July 8, 2015
Constipation can differ for every individual. What’s “regular and normal” varies widely from one person to another, when it comes to bowel function. What is normal is having a pattern that stays mostly constant over the years, and evacuating bowel movements without too much straining; and finishing stool evacuation with the feeling like elimination has been adequate and fairly complete. Constipation is really just a problem in any of these. A reasonable definition of having a constipation “problem” is when constipation symptoms occur at least 25% of the time over a period of weeks or longer. Some normal people have bowel movements once a week or less, others several times a day. Many people who tell us they are constipated actually move more than once a day but feel it is too hard, difficult or doesn’t give a satisfying sense of being fully evacuated.
Constipation is influenced not just by diet but the contraction pattern and regularity of colon evacuation that changes with many other factors. Some causes include:
- Inadequate water intake
- Inadequate fiber in the diet
- A disruption of regular diet or routine; traveling
- Eating large amounts of dairy products
- Resisting the urge to have a bowel movement
- Overuse of laxative muscles
- Neurological condition
- Colon Cancer
- Eating Disorders
- Irritable Bowel Syndrome
Some risk factors can include the following:
Age/Inactivity - Age alone actually doesn’t cause constipation, but decreasing activity, more use of medication with effects on the bowel, diet changes with less fiber and other factors often result in more bowel problems in the elderly.
Any condition, including age and inactivity, which weakens abdominal and chest muscles may make it harder to effectively bear down to empty the colon--one more reason why regular exercise is good. Pelvic floor nerve and muscle disorders can cause extreme difficulty evacuating, or cause rectal pressure that leads people to feel like they are severely constipated.
Surgical/Medical Condition - Constipation, often with some irritable bowel symptoms, is surprisingly common after hysterectomy and pelvic surgery for a period of time, but usually resolves with time. The cause isn’t well understood. A variety of diseases do lead to constipation. It is very common in diabetes, and in Parkinsons. Changes in nerve function, deficiencies of thyroid hormone are other reasons. Stress is a common temporary cause of constipation (or diarrhea).
Signs & Symptoms
Some common signs and symptoms of constipation include:
- Infrequent bowel movements or difficulty having bowel movements (straining)
- Hard or small stools
- Sense of incomplete bowel movement
- Swollen or painful abdomen (bloating is a key symptoms of irritable bowel)
- Vomiting (can be a symptom of a serious blockage)
- Bleeding…which is never normal but is common from hemorrhoids. A cause should be determined however!
Screenings & Diagnostic Tests
Most people do not need extensive testing to diagnose constipation or to treat it. Only a small number of patients with constipation have a more serious medical problem. If you have constipation for more than several weeks without clear cause, you should consult your clinician so they can establish the cause of your constipation and treat it. If constipation is caused by colon cancer, early recognition and treatment is very important. Tests your doctor may perform to diagnose the cause of your constipation include blood tests, determing hormone imbalance; imaging studies like CAT scan to look for obstruction of the colon or a colonoscopy to look for causes of pain, bleeding, blockage or because it is time for a screening test for cancer or polyps.
Look at the causes that apply to you and try to correct as many as possible, here are some possible treatment options if you suffer with constipation:
1. Adequate diet fiber.
2. A schedule that allows you to use the bathroom when you need to and take adequate time.
3. Avoid prolonged or repeated straining to pass the stool.
4. Adequate fluid intake--generally a good idea to be sure you drink at least two 8-ounce glasses of fluids (not coffee or alcohol) beyond what you simply drink to relieve thirst. But remember that fluid does no good unless there is adequate fiber or roughage to soak up the fluid and carry it into the lower bowel!
5. Regular exercise, even if it is just good walks or some swimming a few times a week; but preferably every day.
6. If you skip breakfast, rethink the habit--often the morning meal or beverage helps trigger the colon to “wake up” and perform its function. Coffee or prune juice can be helpful.
7. Identify and deal with emotional tension or stress as well as you can—these often worsen the problem.
8. Use of laxatives and softeners is the subject of another information brochure.
Most patients who follow the treatment options above should have improvement in their constipation.