Constipation

Constipation can be an unpleasant topic to talk about. Most people have experienced constipation at some point in their life. Though typically not serious, constipation can be both painful and frustrating.

What is constipation?

Constipation occurs when bowel movements become difficult or less frequent than normal. The frequency or time between bowel movements ranges widely from person to person. Some people have bowel movements several times a day while others only one to two times a week. Going longer than three days without a bowel movement is too long. After three days, the stool becomes harder and more difficult to pass.

What causes constipation?

Constipation is most commonly caused by inadequate fiber in the diet or a disruption of the regular diet or routine. Chronic constipation may be due to a poor diet, dehydration, certain medications (such as antidepressants, strong pain medications), stress, or the pressure of other activities that force you to ignore the urge to empty the bowel.

Various medical conditions can also cause or aggravate constipation. Some of the more common medical conditions that cause constipation include endocrine problems, such as decreased function of the thyroid gland or diabetes. Colorectal cancer is another medical condition that can cause constipation but it usually also accompanied by other symptoms including blood in the stool and weight loss. Common causes of constipation include the following:

• A diet low in fiber
• Not drinking enough water
• Lack of exercise
• Travel or another change in routine
• Eating large amounts of milk or cheese
• Stress or resisting the urge to have a bowel movement
• Medications:
  1. Strong pain medicines such as narcotics.
  2. Antidepressants
  3. Antacids containing calcium or aluminum
  4. Iron pills
  5. Allergy medications such as antihistamines
  6. Certain blood pressure medicines
  7. Psychiatric medications
  8. Herbal supplements

• Irritable bowel syndrome (IBS)
• Pregnancy
• Neurologic disorders including spinal cord injury and multiple sclerosis (MS)
• Slow transit of the colon

How is constipation evaluated?

Most people do not need extensive testing to evaluate constipation. Only a small number of patients with constipation have a serious underlying medical problem (such as poor function of the thyroid gland, diabetes, or colorectal cancer).

If you have constipation that has persisted for more than two weeks, you should see a doctor to determine if you need further evaluation. For a patient who has colorectal cancer, early detection and treatment may be life-saving.

Standard evaluation for constipation includes performing blood tests and examining the colon by colonoscopy, particularly for patients older than 50 years. Other tests include colonic transit studies (time it takes for stools to move through the colon) and anal manometry (measures pressure and muscle function in the rectum and anus).

Most patients with serious constipation, and without any obvious illness to explain their symptoms, suffer from one of two problems:

• Colonic inertia (also called lazy colon): a condition in which the colon contracts poorly and retains stool. This can be determined by colon transit studies.
• Obstructed defecation: a condition in which the colon contracts normally, but the patient is unable to expel stool from the rectum. This condition can be confirmed by a test called anal manometry.

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 breads and cereals. Fiber and water help the colon pass stool. Most of the fiber in fruits is found in the skins, such as in apples. Fruits with seeds you can eat, like strawberries, have the most fiber. Bran is a great source of fiber: eat bran cereal or add bran cereal to other foods, like soup and yogurt.
• Drink eight 8-ounce glasses of water a day. (Note: Milk can cause constipation in some people). Liquids that contain caffeine, such as coffee and soft drinks, have a dehydrating effect and may need to be avoided until your bowel habits return to normal.
• Exercise regularly.
• Move your bowels when you feel the urge.

How is constipation treated?

• Drink two to four extra glasses of water a day.
• Try warm liquids, especially in the morning.
• Add fruits and vegetables to your diet.
• Eat prunes and/or bran cereal.
• Add supplemental fiber to your diet (there are several types, such as Metamucil® , Citrucel® , and Benefiber® ).
• If needed, use a very mild stool softener or laxative (such as colace [docusate] or Milk of Magnesia® ). Do not use laxatives for more than two weeks without calling your health care provider, as laxative overuse can aggravate your symptoms.

When should I call my healthcare provider?

Call your health care provider if:

• Constipation is a new problem for you
• You have blood in your stool
• You are losing weight unintentionally
• You have severe pain with bowel movements
• Your constipation has lasted more than three weeks