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Constipation is a symptom that has different meanings to
different individuals. Most commonly, it refers to infrequent
bowel
movements, but it may also refer to a decrease in the volume or weight
of stool, the need to strain to have a movement, a sense of incomplete
evacuation, or the need for enemas, suppositories or laxatives in order
to maintain regularity.
For most people, it is normal for bowel movements to
occur from three times a day to three times a week; other people may go a
week or more without experiencing discomfort or harmful effects. Normal
bowel habits are affected by diet. The average American diet includes
12 to 15 grams of fiber per day, although 25 to 30 grams of fiber and
about 60 to 80 ounces of fluid daily are recommended for proper bowel
function. Exercise is also beneficial to proper function of the colon.
About 80 percent of people
suffer from constipation at some time during their lives, and brief
periods of constipation are normal. Constipation may be diagnosed if
bowel movements occur fewer than three times weekly on an ongoing
basis. Widespread beliefs, such as the assumption that everyone should
have a movement at least once each day, have led to overuse and abuse of
laxatives.
Eating foods high in fiber, including bran, shredded
wheat, whole grain breads and certain fruits and vegetables will help
provide the 25 to 30 grams of fiber per day recommended for proper bowel
function.
What causes constipation?
There may be several, possibly simultaneous, causes for
constipation, including inadequate fiber and fluid intake, a sedentary
lifestyle, and environmental changes. Constipation may be aggravated by
travel, pregnancy or change in diet. In some people, it may result from
repeatedly ignoring the urge to have a bowel movement.
More serious causes of constipation include growths or
areas of narrowing in the colon, so it is wise to seek the advice of a
colon and rectal surgeon when constipation persists. Individuals with
spinal cord injuries frequently experience problems with constipation.
Constipation may be a symptom of diabetes. Constipation may also be
associated with scleroderma, or disorders of the nervous or endocrine
systems, including thyroid disease, multiple sclerosis, or Parkinson's
disease.
Can medication cause constipation?
Yes, many medications, including pain killers,
antidepressants, tranquilizers, and other psychiatric medications, blood
pressure medication, diuretics, iron supplements, calcium supplements,
and aluminum containing antacids can slow the movement of the colon
and worsen constipation.
When should I see a doctor about constipation?
Any persistent change in bowel habit, increase or
decrease in frequency or size of stool or an increased difficulty in
evacuating warrants evaluation. Whenever constipation symptoms persist
for more than three weeks, you should consult your physician. If blood
appears in the stool, consult your physician right away.
How can the cause of constipation be determined?
Constipation may have many causes, and it is important
to identify them so that treatment can be as simple and specific as
possible. Your doctor will want to check for any anatomic causes, such
as growths or areas of narrowing in the colon.
Digital examination of the anorectal area is usually the
first step, since it is relatively simple and may provide clues to the
underlying causes of the problem. Examination of the intestine with
either a flexible lighted instrument or barium x-ray study may help
pinpoint the problem and exclude serious conditions known to cause
constipation, such as polyps, tumors, or diverticular disease. If an
anatomic problem is identified, treatment can be directed toward
correcting the abnormality.
Other tests may identify specific functional causes to
help direct treatment. For example, "marker studies," in which the
patient swallows a capsule containing markers that show up on x-rays
taken repeatedly over several days, may provide clues to disorders in
muscle function within the intestine. Other physiologic tests evaluate
the function of the anus and rectum. These tests may involve evaluating
the reflexes of anal muscles that control bowel movements using a small
plastic catheter, or x-ray testing to evaluate function of the anus and
rectum during defecation.
In many cases, no specific anatomic or functional causes are identified and the cause of constipation is said to be nonspecific.
How is constipation treated?
The vast majority of patients with constipation are
successfully treated by adding high fiber foods like bran, shredded
wheat, whole grain breads and certain fruits and vegetables to the diet,
along with increased fluids. Your physician may also recommend
lifestyle changes. Fiber supplements containing indigestible vegetable
fiber, such as bran, are often recommended and may provide many benefits
in addition to relief of constipation. They may help to lower
cholesterol levels, reduce the risk of developing colon polyps and
cancer, and help prevent symptomatic hemorrhoids.
Fiber supplements may take several weeks,
possibly months, to reach full effectiveness, but they are neither
harmful nor habit forming, as some stimulant laxatives may become with
overuse or abuse. Other types of laxatives, enemas or suppositories
should be used only when recommended and monitored by your colon and
rectal surgeon.
Designating a specific time each day to have a bowel
movement also may be very helpful to some patients. In some cases,
bio-feedback may help to retrain poorly functioning anal sphincter
muscles. Only in rare circumstances are surgical procedures necessary to
treat constipation. Your colon and rectal surgeon can discuss these
options with you in greater detail to determine the best treatment for
you.
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