What Is Constipation?
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.
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. Constipation may rarely be a symptom of scieroderma, lupus, or disorders
of the nervous or endocrine systems, including thyroid disease, multiple sclerosis,
Parkinson's disease, stroke, and spinal cord injuries.
Can Medication Cause Constipation?
Yes, many medications, including pain killers, antidepressants, tranquilizers,
and other chiatric medications, blood pressure medication, diuretics, iron supplements,
calcium supplements, and aluminum containing antacids can cause or worsen constipation.
Furthermore, some people who are not actually constipated may become dependent
on laxatives in an illadvised attempt to have daily bowel movements, and many cause
themselves harm through laxative abuse.
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 medical advice. Whenever
constipation symptoms persist for more than three weeks, you should consult your
physician. If blood appears in the stool, consult your colon and rectal surgeon
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 undigestible 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.
Reference: American Society of Colon and Rectal Surgeons