsened. Then there is this 55 year old woman who had to resort to the same manual manipulation reported that she had a "bulge" in the vagina.
The saddest and one of the most extreme display of this symptom is when it happens to cancer patients who become so constipated to the point of having stools blocked in their intestines. These patients need the help of another human's hand/s to take out the blocked stools. The process is painful. It requires topical anesthetic, lubrication and insertion of suppository/enema before extracting the stool.
More of the elderly over 65 years of age report anal blockage compared with middle-aged folks. More women complain of these symptoms of constipation compared to men.
Persistent uncomfortable sense of rectal blockage coupled with the need to evacuate the stool with fingers could suggest pelvic floor dysfunction. In the case of pelvic floor dyssynergy, there is a tendency to support the perineum during bowel movement. Feeling "blocked" is not necessarily due to pelvic floor problem, it could happen to those with slow transit and even those with normal transit.
References for symptoms of constipation :
1. Non-Motor Symptoms of Parkinson's Disease by K Ray Chaudhuri
2. Principle & Practice of Geriatric Surgery, edited by Ronnie Ann Rosenthal, Mark R. Katlic and Michael E. Zenilman.
3. Gender and Age Differences in Constipation Characteristics, Bowel Symptoms, and Bowel and Dietary Habits in Patients Evaluated for Constipation by G. Lindsay McCrea
Pimples - one of the symptoms of constipation?
*Loss of appetite.
*Loss of sleep.
When it's chronic constipation:
* You're constipated for more than 3 weeks.
When it's severe constipation:
In young children, they may:
*turn red face.
*be reluctant to poo.
*soil their underclothes.
*diarrhea seeping through the blocked stool.