Constipation is a common digestive issue characterized by infrequent bowel movements or difficulty passing stool. While not a direct cause of infection, constipation can contribute to conditions that may lead to infection. This article explores the indirect ways constipation can increase the risk for complications that may become infected.
How Constipation Can Lead to Infection
Prolonged stool retention can disrupt the delicate balance of microorganisms in the gut, leading to an overgrowth of bacteria. This imbalance may include conditions like small intestinal bacterial overgrowth (SIBO), where bacteria from the large intestine colonize the small intestine, sometimes causing symptoms like bloating and constipation. An overgrowth of methane-producing archaea in the gut has also been linked to severe constipation.
Severe constipation can exert pressure on the bladder and urethra, close to the rectum. This pressure can hinder the complete emptying of the bladder, leading to urinary retention. Urine that remains in the bladder for extended periods provides a breeding ground for bacteria, increasing the likelihood of a urinary tract infection (UTI). Additionally, the proximity of the rectum to the urethra can facilitate the migration of bacteria from fecal matter to the urinary tract, especially during straining.
Chronic constipation can also contribute to the formation of small pouches in the lining of the colon, known as diverticula. When fecal matter or bacteria become trapped in these pouches, it can lead to inflammation, known as diverticulitis. If this inflammation is severe or infected, diverticulitis can result in an infection within these pouches. While some research suggests constipation may be a symptom rather than a direct cause of diverticulitis, straining from constipation may increase pressure in the colon, contributing to diverticula formation.
In more severe cases, long-standing fecal impaction, a hardened mass of stool stuck in the rectum or colon, can lead to complications like pressure ulcers. The constant pressure from the impacted stool can compromise the blood supply to the bowel wall, causing tissue damage and ulceration. These ulcers can then become sites for bacterial infection, which may lead to more serious conditions like stercoral colitis, an inflammatory condition of the large bowel wall, or even a bowel perforation.
Recognizing Warning Signs
Recognizing the signs of a potential infection related to constipation is important for timely medical care. General signs of infection can include fever, chills, increased fatigue, and unexplained body aches. These symptoms, when combined with digestive issues, suggest a more serious underlying problem.
Specific symptoms can point to particular constipation-induced infections. For urinary tract infections, symptoms include painful urination, a frequent urge to urinate, cloudy or foul-smelling urine, and lower abdominal discomfort. These urinary symptoms, especially if new or worsening, warrant medical attention.
For diverticulitis, severe abdominal pain, often in the lower left abdomen, is a common indicator. It may be accompanied by nausea, vomiting, tenderness in the abdomen, and fever. In cases of severe fecal impaction, symptoms can include rectal bleeding, severe rectal pain, and signs of systemic infection, such as high temperature, rapid heart rate, or confusion.
Preventing Complications
Effective prevention and management of constipation are important for reducing the risk of associated infections. A diet rich in dietary fiber promotes regular bowel movements. Adults should aim for approximately 25–38 grams of fiber daily, gradually increasing intake to allow the body to adjust. Fiber sources include:
- Fruits
- Vegetables
- Whole grains
- Legumes
- Nuts
- Seeds
Adequate hydration is also important, as water helps soften stool and make it easier to pass. Drinking between 8 and 10 glasses of water each day can help prevent dehydration and support regular bowel function. Regular physical activity, even gentle exercise, such as walking, stimulates the muscles in the intestines, aiding stool movement through the digestive system.
Establishing consistent bowel habits, such as not ignoring the urge and setting a regular time for toileting, can help maintain regularity. For short-term relief, over-the-counter laxatives or stool softeners may be considered with medical guidance. If constipation becomes chronic or severe, or if lifestyle changes do not provide relief, seeking medical advice is recommended to address the root cause and prevent complications.