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Avoiding Constipation

It seems odd that as we talk about the most intimate details of our lives (often on national TV talk shows), the subject of constipation remains off limits. Order prunes and bran cereal for breakfast, for example, and you are sure to elicit some smirks. Comedians often find this topic good source material for many laughs. But if you are one of the 2.5 million Americans who suffer from chronic constipation, it is not a laughing matter. It can be a distressing and embarrassing struggle and can interfere with the quality of your life.

What Is Constipation?

Besides being difficult to talk about, constipation is difficult to define. One persons constipation may be anothers regularity. In fact, the frequency of bowel movements among healthy people can range from three per day to three per week. As long as you fall within these limits and having a bowel movement does not involve a lot of difficulty, you are not constipated. However, you may have a problem if you consistently:

  • have less than three bowel movements a week
  • have hard pellet-like "rabbit" stools
  • experience much straining during elimination
  • note a feeling of incomplete evacuation.
Symptoms persisting continuously for over six weeks are termed chronic constipation.

Why Not Daily?

Many people believe that they must have a bowel movement every day to prevent so-called toxins from building up in their body. This simply is not true. This misconception has been present for thousand of years. Ancient Egyptians believed that stool contained toxins and placed laxative and enemas high on their list of important medications. Years ago, people went to spas and were routinely given enemas to clean out their systems. Even today, ads for colonic irrigation are often seen in the Yellow Pages. Privately, Americans seem obsessed with moving their bowels, spending over $725 million each year. However, there is absolutely no evidence that daily bowel movements are necessary. Stool, or feces, is made up of food particles that cannot be absorbed. While these particles contain wastes that are no longer needed by the body, they are not toxic.

What Causes Constipation?

Constipation is a symptom, not a disease. Like a fever, constipation can be caused by many different conditions. These may include a sudden change in your diet or level of activity, dehydration, stress, or side effects of a new medication. In some instances, constipation is due to a problem with the bowel itself, such as irritable bowel syndrome, diverticulitis, hemorrhoids and other anal disorders, or even cancer. Occasionally, health problems such as an underactive thyroid, kidney disease, long-standing diabetes, high blood calcium, or low blood potassium can slow things down. Pregnancy is another common cause of constipation.

Many drugs have a side-effect of constipation. The list is a long one, but common offenders include narcotic derivatives such as Codeine, Darvon, Demerol, Dilaudid, Morphine, Talwin, Percocet, Percodan, and Vicodin; antidiarrheals like Imodium, Lomotil, Paregoric and PeptoBismol; antispasmodics such as Bentyl, Donnatal, Levsin, Levbid, Levsinex, and Librax; antihypertensives, especially calcium channel blockers like Adalat, Calan, Cardizem, Dilacor, Norvasc, and Procardia; antiparkinson drugs like Cogentin and Sinemet; antihistamines; diuretics (water pills); antacids containing aluminum or calcium; and iron pills like ferrous sulfate, Feosol, and Ferrosequels. Of course, there are many others.

Is Constipation Serious?

Not usually. Most cases of constipation are due to inadequate dietary fiber intake, inadequate water intake, and/or reduced physical activity and, as such, are not serious. Constipation not responding to simple measures or symptoms that persist over six weeks signal a need for medical evaluation. Other symptoms such as weight loss, rectal bleeding, abdominal pain, or the discovery of anemia also require a full investigation. Your doctor can help you sort out the many possible causes and plan a course of treatment. In addition to obtaining a medical history and performing a physical exam, he may request some blood tests, and a special scope evaluation of the colon.

How Is Constipation Treated?

Acute constipation often occurs as a result of a sudden decrease in activity or immobility such as during travel, illness, or hospitalization. Such cases usually respond promptly to fiber and water supplements, judicious and temporary use of laxatives, and an increase in physical activity. Chronic symptoms require your doctors care.

How To Avoid Constipation

 

    1. Develop a regular schedule. Food entering the stomach sends a signal to the large intestine, telling it to empty and free up space for the next meal. This so called gastro-colic reflex is usually strongest after eating breakfast, making that the best time to eliminate.Dont ignore the urge to have a bowel movement. Nature knows best.

    2. Eat a high fiber diet. In almost all cases, dietary modifications can correct constipation. Eating plenty of foods that contain fiber is the mainstay of treatment. Fiber acts like a sponge in the intestines, holding in water. As the stool absorbs water, it becomes softer and easier to pass. But, most Americans do not get enough fiber in their diet. The goal should be about 25 grams a day most of us get between 10-15 grams a day. Fiber is found in fruits such as apples, bananas, berries, pears, and prunes. Vegetables such as beans, carrots, corn, and spinach contain healthy amounts of fiber. Try to include a variety of fruits and vegetables in your diet each day at least five to six servings daily.

    Some of the best sources of fiber are the whole grain breads and cereals. It works best if you start each day with a super charged fiber-rich breakfast. As an example, eating a bowl of Raisin Nut Bran cereal mixed with only 1/3 cup of Bran Buds will add over 13 grams of fiber. Throw in two slices of toasted 100% stone ground whole wheat bread and jelly and you have a total of 17 grams of fiber under your belt before your day even begins.

    3. Add a fiber supplement once to twice a day. These bulk-forming agents contain vegetable fibers of the psyllium seed (Metamucil, Fibercon) or cellulose derivatives (Citrucel). Simple unprocessed wheat bran is the cheapest fiber supplement. Fiber supplements are safe long term, but may lead to increased bloating and gas until your body gets used to them.

    4. Drink plenty of fluids when adding extra fiber. Drink six to eight 8-ounce glasses of water a day. Plain water is best, but any non-caffeinated nonalcoholic beverage is fine. Get in the habit of drinking a whole glass of water when you take a pill and pour yourself a full glass of water at every meal. Keep water on your desk and sip it during the day. Be aware that drinking water alone is not enough to prevent constipation. Without fiber, the water is absorbed directly into the bloodstream and the excess is quickly excreted as urine.

    5. Get some physical exercise every day. Even simple exercises like walking and stretching can be of benefit. Special abdominal exercises may be necessary to tone up muscles.

    6. Avoid the chronic use of harsh laxatives. While the occasional use of over-the-counter remedies is not harmful, you should not use laxatives on a regular basis without your doctors approval. Some of the formulations may actually damage your colon and eventually worsen the condition. Stool softeners, or wetting agents, like Colace and Surfak and bulk-agents mentioned above are safe for longterm use.

Summary

Constipation is the most common digestive complaint in the United States, but usually does not signify a serious medical problem. You can usually prevent problems by eating a high fiber diet, drinking more fluids, exercising regularly, and allowing yourself plenty of time to go to the bathroom. Dont become obsessed with having a daily bowel movement. It only makes matters worse.


Text & Images Courtesy of Three Rivers Endoscopy Center
© Dr. Robert Fusco, Three Rivers Endoscopy Center, All Rights Reserved





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