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Constipation

By Alan S. Peterson, MD
Walter L. Aument Family Health Center

WHAT IS CONSTIPATION?

It is a common digestive problem.  It may be hard for you to have a bowel movement, or your bowel movements may not be regular.  Your stools may be very hard, making it difficult to pass them so that you have to strain.  Or you may feel an uncomfortable fullness even after you have had a bowel movement.
 

HOW OFTEN SHOULD I HAVE A BOWEL MOVEMENT?

Not everyone has them once a day.  It’s not true that you must have a daily bowel movement to be considered “regular.”  A normal range is anywhere between three times a day to three times a week.  You may be getting constipated if you start having bowel movements much less often than you usually do. 

HOW DO I PREVENT CONSTIPATION?

  • Don’t resist or ignore the urge to have a bowel movement.
  • Eat more fiber.
  • Drink plenty of fluids (about 8 glasses a day is a good goal – unless medical reasons not to).  Fluids can include water, juices, soup, tea and other nonalcoholic drinks.
  • Don’t use laxatives too often.  Overuse may damage your bowels and could make constipation worse.
  • Exercise often.
  • Limit foods that are high in fat and sugar (such as sweets, cheese, and processed foods). 

WHAT CAUSES CONSTIPATION?

 As the food you eat passes through your digestive tract, your body takes nutrients and water from the food.  This process creates a stool, which is moved through your intestines by muscles squeezing. 

 A number of things can affect this process.  These include older age, not drinking enough fluids, not being active enough, not eating enough fiber, taking certain medicines (such as narcotics), not going to the bathroom when you have the urge to have a bowel movement, or overuse of laxatives. 

HOW IS CONSTIPATION TREATED?

Eating enough fiber and drinking enough liquids are important.  Doing these things helps stools move through your intestines by increasing the bulk of your stools and making them softer.  Exercise also helps. 

TALK TO YOUR DOCTOR IF:

  • Constipation is new and unusual for you.
  • You have constipation (hard stool) for 3 or more weeks.
  • You have stomach pain.
  • You notice any blood in your stools.
  • You lose weight without reason.

WHAT SHOULD I EAT?

Eat plenty of fiber.  At least 2 cups of fruits and 2 ½ cups of vegetables per day is recommended.  Men 50 years and younger should eat at least 38 grams of fiber per day.  Women 50 years and younger should eat at least 25 grams per day.  Add extra fiber to your diet by eating cereals that contain bran or by adding bran as a topping on your fruit or cereal.  Start slowly so as not to create excess gas or diarrhea.  Then increase every 3 or 4 days as needed.
 

WHAT TYPE OF FOODS ARE RICH IN FIBER?

Unprocessed wheat bran; unrefined breakfast cereals; whole-grain bread and brown rice; fresh fruits; dry fruits (such as prunes, apricots, and figs); vegetables; and beans (such as navy, kidney, and pinto beans). 

SHOULD I USE LAXATIVES?

Laxatives should usually be avoided.  They aren’t  meant for long-term use.  An exception to this is bulk-forming laxatives.  These work naturally to add bulk and water to your stools so that they can pass more easily through your intestines.  They include oat bran, phyllium (one brand:  Metamucil), polycarbophil (one brand:  Fiber Con), and methylcellulose (one brand:  Citrucel). 

If the above do not work or you cannot tolerate them, one of the safer laxatives to be used these days is Miralax or Glycolax.  These are synthetic polymers and bloating and gas is less of a problem with them.  The initial dose is 17 grams per day dissolved in 4-8 ounces of liquid.  It might take one to four days to produce a regular BM, but it is quite safe. 

HOW ARE BULK-FORM LAXATIVES USED?

You must use them every day.  Follow the directions on the label.  Start slowly and drink plenty of liquids.  Increase how much you use every three to five days (as your body gets used to it) until your stools are softer and easier to pass.  You can mix these types of laxatives with fruit juice.  You may notice some bloating, gas, or cramping at first, especially if you start taking too much or increase the amount you are using too quickly.  These symptoms may lessen over  time. 

IS MINERAL OIL A GOOD LAXATIVE?

It should be used only when your doctor recommends it.  Mineral Oil should not be used regularly.  If it is used regularly, your body won’t get enough vitamins A, D, E and K.
 

SHOULD I TRY ENEMAS?

Enemas aren’t usually necessary to relieve constipation.  It is better to let your body work naturally.  Let your doctor decide.
 

WHAT IF I’VE BEEN USING ENEMAS OR LAXATIVES FOR A LONG TIME?

You may have to retrain your body to go without them.  This means eating plenty of fiber, possibly using a bulk-forming laxative, drinking plenty of water, exercising, and learning to give yourself enough time to have a bowel movement.  Talk to your doctor.
 

If you’ve used enemas and laxatives for a long time, your doctor may suggest that you gradually reduce the use of them to give your body a chance to adjust.  It may take months for your bowels to get back to normal.

Dr. Peterson is a doctor of Family and Community Medicine at the Walter L. Aument Family Health Center, 317 S. Chestnut St., Quarryville.


 
 





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