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Constipation
Constipation - Keep it moving
Constipation can best be described as infrequent and difficult bowel movements. Although it's seldom serious, it certainly can be quite uncomfortable. Almost everyone experiences occasional bouts of constipation.
Despite what most people think, it's not necessarily "normal" to have at least one bowel movement per day. Normal colon function varies with each individual. Bowel movements ranging from three times per day to as infrequently as three times a week fall within the normal range -- as long as the stools are easy to pass. Misconceptions about constipation have led to a marked overuse and abuse of laxatives. Americans spend about $725 million on laxatives every year. Many are not needed and some can even cause constipation.
Pronunciation
con-sti-PAY-shun
Synonym
- Irregularity
How Common Is Constipation?
Almost everyone is constipated from time to time. The incidence of constipation increases with age, especially after age 60.
Possible Underlying Causes
Constipation's most common cause is a poor diet. The main culprits are eating excess animal fats (meats, dairy products, eggs) and refined sugar (rich desserts and other sweets), and not enough fiber (vegetables, fruits, whole grains). Also, not getting enough exercise and too much stress have been linked to constipation.
Certain gastrointestinal tract disorders, such as irritable bowel syndrome, hemorrhoids, and diverticulitis are associated with chronic constipation. Therefore, it's important to talk to your doctor if you have more than occasional constipation.
Many medications, such as antacids, narcotic analgesics (such as codeine), antihistamines, and some antidepressants can also be a cause.
Triggers of Constipation
Frequently, changes in daily routine, such as traveling long distances, can result in constipation.
Drugs That Can Cause or Aggravate Constipation
Constipation can be a side effect of many drugs, from painkillers to antidepressants to antibiotics. The possibility and frequency of developing constipation from a drug depends on your sensitivity to that drug. Based on your past medical history and drug sensitivities, your doctor can prescribe medications that you will be least sensitive to. If you develop constipation or other reactions to a drug, call your doctor so that an alternative may be considered.
Diagnosing the Underlying Cause
In rare instances, constipation may be a symptom of an underlying disease or disorder. The following conditions may have constipation as a symptom:
- Congenital disorders: Hirschsprung's disease (rare), cystic fibrosis
- Endocrine system disorders: hypothyroidism, diabetes mellitus
- Metabolic disorders: hypercalcemia, uremia (kidney disease)
- Neurologic disorders: Parkinson's disease, multiple sclerosis
Don't attempt to diagnose yourself with a medical condition, even if your symptoms match those of the disorder. If your symptoms persist or concern you, seek medical advice for a proper diagnosis.
Diagnostic Procedures
If your physician suspects your constipation is related to another condition, there are tests available to diagnose the underlying disorder. For example, laboratory tests of blood and stool may reveal if further procedures are needed. In some cases, your doctor may order a direct colon examination such as a sigmoidoscopy, a colonoscopy, or a barium enema X-ray exam.
Goals of Treatment
The main goal in treating constipation is to reduce discomfort and restore normal bowel movements. In most cases, relatively simple changes in your lifestyle, such as improved diet, will solve the problem. There is medication available for those with more persistent problems.
Treatment Options
Drugs most commonly used
In general, laxatives are discouraged as a form of medical treatment for constipation and should be used only as a method of temporary relief and last resort. Some types, such as magnesium salts (Milk of Magnesia), glycerin suppositories (Fleet Babylax), and lactulose (Cephulac), work by drawing water into the intestine to soften the stool. Others, such as methylcellulose (Cologel) are bulk-forming agents, absorbing water and stimulating the intestine. Another category is called stimulant laxatives, and include Ex-Lax and castor oil. Common side effects of all laxatives are bloating, cramping, flatulence, and nausea.
Fiber supplements (like Metamucil) may be very effective in relieving constipation, but only if accompanied by lots of fluids.
Second choices
An enema can provide a simple and fast means of alleviating acute constipation. An easy-to-administer enema is the over-the-counter, premixed sodium phosphate type (Fleet Enema). It uses a hypertonic solution to draw water into the bowel. Check with your doctor before using a Fleet Enema on a child, because it can cause electrolyte and fluid imbalances in children. However, as with laxatives, the use of enemas is not generally encouraged because it can disrupt normal bowel function.
Dietary modifications
Eating less animal fat (like that found in meat, eggs, and dairy products), and increasing high-fiber foods (such as fruits, vegetables, and whole grains) will help keep your colon healthy and your bowel movements regular. Eating high-fiber cereal or a bowl of fruit two or three times a day can help. Drinking lots of fluids is also important to general digestive health, although water is absorbed higher in the bowel and is not considered a laxative.
Considerations for Women
Pregnancy is a common cause of constipation. The womb's pressure compresses the intestine, making a bowel movement more difficult. Another factor may be the hormonal changes during pregnancy. The third trimester may be particularly troublesome, requiring dietary adjustments and supplements.
Considerations for Older People
Constipation often increases with age, especially after age 60. Older people are more prone to constipation because of poor diet, medications, and lack of exercise.
Considerations for Children and Adolescents
Children may have constipation due to poor bowel habits -- that is, not going to the bathroom when they have to. Just as with adults, a healthy diet full of fiber, along with plenty of exercise, will help prevent constipation in children.
Herbs
Psyllium seed: You've probably heard of the bulk-forming laxative Metamucil. Its main ingredient is psyllium seed, a soluble fiber that absorbs water in the digestive tract, thereby increasing stool bulk. As bulk increases, you feel the urge to go. Mix a few teaspoons in a tall glass of water and drink before meals. [1]
Biofeedback
Biofeedback is a relaxation technique that trains you to control automatic body functions, such as skin temperature, that you might not think can be voluntarily controlled. Learning to relax your abdominal floor (solar plexus) may help with constipation. Dutch researchers used biofeedback with 29 chronically constipated children to teach them to relax their sphincters. Ninety percent of the group learned to do so, which helped cure their constipation problems. [2]
Last updated October 1999.
Sources
1 Duke, James. Green Pharmacy. Emmaus, PA: Rodale Press, 1997.
2 Benninga, M.A., et al. "Biofeedback Training in Chronic Constipation," Archives of Disease in Childhood 68:126, 1993.
Self-Care Measures
- Eat more fiber. Bran cereals are one effective way to go, but many other foods are also high in fiber, such as popcorn, prunes, raisins, broccoli, beans, peanuts, carrots, figs, dried apricots, and whole-grain breads.
- Try honey. Around the Mediterranean, honey in warm water is a popular folk remedy. It works, according to Greek researchers, who gave subjects mixtures of different sugars in water. Those who drank water and fructose -- the sugar in honey -- were the most likely to report a bowel movement within 10 hours.
- Avoid foods that can cause or aggravate constipation. These include cheeses, white rice, and white-flour products.
- Drink plenty of liquids. Fluids tend to soften stool and help it pass more easily. You might try caffeinated beverages, like coffee, tea, cocoa, and colas, which have a laxative effect on many people.
- Eat at regular hours. Regular meals help coax your body into regular bowel movements.
- Never ignore the urge to go to the bathroom. Also, try to establish a regular toilet time. A good time is 15 minutes after breakfast.
- Sit, but don't strain -- this can cause hemorrhoids.
- Get regular exercise. Take a brisk, half-hour walk every day.
When to Call the Doctor
- If your symptoms are severe, disabling, or last longer than three weeks
- If you have a significant and prolonged change of usual bowel habits
- If you notice blood in your stool or on the toilet paper
- If you notice secretion of mucus, seen as stains on underwear -- a possible sign of rectal prolapse
Websites & Organizations
American Dietetic Association
216 West Jackson Blvd., Ste. 800
Chicago IL 60606-6995
Phone: 312-899-0040
American Digestive Disease Society
60 East 42nd Street, Room 411
New York, NY 10165
Phone: 212-687-4185
American Digestive Health Foundation
7910 Woodmont Avenue, 7th Floor
Bethesda, MD 20814-3015
Phone: 301-654-2635
Fax: 301-654-1140
Email: dlee@gastro.org
American Society of Colon and Rectal Surgeons
85 W. Algonquin Road, Suite 550
Arlington Heights, IL 60005
Phone: -847-290-9184
Fax: 847-290-9203
National Digestive Diseases Information
P.O. Box NDDIC
Bethesda, MD 20892
Phone: 301-468-6344
Email: nddic@info.niddk.nih.gov
National Self-Help Clearinghouse
25 West 24th St.
New York, NY 10037
Phone: 212-354-8525
Nutritional Institution of America
200 West 86th St., Ste. 17A
New York, NY 10024
Three Rivers Endoscopy Center
725 Cherrington Parkway.
Moon Township, PA 15108-4305
Phone: 412-262-1000
Fax: 412-262-2346
United Ostomy Association
36 Executive Park, Suite 120
Irvine, CA 92714
Phone: 800-826-0826 or 714-660-8624
Email: uoa@deltanet.com
Sources & Further Reading
Books
Balch, James F. and Balch, Phyllis A. Prescription for Nutritional Healing. Garden City Park, NY: Avery Publishing, 1997.
Bennett, J. Claude and Plum, Fred. Cecil Textbook of Medicine, eds. Philadelphia: W. B. Saunders, 1996.
Duke, James. Green Pharmacy. Emmaus, PA: Rodale Press, 1997.
Fauci, Anthony J., et al. Harrison's Principles of Internal Medicine, eds. New York: McGraw-Hill, 1998.
Hardman, Joel G. and Limbird, Lee E. Goodman and Gilman's The Pharmacological Basis of Therapeutics eds. New York: McGraw-Hill, 1996.
Hurst, J. Willis. Medicine for the Practicing Physician eds. Stamford, CT: Appleton & Lange 1996.
Murray, Michael T. Encyclopedia of Natural Medicine. Prima, 1998.
Noble, John. Primary Care Medicine ed. St. Louis: Mosby, 1996.
Physicians' Desk Reference. Montvale, NJ: Medical Economics Co., 1998.
Rakel, Robert E. Conn's Current Therapy eds. Philadelphia: W.B. Saunders, 1998.
Taylor, Robert B. Family Medicine: Principles and Practice. New York: Springer-Verlag, 1998.
Tierney, LM, McPhee, SJ, and Papadakis, MA. Current Medical Diagnosis and Treatment eds. Stamford, CT: Appleton & Lange, 1998.
Articles
Anderson, AS. "Dietary Factors in the Aetiology and Treatment of Constipation During Pregnancy." Br J Obstet Gynaecol. 93(3):245-9. Mar 1986.
Benninga MA et al. "Biofeedback Training in Chronic Constipation," Archives of Disease in Childhood, 68:126, 1993.
Glia, A, Lindberg, G. "Quality of Life in Patients with Different Types of Functional Constipation." Scand J Gastroenterol. 32(11):1083-9. Nov 1997.
Jacobs, EJ, White, E. "Constipation, Laxative Use, and Colon Cancer among Middle-Aged Adults." Epidemiology. 9(4):385-91. Jul 1998.
Kinnunen, O. "Study of Constipation in a Geriatric Hospital, Day Hospital, Old People's Home and at Home." Aging. 3(2):161-70. Jun 1991.
Ladas, SD et al. "Honey May Have a Laxative Effect," Am. J. Clin. Nutrition, 62:1212, 1995.
Leung, AK, Chan, PY, Cho, HY. "Constipation in Children." Am Fam Physician. 54(2):611-8, 627. Aug 1996.
Probert, CS, Emmett, PM, Cripps, HA, Heaton, KW. "Evidence for the Ambiguity of the Term Constipation: The Role of Irritable Bowel Syndrome." Gut. 35(10):1455-8. Oct 1994.
Rantis, PC Jr, Vernava, AM 3rd, Daniel, GL, Longo, WE. "Chronic Constipation--Is the Work-up Worth the Cost?" Dis Colon Rectum. 40(3):280-6. Mar 1997.
Sandler, RS, Jordan, MC, Shelton, BJ. "Demographic and Dietary Determinants of Constipation in the US Population." Am J Public Health. 80(2):185-9. Feb 1990.
Sonnenberg, A, Koch, TR. "Epidemiology of Constipation in the United States." Dis Colon Rectum. 32(1):1-8. Jan 1989.
Whitehead, WE, Drinkwater, D, Cheskin, LJ, Heller, BR, Schuster, MM. "Constipation in the Elderly Living at Home. Definition, Prevalence, and Relationship to Lifestyle and Health Status." J Am Geriatr Soc. 37(5):423-9. May 1989.