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By Daniel Lindenberg, MD, PA –
Constipation is one of those topics few like to talk about. If you’ve suffered from this problem, though, you know it can be both painful and frustrating.
Almost everyone gets constipated at some time during his or her life. It affects approximately 2% of the population in the U.S. Women and the elderly are more commonly affected. Constipation, the most common digestive complaint in the U.S. population, can make life miserable. Not only does constipation make you feel bloated, headachy, and irritable, but relieving constipation — especially long-term or chronic constipation — is time consuming and expensive. Each year in the U.S., chronic constipation leads to around 2.5 million doctor visits — and medication costs of many hundreds of millions of dollars.
What Is Constipation?
Constipation occurs when bowel movements become difficult or less frequent. The normal length of time between bowel movements ranges widely from person to person. Some people have bowel movements three times a day; others, only one or two times a week. Going longer than three days without a bowel movement is too long. After three days, the stool or feces become harder and more difficult to pass.
You are considered constipated if you have two or more of the following for at least 3 months:
• Straining during a bowel movement more than 25% of the time
• Hard stools more than 25% of the time
• Incomplete evacuation more than 25% of the time
• Two or fewer bowel movements in a week
What Causes Constipation?
Constipation is usually caused by a disorder of bowel function rather than a structural problem. Common causes of constipation include:
• Inadequate water intake
• Inadequate fiber in the diet
• A disruption of regular diet or routine; traveling
• Inadequate activity or exercise or immobility
• Eating large amounts of dairy products
• Stress
• Resisting the urge to have a bowel movement, which is sometimes the result of pain from hemorrhoids
• Hypothyroidism
• Neurological conditions such as Parkinson’s disease or multiple sclerosis
• Antacid medicines containing calcium or aluminum
• Medicines (especially strong pain medicines, such as narcotics, antidepressants, or iron pills)
• Depression
• Eating disorders
• Irritable bowel syndrome
• Pregnancy
• Colon cancer
In some cases, lack of good nerve and muscle function in the bowel may also be a cause of constipation.
How Is Constipation Diagnosed?
Most people do not need extensive testing to diagnose constipation. Only a small number of patients with constipation have a more serious medical problem. If you have constipation for more than two weeks, you should see a doctor so he or she can determine the source of your problem and treat it. If constipation is caused by colon cancer, early detection and treatment is very important. Tests your doctor may perform to diagnose the cause of your constipation include:
• Blood tests if a hormonal imbalance is suspected
• Barium studies to look for obstruction of the colon
• Colonoscopy to look for obstruction of the colon
The vast majority of patients with constipation do not have any obvious illness to explain their symptoms Chronic constipation may be associated with normal or slow stool transit time, functional defecation disorder (dyssynergic defecation) or a combination of both. With slow-transit constipation, there is a prolonged delay in the transit of stool through the colon. Dyssynergic or outlet obstruction (also called pelvic floor dyssynergia) is characterized by either difficulty or inability to expel the stool. With pelvic floor dysfunction (dyssynergic defecation), the muscles of the lower pelvis that surround the rectum (the pelvic floor muscles) do not work normally. A third type of constipation occurs with irritable bowel syndrome (IBS) where constipation alternates with bouts of diarrhea.
How Can I Prevent Constipation?
• Eat a well-balanced diet with plenty of fiber. Good sources of fiber are fruits, vegetables, legumes, and whole-grain bread and cereal (especially bran). Fiber and water help the colon pass stool.
• Drink 1 1/2 to 2 quarts of water and other fluids a day (unless fluid restricted for another medical condition). Liquids that contain caffeine, such as coffee and soft drinks, seem to have a dehydrating effect and may need to be avoided until your bowel habits return to normal. Some people may need to avoid milk, as dairy products may be constipating for them.
• Exercise regularly.
• Move your bowels when you feel the urge.
What Should I Do If I Am Constipated?
• Drink two to four extra glasses of water a day (unless fluid restricted).
• Try warm liquids, especially in the morning.
• Add fruits and vegetables to your diet.
• Eat prunes and/or bran cereal.
Treatment options for constipation:
Treating constipation, especially chronic constipation can seem overwhelming and has the best treatment outcomes under the care of Gasteroentrologist who specializes in this type of difficulty. Treatment options include:
• Fiber which can be found in healthy foods we commonly consume including fruit, vegetables, and bran. It is recommended an adult consume between 20-30 grams of fiber every day. In addition to consuming high fiber foods, one can add raw bran to reach this goal.
• Bulk forming laxatives this includes psyllium seed (eg, Metamucil), methylcellulose (eg, Cirtucel), calcium polycarbophil (eg, Fibercon), and wheat dextran (eg Benefiber). These laxatives are effective in increasing frequency and softening consistency of stool with a minimum of adverse effects.
• Surfactants or more commonly called stool softeners (eg Colace) are rarely effective in treating chronic constipation. Research supports psyllium being a better treatment option.
• Osmotic agents such as (PEG, GoLYELY, MiraLax, Enulose) cause intestinal water secretion and thereby increase stool frequency. Excessive use of these medications may result in electrolyte and volume overload in people with renal and cardiac dysfunction.
• Stimulant laxatives such as bisacodyl (eg Dulcolax), senna (eg Senokot), and sodium picosulfate (eg Dulcolax drops) work by increasing intestinal motor activity while altering electrolyte transport by the intestinal mucosa. These medications can lead to various health problems if used chronically.
• Suppositories, enema, and disimpaction can be effective for severe constipation.
Warning About Constipation Call your doctor if:
• Constipation is a new problem for you
• You have blood in your stool
• You are losing weight even though you are not dieting
• You have severe pain with bowel movements
• Your constipation has lasted more than two weeks
