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Constipation

What is Constipation?

Constipation is the infrequent and difficult passage of stool. The frequency of bowel movements among healthy people varies greatly, ranging from three movements a day to three a week. As a rule, if more than three days pass without a bowel movement, the intestinal contents may harden and a person may have difficulty or even pain during elimination. Stool may harden and be painful to pass. Straining during bowel movements or the feeling of incomplete evacuation may also be reported as constipation.

A common misconception is that a bowel movement every day is necessary. Another common fallacy is that wastes stored in the body are absorbed and are dangerous to health or shorten the lifespan. These misconceptions have led to a marked overuse and abuse of laxatives. Many are not needed and routine use of some stimulant laxatives can cause dependency.

What Are The Causes Of Constipation?

Constipation can be caused by many different conditions. Most people have experienced an occasional brief bout of constipation that has corrected itself with diet and time. The following is a list of some of the most common causes of constipation:

  • Poor Diet: A main cause of constipation may be a diet high in animal fats (meats, dairy products, eggs) and refined sugar (rich desserts and other sweets), but low in fiber (vegetables, fruits, whole grains), especially insoluble dietary fiber, which helps move bulk through the intestines and promote bowel movements. Some studies have suggested that high-fiber diets result in larger stools, more frequent bowel movements.
  • Imaginary Constipation: This is very common and results from misconceptions about what is normal and what is not. If recognized early enough, this type of constipation can be cured by informing the sufferer that the frequency of his or her bowel movements is normal.
  • Poor Bowel Habits: A person can initiate a cycle of constipation by ignoring the urge to have a bowel movement. Some people do this to avoid using public toilets, others because they are too busy. After a period of time, a person may stop feeling the urge. This leads to progressive constipation.
  • Travel: People often experience constipation when traveling long distances, which may relate to changes in lifestyle, schedule, diet and drinking water.
  • Medications: Many medications can cause constipation. These include pain medications (especially narcotics), antacids that contain aluminum or calcium, antispasmodic drugs, antidepressant drugs, tranquilizers, iron supplements, anticonvulsants for epilepsy, antiparkinsons drugs and calcium channel blockers for high blood pressure and heart conditions.

What Are The Signs and Symptoms Of Constipation?

If you are dealing with constipation you may feel:

  • Few bowel movements
  • Trouble having a bowel movement (straining to go)
  • Hard or small stools
  • A sense that everything didn’t come out
  • Belly bloating

What Are The Risk Factors Of Constipation?

  • Irritable Bowel Syndrome (IBS): Also known as spastic colon, IBS is one of the most common causes of constipation in the U.S. Some people develop spasms of the colon that delay the speed with which the contents of the intestine move through the digestive tract, leading to constipation.
  • Laxative Abuse: People who habitually take stimulant laxatives become dependent upon them and may require increasing dosages until, finally, the intestine becomes insensitive and fails to work properly.
  • Hormonal Disturbance: Certain hormonal disturbances, such as an underactive thyroid gland, can produce constipation.
  • Pregnancy: Pregnancy is another common cause of constipation, which may be partly due to hormonal changes during pregnancy.
  • Fissures and Hemorrhoids: Painful conditions of the anus can produce a spasm of the anal sphincter muscle, which can delay a bowel movement.
  • Specific Diseases: Many diseases that affect the body tissues, such as scleroderma or lupus, and certain neurological or muscular diseases, such as multiple sclerosis, Parkinson’s disease, and stroke, can be responsible for constipation.
  • Loss of Body Salts: The loss of body salts through the kidneys or through vomiting or diarrhea is another cause of constipation.
  • Mechanical Compression: Scarring, inflammation around diverticula, tumors, and cancer can produce mechanical compression of the intestine and result in constipation.
  • Nerve Damage: Injuries to the spinal cord and tumors pressing on the spinal cord can produce constipation by affecting the nerves that lead to the intestine.

How Is Constipation Diagnosed?

Constipation may be caused by abnormalities or obstructions of the digestive system in some people. A doctor can perform tests to determine if constipation is the symptom of an underlying disorder. In addition to routine blood, urine and stool tests, a flexible sigmoidoscopy or a colonoscopy may help detect problems in the rectum and colon. Other highly specialized techniques are available for measuring pressures and movements within the colon and its sphincter muscles.

What Are Possible Treatments For Constipation?

The first step in treating constipation is to understand that normal frequency varies widely, from three bowel movements a day to three a week. Each person must determine what is normal to avoid becoming dependent on laxatives.

For most people, dietary and lifestyle improvements can lessen the chances of constipation. A well-balanced diet that includes fiber-rich foods, such as unprocessed bran, whole-grain bread, and fresh fruits and vegetables, is recommended. Drinking plenty of fluids and exercising regularly will help to stimulate intestinal activity. Special exercises may be necessary to tone up abdominal muscles after pregnancy or whenever abdominal muscles are lax.

Bowel habits also are important. Sufficient time should be set aside to allow for undisturbed visits to the bathroom. In addition, the urge to have a bowel movement should not be ignored. If an underlying disorder is causing constipation, treatment will be directed toward the specific cause. For example, if an underactive thyroid is causing constipation, the doctor may prescribe thyroid hormone replacement therapy. In most cases, stimulant laxatives should be the last resort and taken only under a doctor’s supervision. A doctor is best qualified to determine when a laxative is needed and which type is best. There are various types of oral laxatives and they work in different ways.

Above all, it is necessary to recognize that a successful treatment program requires persistent effort and time. Constipation does not occur overnight and it is not reasonable to expect that constipation can be relieved overnight.

Preventative Steps To Avoid Constipation?

  • Most people experience occasional short bouts of constipation. If a laxative is necessary for longer than three weeks, seek medical advice.
  • Eat a well-balanced diet that includes unprocessed bran, whole-wheat grains, fresh fruits, and vegetables.
  • Drink plenty of fluids.
  • Exercise regularly.
  • Set aside time after breakfast or dinner for undisturbed visits to the toilet.
  • Don’t ignore the urge to have a bowel movement.
  • Whenever there is a significant or prolonged change in bowel habits, see your doctor.
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Meet Jennifer Bonheur, MD

Dr. Jennifer Bonheur is a board-certified gastroenterologist who loves her work and values her relationships with her patients. As a female gastroenterologist, she strives to connect and treat the patient and not simply the illness. Dr. Bonheur offers specialized care in gastroenterology and therapeutic endoscopy. Together with her staff, she is committed to providing the highest quality medical care in a comfortable, professional and personalized environment. Learn More »