“Constipation is a difficulty in performing the intestinal function and it is characterized by an evacuation less than three times a week, a difficulty in evacuating and the presence of particularly hard stools and a small volume (the so-called goat stools). This is a disorder that affects especially the female sex and it is the second cause of absence from work, after seasonal flu”, explains Dr. Federica Furfaro, gastroenterologist in Humanitas, guest in the studio at My doctor on Tv2000.

“Patients generally experience a feeling of incomplete emptying and sometimes also have to resort to manual maneuvers or the use of garrisons such as suppositories or enemas, which are not, however, the laxative indicated for this disease because they empty the last tract of the intestine but the problem is often at the top,” the specialist pointed out.


Acute and chronic forms

“There are episodic forms that could be defined as acute, which suddenly appear for example after the use of certain drugs (such as antidepressants or some antibiotics or iron supplements by mouth), in case of pregnancy, for the presence of stenosis (inflammatory shrinkage), or following surgery. Changes in lifestyle or location are also important.

There are also chronic forms that last for over six months and are often related to chronic diseases such as Parkinson’s disease, hypothyroidism and diabetes mellitus, but which can also be related to other factors such as a pelvic floor malfunction (dyskinesia),” explained Dr. Furfaro.


What tests are necessary for diagnosis?

“In presence of warning signs like blood in the feces, sudden slimming associated perhaps with symptoms such as very strong abdominal pain and fever, it is good to do some deeper investigation.

In these cases, the first examination to undergo is usually colonoscopy. However, this is not the only examination; we have the possibility of studying the intestine to check for the presence of alterations in the walls with the ultrasound scanning of the intestinal loops, a simple and painless examination. Fecal tests or blood tests can then be used to assess any signs of inflammation or other problems, such as hypothyroidism. It is also possible to study the intestinal transit to verify if there is indeed a slow emptying of the intestine. In the past, a direct X-ray of the abdomen was used with radiopaque markers, now we use the breath test with lactulose, a breath test that helps determine if the problem is related to a reduced transit,” said the doctor.


Beware of laxative abuse

Attention should be paid to the use of laxatives and herbs: “laxatives are medicines and as such require a medical prescription, abusing them can cause problems. Then it is wrongly thought that herbs are beneficial as such, but not all herbs are the same: senna for example is a laxative that can irritate the wall of the intestine and therefore it is always necessary to rely on the doctor to choose the most appropriate therapy.

The laxatives that we most commonly use are called osmotics, that is, capable of attracting liquids inside the intestine; next to these are laxatives based on fibers, the most widely used fiber is psyllium, which promotes the creation of fecal mass and also has an osmotic action by recalling water in the lumen,” explained Dr. Furfaro.


Nutrition and moisturization

“Moreover, nutrition and water consumption are also crucial. The most suitable diet provides for the use of different types of fiber, therefore there is a green light for: lettuce, courgettes, spinach, yogurt with its lactic ferments, figs and plums, whole grains, legumes (although promoting fermentation can help produce air and thus annoy). It is better to avoid foods that slow down intestinal emptying, the more complex and fatty ones (such as fatty cheeses, sausages, sugars), but also those rich in starch such as bread and non-wild rice. Cold foods (soft drinks, ice cream) also slow down bowel movements. It is essential to drink at least two liters of water a day.

For prevention it is advisable to drink enough water, eat fruit and vegetables and practice regular physical activity, beneficial for our intestines because the aerobic movement sets the intestine in motion and thus reduces the risk of constipation,” concluded the specialist.


Watch the full interview with Dr. Federica Furfaro, click here.