• Hard, dry stools that are difficult to pass in a bowel movement, or having fewer than three bowel movements per week.
   
• Constipation is a condition in which too much water is absorbed from the large intestine back into the bloodstream, leaving the faeces dry, hard and difficult to expel. This can be caused by a lack of fibre in the diet (fibre holds water, preventing the faeces becoming too hard).

• Constipation

  On this page:

  • Who gets constipated?
  • What causes constipation?
  • What diagnostic tests are used?
  • How is constipation treated?
  • Can constipation be serious?
  • Hope Through Research
  • Points to Remember
  • For More Information

   

  The lower digestive tract

  Constipation is passage of small amounts of hard, dry bowel movements, usually fewer than three times a week. People who are constipated may find it difficult and painful to have a bowel movement. Other symptoms of constipation include feeling bloated, uncomfortable, and sluggish.

  Many people think they are constipated when, in fact, their bowel movements are regular. For example, some people believe they are constipated, or irregular, if they do not have a bowel movement every day. However, there is no right number of daily or weekly bowel movements. Normal may be three times a day or three times a week depending on the person. Also, some people naturally have firmer stools than others.

  At one time or another, almost everyone gets constipated. Poor diet and lack of exercise are usually the causes. In most cases, constipation is temporary and not serious. Understanding its causes, prevention, and treatment will help most people find relief.

   

  Hopefully this website will help you.  You run across  something on this topic from friends or from the internet  If you would like us to enter the article on this page we can usually do so. The contact information is: Brian Nelson 31 Gessner Rd. Houston, TX  77024 713-467-3025 Fax 713-467-3192 Click here to  e-mail me with any questions. www.NelsonIdeas.com www.PartyTentCity.com www.BrianNelsonConsulting.com www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html

   

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  Who gets constipated?

  According to the 1996 National Health Interview Survey, about 3 million people in the United States have frequent constipation. Those reporting constipation most often are women and adults age 65 and over. Pregnant women may have constipation, and it is a common problem following childbirth or surgery.

  Constipation is one of the most common gastrointestinal complaints in the United States, resulting in about 2 million doctor visits annually. However, most people treat themselves without seeking medical help, as is evident from the millions of dollars Americans spend on laxatives each year.

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  Irritable Bowel Syndrome (IBS)

  Some people with IBS, also known as spastic colon, have spasms in the colon that affect bowel movements. Constipation and diarrhea often alternate, and abdominal cramping, gassiness, and bloating are other common complaints. Although IBS can produce lifelong symptoms, it is not a life-threatening condition. It often worsens with stress, but there is no specific cause or anything unusual that the doctor can see in the colon.

  Changes in Life or Routine

  During pregnancy, women may be constipated because of hormonal changes or because the heavy uterus compresses the intestine. Aging may also affect bowel regularity because a slower metabolism results in less intestinal activity and muscle tone. In addition, people often become constipated when traveling because their normal diet and daily routines are disrupted.

  Abuse of Laxatives

  Myths about constipation have led to a serious abuse of laxatives. This is common among people who are preoccupied with having a daily bowel movement.

  Laxatives usually are not necessary and can be habit-forming. The colon begins to rely on laxatives to bring on bowel movements. Over time, laxatives can damage nerve cells in the colon and interfere with the colon's natural ability to contract. For the same reason, regular use of enemas can also lead to a loss of normal bowel function.

  Ignoring the Urge to Have a Bowel Movement

  People who ignore the urge to have a bowel movement may eventually stop feeling the urge, which can lead to constipation. Some people delay having a bowel movement because they do not want to use toilets outside the home. Others ignore the urge because of emotional stress or because they are too busy. Children may postpone having a bowel movement because of stressful toilet training or because they do not want to interrupt their play.

  Specific Diseases

  Diseases that cause constipation include neurological disorders, metabolic and endocrine disorders, and systemic conditions that affect organ systems. These disorders can slow the movement of stool through the colon, rectum, or anus.

  Several kinds of diseases can cause constipation:

  Neurological disorders

  • multiple sclerosis
  • Parkinson's disease
  • chronic idiopathic intestinal pseudo-obstruction
  • stroke
  • spinal cord injuries

  Metabolic and endocrine conditions

  • diabetes
  • underactive or overactive thyroid gland
  • uremia
  • hypercalcemia

  Systemic disorders

  • amyloidosis
  • lupus
  • scleroderma

  Problems with the Colon and Rectum

  Intestinal obstruction, scar tissue (adhesions), diverticulosis, tumors, colorectal stricture, Hirschsprung's disease, or cancer can compress, squeeze, or narrow the intestine and rectum and cause constipation.

  Problems with Intestinal Function (Chronic Idiopathic Constipation)

  Some people have chronic constipation that does not respond to standard treatment. This rare condition, known as idiopathic (of unknown origin) chronic constipation may be related to problems with intestinal function such as problems with hormonal control or with nerves and muscles in the colon, rectum, or anus. Functional constipation occurs in both children and adults and is most common in women.

  Colonic inertia and delayed transit are two types of functional constipation caused by decreased muscle activity in the colon. These syndromes may affect the entire colon or may be confined to the lower or sigmoid colon.

  Functional constipation that stems from abnormalities in the structure of the anus and rectum is known as anorectal dysfunction, or anismus. These abnormalities result in an inability to relax the rectal and anal muscles that allow stool to exit.
  What diagnostic tests are used?

  Most people with constipation do not need extensive testing and can be treated with changes in diet and exercise. For example, in young people with mild symptoms, a medical history and physical examination may be all the doctor needs to suggest successful treatment. The tests the doctor performs depend on the duration and severity of the constipation, the person's age, and whether blood in stools, recent changes in bowel movements, or weight loss have occurred.

  Medical History

  The doctor may ask a patient to describe his or her constipation, including duration of symptoms, frequency of bowel movements, consistency of stools, presence of blood in the stool, and toilet habits (how often and where one has bowel movements). A record of eating habits, medication, and level of physical activity or exercise will also help the doctor determine the cause of constipation.

  The clinical definition of constipation is any two of the following symptoms for at least 12 weeks (not necessarily consecutive) in the previous 12 months:

  • straining during bowel movements
  • lumpy or hard stool
  • sensation of incomplete evacuation
  • sensation of anorectal blockage/obstruction
  • fewer than three bowel movements per week

  Physical Examination
  A physical exam may include a rectal exam with a gloved, lubricated finger to evaluate the tone of the muscle that closes off the anus (anal sphincter) and to detect tenderness, obstruction, or blood. In some cases, blood and thyroid tests may be necessary to look for thyroid disease and serum calcium or to rule out inflammatory, neoplastic, metabolic, and other systemic disorders.

  Extensive testing usually is reserved for people with severe symptoms, for those with sudden changes in number and consistency of bowel movements or blood in the stool, and for older adults. Additional tests that may be used to evaluate constipation include

  • colorectal transit study
  • anorectal function tests

  Because of an increased risk of colorectal cancer in older adults, the doctor may use tests to rule out a diagnosis of cancer, including

  • barium enema x ray
  • sigmoidoscopy or colonoscopy

  Colorectal transit study. This test, reserved for those with chronic constipation, shows how well food moves through the colon. The patient swallows capsules containing small markers that are visible on an x ray. The movement of the markers through the colon is monitored with abdominal x rays taken several times 3 to 7 days after the capsule is swallowed. The patient follows a high-fiber diet during the course of this test.

  Anorectal function tests. These tests diagnose constipation caused by abnormal functioning of the anus or rectum (anorectal function). Anorectal manometry evaluates anal sphincter muscle function. For this test, a catheter or air-filled balloon inserted into the anus is slowly pulled back through the sphincter muscle to measure muscle tone and contractions.

  Defecography is an x ray of the anorectal area that evaluates completeness of stool elimination, identifies anorectal abnormalities, and evaluates rectal muscle contractions and relaxation. During the exam, the doctor fills the rectum with a soft paste that is the same consistency as stool. The patient sits on a toilet positioned inside an x ray machine and then relaxes and squeezes the anus to expel the paste. The doctor studies the x rays for anorectal problems that occurred as the paste was expelled.

  Barium enema x ray.This exam involves viewing the rectum, colon, and lower part of the small intestine to locate any problems. This part of the digestive tract is known as the bowel. This test may show intestinal obstruction and Hirschsprung's disease, a lack of nerves within the colon.

  The night before the test, bowel cleansing, also called bowel prep, is necessary to clear the lower digestive tract. The patient drinks a special liquid to flush out the bowel. A clean bowel is important, because even a small amount of stool in the colon can hide details and result in an incomplete exam.

  Because the colon does not show up well on x rays, the doctor fills it with barium, a chalky liquid that makes the area visible. Once the mixture coats the inside of colon and rectum, x rays are taken that reveal their shape and condition. The patient may feel some abdominal cramping when the barium fills the colon, but usually feels little discomfort after the procedure. Stools may be a whitish color for a few days after the exam.

  Sigmoidoscopy or colonoscopy. An examination of the rectum and lower (sigmoid) colon is called a sigmoidoscopy. An examination of the rectum and entire colon is called a colonoscopy.

  The patient usually has a liquid dinner the night before a sigmoidoscopy and takes an enema early the next morning. A light breakfast and a cleansing enema an hour before the test may also be necessary.

  To perform a sigmoidoscopy, the doctor uses a long, flexible tube with a light on the end called a sigmoidoscope to view the rectum and lower colon. First, the doctor examines the rectum with a gloved, lubricated finger. Then, the sigmoidoscope is inserted through the anus into the rectum and lower colon. The procedure may cause a mild sensation of wanting to move the bowels and abdominal pressure. Sometimes the doctor fills the colon with air to get a better view. The air may cause mild cramping.

  To perform a colonoscopy, the doctor uses a flexible tube with a light on the end called a colonoscope to view the entire colon. This tube is longer than a sigmoidoscope. The same bowel cleansing used for the barium x ray is needed to clear the bowel of waste. The patient is lightly sedated before the exam. During the exam, the patient lies on his or her side and the doctor inserts the tube through the anus and rectum into the colon. If an abnormality is seen, the doctor can use the colonoscope to remove a small piece of tissue for examination (biopsy). The patient may feel gassy and bloated after the procedure.
  How is constipation treated?

  Although treatment depends on the cause, severity, and duration, in most cases dietary and lifestyle changes will help relieve symptoms of constipation and help prevent it.
  Diet

  A diet with enough fiber (20 to 35 grams each day) helps form soft, bulky stool. A doctor or dietitian can help plan an appropriate diet. High-fiber foods include beans, whole grains and bran cereals, fresh fruits, and vegetables such as asparagus, brussels sprouts, cabbage, and carrots. For people prone to constipation, limiting foods that have little or no fiber, such as ice cream, cheese, meat, and processed foods, is also important.

  Lifestyle Changes
  Other changes that can help treat and prevent constipation include drinking enough water and other liquids such as fruit and vegetable juices and clear soups, engaging in daily exercise, and reserving enough time to have a bowel movement. In addition, the urge to have a bowel movement should not be ignored.
  Laxatives

  Most people who are mildly constipated do not need laxatives. However, for those who have made diet and lifestyle changes and are still constipated, doctors may recommend laxatives or enemas for a limited time. These treatments can help retrain a chronically sluggish bowel. For children, short-term treatment with laxatives, along with retraining to establish regular bowel habits, also helps prevent constipation.

  A doctor should determine when a patient needs a laxative and which form is best. Laxatives taken by mouth are available in liquid, tablet, gum, powder, and granule forms. They work in various ways:

  • Bulk-forming laxatives generally are considered the safest but can interfere with absorption of some medicines. These laxatives, also known as fiber supplements, are taken with water. They absorb water in the intestine and make the stool softer. Brand names include Metamucil, Citrucel, Konsyl, and Serutan.
    
     
  • Stimulants cause rhythmic muscle contractions in the intestines. Brand names include Correctol, Dulcolax, Purge, and Senokot. Studies suggest that phenolphthalein, an ingredient in some stimulant laxatives, might increase a person's risk for cancer. The Food and Drug Administration has proposed a ban on all over-the-counter products containing phenolphthalein. Most laxative makers have replaced or plan to replace phenolphthalein with a safer ingredient.
    
     
  • Stool softeners provide moisture to the stool and prevent dehydration. These laxatives are often recommended after childbirth or surgery. Products include Colace and Surfak.
     
  • Lubricants grease the stool enabling it to move through the intestine more easily. Mineral oil is the most common example.
     
  • Saline laxatives act like a sponge to draw water into the colon for easier passage of stool. Laxatives in this group include Milk of Magnesia and Haley's M-O.

  People who are dependent on laxatives need to slowly stop using them. A doctor can assist in this process. In most people, this restores the colon's natural ability to contract.
  Other Treatments

  Treatment may be directed at a specific cause. For example, the doctor may recommend discontinuing medication or performing surgery to correct an anorectal problem such as rectal prolapse.

  People with chronic constipation caused by anorectal dysfunction can use biofeedback to retrain the muscles that control release of bowel movements. Biofeedback involves using a sensor to monitor muscle activity that at the same time can be displayed on a computer screen, allowing for an accurate assessment of body functions. A health care professional uses this information to help the patient learn how to use these muscles.

  Surgical removal of the colon may be an option for people with severe symptoms caused by colonic inertia. However, the benefits of this surgery must be weighed against possible complications, which include abdominal pain and diarrhea.

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  Hope Through Research

  NIDDK's Division of Digestive Diseases and Nutrition supports basic and clinical research into gastrointestinal conditions, including constipation. Among other areas, researchers are studying the anatomical and physiological characteristics of rectoanal motility and the use of new medications and behavioral techniques, such as biofeedback, to treat constipation.

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  Points to Remember

  • Constipation affects almost everyone at one time or another.
    
     
  • Many people think they are constipated when, in fact, their bowel movements are regular.
    
     
  • The most common causes of constipation are poor diet and lack of exercise.
    
     
  • Additional causes of constipation include medications, irritable bowel syndrome, abuse of laxatives, and specific diseases.
    
     
  • A medical history and physical examination may be the only diagnostic tests needed before the doctor suggests treatment.
    
     
  • In most cases, following these simple tips will help relieve symptoms and prevent recurrence of constipation:
    
     
    • Eat a well-balanced, high-fiber diet that includes beans, bran, whole grains, fresh fruits, and vegetables.
    • Drink plenty of liquids.
    • Exercise regularly.
    • Set aside time after breakfast or dinner for undisturbed visits to the toilet.
    • Do not ignore the urge to have a bowel movement.
    • Understand that normal bowel habits vary.
    • Whenever a significant or prolonged change in bowel habits occurs, check with a doctor.
      
       
  • Most people with mild constipation do not need laxatives. However, doctors may recommend laxatives for a limited time for people with chronic constipation.

Constipation, Dispelling the Myths

Related MedicineNet Links

• Constipation (article)
• Digestive Disease Myths (Health e-Tool)

Bulk of Constipation Myths Unfounded
Fiber, water won't cure condition and laxatives don't damage colon, study says

By Steven Reinberg
HealthDay Reporter

TUESDAY, Jan. 4 (HealthDayNews) -- Conventional wisdom about constipation is often only folklore, with no basis in fact, a new German report claims.

The beliefs that fiber or water can cure constipation and that laxatives can damage the colon or become addictive are simply wrong, the researchers said. To dispel these and other misconceptions, they looked at the common beliefs about constipation and reviewed medical trials to separate fact from fiction.

"Chronic constipation is uncomfortable, but not dangerous," lead researcher Dr. Stefan A. Müller-Lissner, a professor of internal medicine and gastroenterology at Humboldt University in Berlin, said in a statement. "This might be the reason why medical doctors often do not take it seriously. There are many unproven beliefs about constipation, but most of them are not tenable upon closer investigation with scientific methods."

For example, there is no evidence that disease can be caused by the absorption of poisonous substances from stools being absorbed by the colon, according to the report in the January issue of the American Journal of Gastroenterology.

Other common misconceptions are that an elongated colon can cause constipation, or that a low-fiber diet can cause constipation. Although some patients may be helped by a high-fiber diet, many who have severe constipation may get worse when fiber intake is increased, the researchers noted.

Moreover, unless you are dehydrated, increasing the amount of fluid you drink won't cure constipation, Müller-Lissner's team said.

Perhaps most interesting is the myth that laxatives can damage the colon. According to the researchers, "It is unlikely that stimulant laxatives at recommended doses are harmful to the colon."

Although some patients with chronic constipation are dependent on laxatives, this does not mean this is the result of continuous use of laxatives. "Tolerance to stimulant laxatives is uncommon. There is no indication for the occurrence of 'rebound constipation' after stopping laxative intake. While laxatives may be misused, there is no potential for addiction," the researchers wrote.

Moreover, laxatives do not increase the risk of colon cancer or nerve damage in the colon, the researchers said.

Among older patients, constipation may be present with decreased physical activity, but the decrease in activity is not the cause of constipation, the researchers added.

Given these facts, "patients may no longer be bothered by ineffective advice regarding fiber and fluid ingestion nor threatened by the side effects of laxatives," Müller-Lissner said. "Also, unnecessary colonic resections may be avoided."

According to the American College of Gastroenterology, there are 2.5 million doctor visits for constipation in the United States each year, and hundreds of millions of dollars are spent on laxatives annually.

"This is an important article," said Dr. Benjamin Krevsky, director of gastrointestinal endoscopy at Temple University School of Medicine in Philadelphia. "It is important because there are a lot of misconceptions about chronic constipation, both amongst doctors and patients."

Krevsky noted that fiber or fluid can be part of the treatment.

In terms of laxatives, Krevsky said that modern laxatives are both safe and effective. "The laxatives we have today are different than the laxatives we had in the '40s and '50s," he stressed.

"Probably in the '40s and '50s, there were people who did get injury to their bowel from the chronic use of laxatives. But the laxatives out there today are much safer and much less likely to do that," he said.

If you have constipation, see your doctor, Krevsky advised. "Work with your doctor to find a regimen that is going to be safe and healthy for you," he said.

Digestive Diseases Awareness

11 Digestive Disease Myths

Researchers have only recently begun to understand the many, often complex, diseases that affect the digestive system. Accordingly, people are gradually replacing folklore, old wives' tales, and rumors about the causes and treatments of digestive diseases with accurate, up-to-date information. But misunderstandings still exist, and, while some folklore is harmless, some can be dangerous if it keeps a person from correctly preventing or treating an illness. Listed below are some common misconceptions (fallacies), about digestive diseases, followed by the facts as professionals understand them today.

Myth # 1: Crohn's disease is contagious.

False

Crohn's disease is not contagious. The cause of Crohn's disease is unknown. Some scientists suspect that infection by certain bacteria, such as strains of mycobacterium, may be the cause of Crohn's disease. To date, however, there has been no convincing evidence that the disease is caused by infection. Although diet may affect the symptoms in patients with Crohn's disease, it is unlikely that diet is responsible for the disease.

Myth # 2: Inflammatory bowel disease is caused by psychological problems.

False

Inflammatory bowel disease is the general name for two diseases that cause inflammation in the intestines, Crohn's disease and ulcerative colitis. The cause of the disease is unknown, but researchers speculate that it may be a virus or bacteria interacting with the body's immune system. There is no evidence to support the theory that inflammatory bowel disease is caused by tension, anxiety, or other psychological factors or disorders.

Myth # 3: Spicy food and stress cause stomach ulcers.

False

The truth is, almost all stomach ulcers are caused either by infection with a bacterium called Helicobacter pylori (H. pylori) or by use of pain medications such as aspirin, ibuprofen, or naproxen, the so-called nonsteroidal anti-inflammatory drugs (NSAIDs). Most H. pylori-related ulcers can be cured with antibiotics. NSAID-induced ulcers can be cured with time, stomach-protective medications, antacids, and avoidance of NSAIDs. Spicy food and stress may aggravate ulcer symptoms in some people, but they do not cause ulcers.

Myth # 4: Smoking a cigarette helps relieve heartburn.

False

Actually, cigarette smoking contributes to heartburn. Heartburn occurs when the lower esophageal sphincter (LES)-a muscle between the esophagus and stomach-relaxes, allowing the acidic contents of the stomach to splash back into the esophagus. Cigarette smoking causes the LES to relax.

Myth # 5: Bowel regularity means a bowel movement every day.

False

The frequency of bowel movements among normal, healthy people varies from three a day to three a week, and perfectly healthy people may fall outside both ends of this range.

Myth # 6: Habitual use of enemas to treat constipation is harmless.

False

The truth is, habitual use of enemas is not harmless. Over time, enemas can impair the natural muscle action of the intestines, leaving them unable to function normally. An ongoing need for enemas is not normal; you should see a doctor if you find yourself relying on them or any other medication to have a bowel movement.

Myth # 7: Celiac disease is a rare childhood disease.

False

Celiac disease affects children and adults. At least 1 in 1,000 people and, in some populations, 1 in 200 people have celiac disease. Most often, celiac disease first causes symptoms during childhood, usually diarrhea, growth failure, and failure to thrive. But the disease can also first cause symptoms in adults. These symptoms may be vague and therefore attributed to other conditions. Symptoms can include bloating, diarrhea, abdominal pain, skin rash, anemia, and thinning of the bones (osteoporosis). Celiac disease may cause such nonspecific symptoms for several years before being correctly diagnosed and treated.

People with celiac disease should not eat any foods containing gluten, a protein in wheat, rye, barley, and possibly oats, regardless of whether or not they have symptoms. In these people, gluten destroys part of the lining of the small intestine, which interferes with the absorption of nutrients. The damage can occur from even a small amount of gluten, and not everyone has symptoms of damage.

Myth # 8: Diverticulosis is an uncommon and serious problem.

False

Actually, the majority of Americans over age 60 have diverticulosis, but only a small percentage have symptoms or complications. Diverticulosis is a condition in which little sacs-or out-pouchings-called diverticula, develop in the wall of the colon. These tend to appear and increase in number with age. Most people do not have symptoms and would not know that they had diverticula unless x-ray or intestinal examination were done. Less than 10 percent of people with diverticulosis ever develop complications such as infection (diverticulitis), bleeding, or perforation of the colon.