Division of Gastroenterology & Hepatology
An Uncomfortable Problem
Constipation is a common and often uncomfortable problem. There exists much folklore, unnecessary anxiety and frankly, misinformation about this issue. You have constipation if you have bowel movements less than every three days or strain to pass hard, dry stool. Constipation can be a temporary problem that lasts a short time. Or it can be a chronic problem that never seems to go away. Fortunately, it can often be controlled.
Symptoms of constipation include:
Feeling of fullness in the rectum
Bloating and gas
Feeling the urge, but being unable to pass stool
Abdominal pain and cramping
With straining at stool: pain in the anal area may be caused by an anal fissure; fresh blood on the stool or the toilet paper may come from a fissure or a hemorrhoid ("pile"). If these symptoms are present, both conditions can be treated by a gastroenterologist. Severe constipation may lead to bowel obstruction (fecal impaction) which requires urgent attention.
Causes of Constipation
One of the main causes of constipation is a diet that's too low in fiber. Travel that disrupts your normal routine can lead to temporary constipation. Pregnant women often become constipated. Other causes include getting too little exercise, taking certain medications (such as pain medications, antidepressants and antihistamines), or ignoring the urge to have a bowel movement. Diseases such as diabetes or hypothyroidism may also cause constipation.
Most of the time, the cause of constipation is not serious. But, in rare cases, chronic constipation may be a sign of an obstruction or abnormality in the colon. Your doctor should evaluate you to determine the cause of your constipation and rule out any underlying disorder. In general, new onset constipation requires a more detailed evaluation than life-long constipation.
Your Medical History
Your doctor may ask you questions life these:
How long have you had symptoms?
What types of foods do you eat?
How much activity do you usually get?
Do you have any other medical problems?
What medications do you take?
Do you often use laxatives or enemas?
Did you have an operation on your abdomen or on your pelvic organs?
Tests may be done to rule out more serious causes of constipation. Your doctor may take a sample of your blood and stool for testing. Sigmoidoscopy or colonoscopy may be done. During this test, your doctor views your colon through a flexible tube. A barium enema may also be done. For this test, your colon is filled with a liquid barium solution and x-rays are taken of your entire colon. In some situations a capsule containing 24 small radiopaque markers is ingested; their retention and location provide clues to the type of constipation. Occasionally, procedures such as defecography (a special x-ray study) and anorectal manometry (a test for recording pressure from the anus and rectum) would be done.
After your evaluation, your doctor can recommend the treatment plan that's best for you. This plan may include eating more fiber, getting more exercise, and proper and safe use of laxatives.
Eat More Fiber
One of the best ways to help treat constipation is to eat a high fiber diet. Fiber (in whole grains, fruits, and vegetables) adds bulk and absorbs water to soften the stool. Note that peas, beans and broccoli cause extra gas formation. This helps the stool pass through the colon more easily. Drinking more water is of little or no help to soften the stool. Many fiber supplements are available (Metamucil, FiberCon®, etc.). The best and most economical is 2-3 tablespoons of wheat bran per day.
Get Regular Exercise
Regular exercise helps improve the working of your colon and helps ease constipation. Start an exercise program.
There are two types: stimulant agents (e.g. Dulcolax®) and osmotic agents that keep water inside the bowel and get things moving. The osmotics are gentle and usually are tried first. On the other hand. there is little indication that stimulant laxatives cause chronic damage to the bowel.
Normal Bowel Movements
During digestion, nutrients are removed from the food you eat. The waste that's left is passed on to the colon (large intestine). The colon's main job is to absorb water from the stool before it leaves the body. Normally, stool moves through the colon at a steady, regular pace – not too fast or too slow. The stool stays in the colon just long enough for most of the water to be absorbed, with enough water left to ease the passage of the stool out of the body. The solid matter of stool consists of about equal parts of indigested fiber and of bacteria normally produced in the colon.
If the stool moves through the colon more slowly than normal, it stays in the colon too long. Because water is constantly being removed, the stool becomes dry and hard. This causes constipation: bowel movements that are less frequent than usual and very difficult or painful.