Constipation: A moving experience

Not so regular? You’re not alone. In most surveys, roughly 15 percent of adults report chronic constipation. In fact, almost everyone knows what it’s like to be constipated. Constipation isn’t usually dangerous, but it can be annoying, uncomfortable, and expensive. In the US, for instance, Americans spend $750 million on laxatives a year and constipation leads to eight million trips to the doctor and some $7 billion for evaluation and diagnostic testing.

Fortunately, most of the time, it is usually temporary, and lifestyle changes can be an effective way of preventing or alleviating constipation. And if self-care measures don’t work, your doctor can direct you toward other treatments.

What’s normal

A common misconception is that being “regular” means having at least one bowel movement a day. But normal bowel habits vary from person to person and may range from three bowel movements a day to three bowel movements a week.

On the other hand, you’re likely constipated if you frequently:

• Have fewer than three bowel movements a week.

• Strain to pass stools.

• Have stools that are hard, lumpy, and often small in size.

• Feel bloated or like you haven’t completely emptied your bowel.

Causes of constipation

The whole process of digestion can take about 40 hours. After undergoing various changes on its way through your mouth, esophagus, and stomach, food is further broken down by chemicals in your small intestine so that nutrients can be absorbed into the bloodstream. What can’t be digested is propelled through your large intestine (colon) by muscle contractions and compacted into stool, which is then eliminated through the anus (see diagram).

If the stool remains for a long time in the colon due to an intestinal movement (motility) or evacuation problem, or dehydration, it can become hard and difficult to pass, leaving you constipated.

A number of factors can cause your digestive system to slow down. Sometimes, constipation is due to disease or abnormality that affects the structure or function of the colon. For example, the pelvic muscles that serve the anus and rectum may be weak or uncoordinated (pelvic floor dysfunction), so stool moves through your colon but gets hung up in the rectum. A tumor can block the movement of stool through the intestine or a stroke can affect the muscles and nerves that govern the colon’s muscle contractions. Other medical conditions, such as irritable bowel syndrome, diabetes or thyroid disease, can also cause constipation.

In addition, constipation may develop as a side effect of medications, including drugs to treat pain, Parkinson’s disease, high blood pressure, allergies, and depression. Calcium and iron supplements may also cause constipation. More often than not, however, constipation is caused by everyday factors such as:

• Diet imbalances. Diets high in protein, fats, and refined sugars (and, therefore, often low in fiber) are often associated with constipation. Not consuming enough food or calories also can lead to constipation.

• Inattention to bowel habits. Putting off the urge to go to the bathroom can lead to constipation.

• Inadequate fluid intake. Not consuming enough fluid can lead to dehydration, which leaves little water left to moisten the stool after your body draws out what it needs.

• Lack of physical activity. Constipation is common in people who are on bed rest or who are inactive for a long time. Women report feeling constipated more often than men do, but the reason isn’t clear. Hormonal changes associated with pregnancy are known to cause constipation. Older adults also report constipation more frequently, and this may be due to changes in diet, changes in nerve signals to and from the muscles, decrease in muscle tone and exercise, and increased use of medications.

When to call your doctor

Although bothersome, constipation usually isn’t serious. But rarely, it may be caused by a serious underlying condition. If you experience persistent constipation, an unusual change in bowel habits, or if the constipation is associated with rectal bleeding or weight loss, talk to your doctor. He/she can do tests to determine if it’s caused by another illness. Your doctor will also want to check your medications in case they may be causing your constipation.

Self-care

The safest and most practical way to begin treatment for constipation and prevent its recurrence is through lifestyle changes. Here’s what the experts advise on how to keep things moving:

• Drink fluids. Even if you don’t feel thirsty, try to drink a minimum of three to four glasses of water a day. Limit caffeinated and alcoholic drinks, which can be counterproductive and cause you to lose water.

• Add fiber-rich foods to your diet. Gradually increase your daily servings of fresh fruits and vegetables, beans and peas (legumes), and whole-grain cereals and breads. A high-fiber diet has been associated with improvement in symptoms of constipation. Fiber provides bulk, holds on to fluid (making stool softer), stimulates mucus secretion by the membrane lining the colon, and may improve frequency of bowel movements. Aim for around 20 to 25 grams of fiber a day.

• Stay active. Engage in regular exercise, such as walking, biking or swimming on most days. Being physically active may promote movement of your colon muscles.

These measures may help improve not just constipation but your overall health. It may take some time after starting these measures for symptoms to improve, so it’s important to stick with the changes you make to gain their benefits.

Fiber supplements and laxatives

If these measures aren’t enough, your doctor may recommend a fiber supplement, such as psyllium or methylcellulose. Fiber supplements can help bulk up your stool, and psyllium has been shown to increase stool frequency. Experts recommend that you take fiber supplements with water or the supplements may actually worsen the constipation. Add fiber slowly to your diet to avoid gas and bloating. As with other self-care measures, it may take awhile for the fiber supplements to work, typically two to three weeks, but often you’ll notice some change in a few days.

In some cases, your doctor might recommend a short-term course of laxatives to help stool pass more easily. There are many types of laxatives:

• Osmotics alter the flow of fluids through the colon. A subset of these is saline laxatives (e.g. milk of magnesia) which draw water into the colon to moisten the stool.

• Stool softeners (e.g. Colace) make fecal matter moister and softer.

• Lubricants (mineral oil, Fleet) grease the stool.

• Stimulants (Senokot, Dulcolax, others) induce muscle contractions in the intestines.

Many of these laxatives are available without a prescription. But it’s wise to consult with your doctor before taking laxatives, especially if you do so regularly. Overuse of certain kinds of laxatives, such as stimulants and stool softeners, can cause other problems.

Prunes and yogurt

Prunes are also an excellent choice to treat constipation. They are high in fiber, but that does not account fully for their laxative effects, because prune juice, which has little fiber, also works. Both the fruit and juice naturally contain high amounts of sorbitol and other substances that promote bowel movements. But their laxative effect is not completely understood.

Several yogurt brands now claim to promote regularity. These yogurts contain live bacteria that, according to some research, may shorten transit time through the intestine or have other effects that may help prevent constipation. Still, how much of a difference this would make is questionable. Yogurt with live cultures is also promoted for controlling diarrhea.

Exit strategy

Most of the time, constipation can be treated with self-care methods. But sometimes, treatment may be aimed at a specific cause, such as discontinuing a medication or performing surgery to correct a structural problem. The important thing for you to realize is help is available to control your constipation.