Constipation: Quick Guide to a Hard Problem

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Beware the No-Go Zone!

One of the most frequent complaints I hear from my patients has to do with constipation. How exciting. Well, I suppose if you are unfortunate enough to move your bowels only once every couple of weeks, you WOULD be excited when it finally happened! I have marveled at the stories women tell of years of this type of pattern, and I wouldn’t be surprised if their weight changes by a couple of pounds every so often.

How does a person get into such a bad pattern? It is complicated, but women seem to be more prone than men to have chronic, long-standing constipation, and perhaps it relates to the fact that some women have to be in a comfortable place, i.e. home, in order to have that joyous movement. Their workday literally gets in the way.

Bowel function typically follows a predictable pattern, and there are actually reflexes associated with having a daily bowel movement. For instance, the gastrocolic reflex occurs when there is even a small amount of food in the stomach, which then stimulates the colon to contract. If that urge to go is ignored because the “social setting” isn’t quite right (i.e. you’re at work), then the natural forces are squelched and the urge goes away. That all-important urge may not come back the rest of the day…or the next. It’s really a bad pattern of behavior that sends the colon into dormancy. So how can a person get back into a good, solid pattern of going? The simple answer is not to ignore that urge to go even when it might not be the most convenient time and place to answer the call.

Another issue is the difficulty in passing hard stool that can literally impact in the colon/rectal vault. What a disaster! Stool softeners help draw more water into the colon and make the dryness factor less problematic. Also, bulking agents such as psyllium fiber found in many commercial fiber laxatives can make things move easier. Fiber alone, without sufficient intake of liquids, can actually cause more of a constipation and gas problem that it solves, so be aware that drinking plenty of water is an absolute necessity.

Regular exercise (or lack of it) also has an important role to play in regular, normal bowel function. Sedentary people who potentially take multiple medications for various health problems are the most likely to benefit from getting out of the chair to do ANYTHING that moves their body and stimulates their bowels. The elderly have several issues that make them suffer much more frequently from constipation, and a quick peek at their medication list can readily reveal the offending drugs. Antidepressants, bladder medications and a host of others can slow down the bowels.

Using a laxative on a daily basis is not the best solution, and it can become a habit. It is worth noting, that constipation and chronic laxative use do not increase the chance of colon cancer. A better solution is diet alteration: a diet with at least 20 to 35 grams of fiber daily can help the body form soft, bulky stool. Examples of high fiber foods are beans, whole grains, fresh fruits and vegetables. Low or zero fiber foods such as cheese, meat and heavily processed foods of all kinds should be minimized.

The Mayo Clinic lists the following products as useful for treating constipation:

· Fiber supplements, or bulk laxatives ( FiberCon, Metamucil, Konsyl, Serutan and Citrucel)

· Stimulants cause rhythmic contractions in the intestines (Correctol, Dulcolax and Senokot)

· Lubricants enable stool to move through your colon more easily (mineral oil and Fleet)

· Stool softeners moisten the stool and help prevent dehydration (Colace and Surfak)

· Osmotics help fluids to move through the colon (Cephulac, Sorbitol and Miralax)

· Saline laxatives act like a sponge to draw water into the colon for easier passage of stool (milk of magnesia and Haley's M-O)

If simple lifestyle changes and use of over-the-counter remedies is not sufficient to improve symptoms, your doctor may need to try prescription medication. One such medication commonly used today is Amitiza, which increases the fluid content of stool as its main mechanism of action.

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