CHAPTER 5: Constipation

Contents

CHAPTER 5: Constipation

Persons who say they are "constipated" are bothered most by straining and hard bowel movements. "Regularity" may be twice-daily bowel movements for some or two bowel movements a week for others.

Who Has Constipation?

Many persons worry that if they only have a few bowel movements a week, they are "constipated". However, 15% of persons who otherwise never feel constipated, have two or fewer bowel movements a week.

Ask yourself these questions to decide if you are really constipated. Do you have difficulty passing stools? Are they usually hard? Do you have difficulty emptying? Is there pain? Are there other problems such as bleeding? Unless these are regular symptoms for you, you are probably not constipated. If you are constipated, you can improve your condition without resorting to harsh treatments.

From HowsYourHealth we know that about 3 of 100 (3%) people who have few diseases are bothered often or always by constipation. About 10 of 100(10%) of those with many diseases are bothered.

What Causes Constipation?

Doctors do not always know what causes constipation. But a person who eats a poor diet, drinks too little fluid, does not walk or exercise regularly, or misuses laxatives can easily become constipated. For example, people who have difficulty paying for enough good food are over twice as likely to be bothered by constipation than people who have enough money for a good diet.

Ignoring the natural urge to have a bowel movement can result in constipation. Some people prefer to have their bowel movements only at home. But holding a bowel movement can cause problems if the delay is too long.

Lengthy bed rest, after an accident or illness, and lack of exercise may help cause constipation. For patients who stay in bed and who suffer from chronic constipation, drug therapy may be the best solution. But simply being more active is a better idea for people who do not have to stay in bed.

Drugs given for other conditions can cause constipation in some people. For example, certain antidepressants, heart medications, antacids containing aluminum or calcium, antihistamines, diuretics, narcotics, and anti-parkinson drugs all are known to cause constipation.

Heavy use of laxatives is usually not necessary and often can be habit-forming. The body begins to rely on the laxatives to bring on bowel movements. Over time, the natural "emptying" mechanisms fail to work without the help of these drugs. For the same reason, the regular use of enemas can also lead to a loss of normal bowel function. Another side effect of heavy laxative use is diarrhea.

Overuse of mineral oil -- a popular laxative-- may reduce the absorption of certain vitamins (A,D,E, and K). Mineral oil may also interact with drugs such as anticoagulants (given to prevent blood clots) and other laxatives, causing undesired side effects.

Once in a while constipation may be caused by something abnormal or by a blockage of the digestive system. These disorders may affect either the muscles or nerves that create normal bowel movements. Your doctor can perform a series of tests to find out if constipation is the symptom of an underlying (and often treatable) disorder.

Treatment

If you suddenly become constipated, you should contact your doctor. If, on the other hand, you have had difficulty for a long time you should try the two approaches known to reduce straining and hard bowel movements: fiber in the diet and bulk laxatives.

Try to eat about a cup of fruit and vegetables (peas, strawberries), either cooked or raw, each day. Dried fruit such as apricots, prunes, and raisins are especially high in fiber. A bowl of whole grain cereals (All-Bran, Puffed Wheat) and breads can be very helpful as well. Try to cut back on highly processed foods (such as sweets) and foods high in fat.
Try adding small amounts (a tablespoon or two) of unprocessed bran ("Miller's Bran") to baked goods, cereals, scrambled eggs, soups, and fruit as a way of increasing the fiber content of your diet. Start with one or two tablespoons and increase to five tablespoons of bran a day. Unprocessed bran is usually sold in health food stores or the health food section of supermarkets. It should not be confused with the packaged cereals that contain large amounts of bran or bran flakes. (These are high in sugars). If your diet is well-balanced and contains a variety of foods high in natural fiber, you usually do not need to add bran to other foods. If you do use unprocessed bran, remember that some people suffer from bloating and gas for several weeks after adding bran to their diets. All changes in the diet should be made slowly, to allow the digestive system to adapt.
Drink as much fluid as you urinate each day plus an additional three cups of liquid. Use part of your fluid allowance as a warm drink first thing in the morning or before bed in the evening. This often helps trigger bowel activity. Warm tea or lemonade work well.
Stay active. Even taking a brisk walk after dinner can help you stimulate the muscles in your intestines.
Try to develop a regular bowel habit. If you have had problems with constipation, attempt to have a bowel movement shortly after breakfast or dinner.
If the above treatments do not work, try adding other bulk laxatives such as psyllium (Metamucil).

Avoid taking laxatives if at all possible. Although they will usually relieve the constipation, you can quickly come to depend on them. Then the natural muscle actions required for bowel movements will be impaired.

Those most likely to be helpful and safe for long term use are polyethelene glycol, lactulose and sorbitol (least expensive). Wetting agents (docusate) soften stool.

For once-in-a while use, try a mixture of apple sauce, prune juice, and bran (so-called "black magic"). Also useful once in a while can be the irritant laxatives such as (senna) and enemas.

Above all, do not expect to have a bowel movement every day or even every other day. "Regularity" differs from person to person. If your bowel movements are usually painless and occur regularly (whether the pattern is three times a day or three times each week), then you are probably not constipated.

We have tried to make the How's Your Health error-free. However, those involved in its preparation can not warrant that all of the information is accurate and complete. When you use How's Your Health as a guide for your health and medical care, be sure to discuss any questions about it with your doctor, nurse, or other health care worker.

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