Constipation in Chronic Diseases: Easing the hard truth

Constipation is a gastrointestinal disorder which is quite prevalent in daily clinical practice. According to the latest research journals, 30% of the general population experience this benign problem during their lifetime. Unfortunately, people with chronic diseases like diabetic kidney disease, chronic kidney disease have a higher incidence of this disease than the general population. This condition hampers the quality of life of patients and imposes a social and economic burden.

Constipation is mostly benign and treatable. But many often get confused regarding this disease condition. Bowel movement varies from person to person. The most widely used criteria to identify constipation in primary care setting is Rome IV criteria. The Rome criteria is composed of 6 constipation-related symptoms, and the diagnosis of constipation is established by the presence of 2 or more symptoms for at least 3 months. The table alongside details on the symptoms.

People with impaired kidney functions suffer from constipation due to dietary restrictions involving limited fiber and fluid intake, medications like phosphate binders and coexisting disease conditions. The microorganisms in the gut are also altered in CKD (Chronic Kidney Disease) patients. These gut microbiota plays an important role in the hosts immune system, nutrition and metabolism in normal human beings sharing a mutualistic relationship. In case of kidney patients, this healthy gut microflora is depleted that promotes gut dysbiosis and accumulation of uremic toxins.

Diabetic patients are not far behind in the race. According to researchers, 56-60% of diabetic patients suffer from constipation. In diabetics, nerve damage clinically termed as neuropathy is a common phenomenon. If the vagus nerve is affected it impacts the movement of food through the digestive tract causing gastroparesis. Some medications in diabetes also causes constipation. Beware and speak to your physician in that case without delay. I have launched an online diabetes education program, Art of Living with Diabetes for many such challenges faced by a diabetic and their related solutions. The link for the course is provided below.

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Do you know if someone is suffering from constipation for a prolonged time (beyond 3 months) it is a potentially serious condition? Scientific research evidences state that constipation can lead to cardiovascular incidence, promotes CKD progression, Parkinson’s disease and mortality. Needless to state, adequate management of this abnormal condition will be a wise choice to avoid dire consequences.

Dietary and lifestyle modification is the key management for most of the lifestyle diseases and constipation is no exception. Patients are mostly impacted psychologically by a disease and prefer to remain bedbound abstaining from normal activity. This is a very wrong attitude that aggravates situations. Physical activity aids in constipation. Yoga helps to heal a person psychologically, strengthening their willpower and hence, it positively impacts their health. My patients have benefitted from MUKTI, which has been designed by me and I coach my patients directly.

Include prebiotics and probiotics in your diet under the supervision of your dieticians or physician which will aid not only in constipation but is also beneficial in reducing inflammation and uremic toxins in CKD patients.

In the pharmacological side, there are multiple options available for CKD patients and has also proven to be more effective than the non-pharmacological options. The common types include laxatives, stimulants, stool softeners and lubricants. There are several new options available as well chloride channels activators, Guanylate cyclase C receptor agonists, Selective serotonin 5-HT4 receptor agonist and Ileal bile acid transporters inhibitors. But all these medications have their own side effects so do not self medicate. Some laxatives can spike the blood sugar level as well.

It is time to reconsider our thoughts on this overlooked, unpleasant and hazardous gastrointestinal condition beyond the conventional constipation management.

Published by Dr.Pratim Sengupta

Dr. Pratim Sengupta thinks of himself as conscious, living, soulful being with an inner urge to break the inertia of life. He feels that life is nothing but a material expression of the Supreme Almighty Consciousness. His conscious existence empowered him to see, to hear, to talk, to interact, to feel, to dream, to ask questions, and to seek solutions to every problem. In the flow of life, as he grew up, he understood that knowledge of life is the only way to understand the scientific basis of conscious existence. Hence Dr. Sengupta felt the urge to study the science of life – i.e. Medicine. After he completed his higher secondary education from the Ramakrishna Mission Vidyamandira in Belurmath, he joined the MBBS (Bachelor of Medicine, Bachelor of Surgery) course at RG Kar Medical College, Kolkata. The professional packaging of knowledge in terms of a time-bound, goal-oriented syllabus frustrated him a bit, but nevertheless ignited the urge within him to study further. He thus went on to his post-graduation (MD) in Medicine from IPGMER and SSKM Hospital, Kolkata. During his MD training, he got a glimpse of the vastness of knowledge, and the quest to learn precisely the facts of life narrowed down his area of interest to the functioning of the kidneys and the specialisation of Nephrology – a discipline that is complex, yet relatively new and still evolving in terms of complete understanding of renal physiology and pathology. So, Dr. Sengupta decided to study and train for the DM (Doctorate of Medicine) degree in Nephrology. Right from the start of his career, Dr. Sengupta was passionate about Research. During the MD programme he worked on Cirrhotic Cardiomyopathy, Autonomic Neuropathy of Lupus, and Insulin resistance in Diabetics. All these research studies were published in national journals. During his postdoctoral study in Nephrology, he worked on Hemodialysis efficiency, and suggested an angular placement of the Dialyser in order to increase efficiency. This innovative concept was accepted for presentation at the World Congress of Nephrology, Milan, in 2009, and also published in Hemodialysis International. Dr. Sengupta also worked on Plasmapheresis – a blood filtering technique by which toxic and pathogenic immunoglobulins can be removed from the body. He studied the role of Prethymectomy Plasmapheresis in Myasthenia Gravis patients, and his findings were published in the journal Interactive Cardiovascular and Thoracic Surgery. The patient-empowered nutritional model for nutritional care of kidney patients is another interesting and innovative area in which Dr. Sengupta has worked for quite a long time. Dr.Pratim Sengupta won the Bharat Jyoti award for his excellency in the field of medicine. He is also the president of our non-governmental organization, The Kidney Care Society. His tireless contribution to provide quality living for his patients is worth mentioning. He introduced Mukti, blending ancient Indian yoga with modern medicine for well being of every patient. He has also introduced an unique online course "Art of Living with diabetes" which is a complete solution to diabetes management. He has authored many books, blogs, for the patients. Searching and researching for solutions to problems in the field of Nephrology remains the passion and dream of Dr. Pratim Sengupta, and he intends to persist on this journey as long as he is conscious. Meanwhile, even as he pursues his dreams, Dr. Sengupta diligently puts into practice all he has learned about Nephrology over the years, at the Belle Vue Clinic in Kolkata and ILS hospital,Dumdum where he is available for his patient

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