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This page is a Constipation Compendium  What is it ?  Causes,  Treatment, Old myths,   Medications, Diagnostic Tests, Research, Hope, Who Gets it. , More information, noitapitsnoc, irritable bowel syndrome, hard faeces. laxitives, intestinal function, chronic idopathic constipation, colon and rectal problems, anal sphincter, digestive diseases, treatment, research, myths, suppositories, enemas, colon cleansing, bulk agents,  medications, habits, regular exercise, bran and other medical helpers.
What is Constipation?

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  Constipation Myths?

Constipation, Dispelling the Myths

Related MedicineNet Links

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

By Steven Reinberg
HealthDay Reporter

Constipation

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.

What causes constipation?

To understand constipation, it helps to know how the colon (large intestine) works. As food moves through the colon, it absorbs water while forming waste products, or stool. Muscle contractions in the colon push the stool toward the rectum. By the time stool reaches the rectum, it is solid because most of the water has been absorbed.

The hard and dry stools of constipation occur when the colon absorbs too much water or if the colon's muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly. Common causes of constipation are

  • not enough fiber in the diet
  • not enough liquids
  • lack of exercise
  • medications
  • irritable bowel syndrome
  • changes in life or routine such as pregnancy, older age, and travel
  • abuse of laxatives
  • ignoring the urge to have a bowel movement
  • specific diseases such as stroke (by far the most common)
  • problems with the colon and rectum
  • problems with intestinal function (chronic idiopathic constipation)

Not Enough Fiber in the Diet

The most common cause of constipation is a diet low in fiber found in vegetables, fruits, and whole grains and high in fats found in cheese, eggs, and meats. People who eat plenty of high-fiber foods are less likely to become constipated.

Fiber--both soluble and insoluble--is the part of fruits, vegetables, and grains that the body cannot digest. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Insoluble fiber passes through the intestines almost unchanged. The bulk and soft texture of fiber help prevent hard, dry stools that are difficult to pass.

According to the National Center for Health Statistics, Americans eat an average of 5 to 14 grams of fiber daily,* short of the 20 to 35 grams recommended by the American Dietetic Association. Both children and adults eat too many refined and processed foods from which the natural fiber has been removed.

A low-fiber diet also plays a key role in constipation among older adults, who may lose interest in eating and choose convenience foods low in fiber. In addition, difficulties with chewing or swallowing may force older people to eat soft foods that are processed and low in fiber.

*National Center for Health Statistics. Dietary Intake of Macronutrients, Micronutrients, and Other Dietary Constituents: United States, 1988-94. Vital and Health Statistics, Series 11, number 245. July 2002.

Not Enough Liquids

Liquids like water and juice add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass. People who have problems with constipation should drink enough of these liquids every day, about eight 8-ounce glasses. Liquids that contain caffeine, like coffee and cola drinks, and alcohol have a dehydrating effect.

Lack of Exercise

Lack of exercise can lead to constipation, although doctors do not know precisely why. For example, constipation often occurs after an accident or during an illness when one must stay in bed and cannot exercise.

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 Constipation  Medications.

Medications

Some medications can cause constipation. They include

  • pain medications (especially narcotics)
  • antacids that contain aluminum and calcium
  • blood pressure medications (calcium channel blockers)
  • antiparkinson drugs
  • antispasmodics
  • antidepressants
  • iron supplements
  • diuretics
  • anticonvulsants

Medications: A frequently over-looked cause of constipation is medications.
 The most common offending medications include:

  • Narcotic pain medications such as codeine (e.g., Tylenol #3), oxycodone (e.g., Percocet), and hydromorphone (Dilaudid);
  • Antidepressants such as amitriptylene (Elavil) and imipramine (Tofranil)
  • Anticonvulsants such as phenytoin (Dilantin) and carbamazepine (Tegretol)
  • Iron supplements
  • Calcium channel blocking drugs such as diltiazem (Cardizem) and nifedipine (Procardia)
  • Aluminum-containing antacids such as Amphojel and Basaljel
  •  
  • In addition to the medications listed above, there are many others that can cause constipation. Simple measures (e.g., increasing dietary fiber) for treating the constipation caused by medications often are effective, and discontinuing the medication is not necessary. If simple measures don't work, it may be possible to substitute a less constipating medication. For example, a non-steroidal anti-inflammatory drug (e.g., ibuprofen) may be substituted for narcotic pain medications. Additionally, one of the newer and less constipating anti-depressant medications (e.g., fluoxetine or Prozac) may be substituted for amitriptylene and imipramine.
 Constipation Treatments

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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Habit: Bowel movements are under voluntary control. This means that the normal urge people feel when they need to have a bowel movement can be suppressed. Although occasionally it is appropriate to suppress an urge to defecate (e.g., when a bathroom is not available), doing this too frequently can lead to a disappearance of urges and result in constipation.

Diet: Fiber is important in maintaining a soft, bulky stool. Diets that are low in fiber can, therefore, cause constipation. The best natural sources of fiber are fruits, vegetables, and whole grains.

Laxatives: One suspected cause of severe constipation is the over-use of stimulant laxatives (e.g., senna, castor oil, and certain herbs). An association has been shown between the chronic use of stimulanat laxatives and damage to the nerves and muscles of the colon, and it is believed that the damage is responsible for the constipation.  It is not clear, however, whether the laxatives have caused the damage or whether the damage existed prior to the use of laxatives and, indeed, has caused the laxatives to be used.  Nevertheless, because of the possibility that stimulant laxatives can damage the colon, most experts recommend that stimulant laxatives be used as a last resort after non-stimulant treatments have failed.

Hormonal disorders: Hormones can affect bowel movements. For example, too little thyroid hormone (hypothyroidism) and too much parathyroid hormone (by raising the calcium levels in the blood) can cause constipation. At the time of a woman's menstrual periods, estrogen and progesterone levels are high and may cause constipation. However, this is rarely a prolonged problem. High levels of estrogen and progesterone during pregnancy also can cause constipation.

Diseases that affect the colon: There are many diseases that can affect the function of the muscles and/or nerves of the colon. These include diabetes, scleroderma, intestinal pseudo-obstruction, Hirschsprung's disease, and Chagas disease. Cancer or narrowing (stricture) of the colon that blocks the colon likewise can cause a decrease in the flow of stool.

Central nervous system diseases: A few diseases of the brain and spinal cord may cause constipation, including Parkinson's disease, multiple sclerosis, and spinal cord injuries.

Colonic inertia: Colonic inertia is a condition in which the nerves and/or muscles of the colon do not work normally. As a result, the contents of the colon are not propelled through the colon normally. The cause of colonic inertia is unclear. In some cases, the muscles or nerves of the colon are diseased. Colonic inertia can also be the result of the chronic use of stimulant laxatives. In most cases, however, there is no clear cause.

Pelvic floor dysfunction: Pelvic floor dysfunction (also known as outlet obstruction or outlet delay) refers to a condition in which the muscles of the lower pelvis that surround the rectum (the pelvic floor muscles) do not work normally. These muscles are critical for defecation (bowel movement). It is not known why these muscles fail to work properly in some people, but they can make the passage of stools difficult even when everything else is normal.

For More Information

International Foundation for Functional Gastrointestinal Disorders Inc.
P.O. Box 170864
Milwaukee, WI 53217
Phone: 1-888-964-2001 or (414) 964-1799
Fax: (414) 964-7176
Email: iffgd@iffgd.org
Internet: www.iffgd.org

American Gastroenterological Association
National Office
4930 Del Ray Avenue
Bethesda, MD 20814
Phone: (301) 654-2055
Fax: (301) 654-5920
Email: info@gastro.org or webmaster@gastro.org
Internet: www.gastro.org

 

Can constipation be serious?

Sometimes constipation can lead to complications. These complications include hemorrhoids caused by straining to have a bowel movement or anal fissures (tears in the skin around the anus) caused when hard stool stretches the sphincter muscle. As a result, rectal bleeding may occur, appearing as bright red streaks on the surface of the stool. Treatment for hemorrhoids may include warm tub baths, ice packs, and application of a special cream to the affected area. Treatment for anal fissure may include stretching the sphincter muscle or surgical removal of tissue or skin in the affected area.

Sometimes straining causes a small amount of intestinal lining to push out from the anal opening. This condition, known as rectal prolapse, may lead to secretion of mucus from the anus. Usually eliminating the cause of the prolapse, such as straining or coughing, is the only treatment necessary. Severe or chronic prolapse requires surgery to strengthen and tighten the anal sphincter muscle or to repair the prolapsed lining.

Constipation may also cause hard stool to pack the intestine and rectum so tightly that the normal pushing action of the colon is not enough to expel the stool. This condition, called fecal impaction, occurs most often in children and older adults. An impaction can be softened with mineral oil taken by mouth and by an enema. After softening the impaction, the doctor may break up and remove part of the hardened stool by inserting one or two fingers into the anus.

Have You Had Your Bowel Movement Today?
By: Dr. Edward F. Group III, DC, ND, Ph.D, DACBN

Many people are under the impression that they only need to have one bowel movement a week or less. Bowel disease, constipation, colon cancer, and stomach pain are all disorders that are leading to what I call the “Silent Killer in America.” Colon health and colon problems are the most over-looked health problems in today’s society. Due to the poor diet in America, 200 million people suffer from constipation and do not have the required two to four bowel movements daily. The average person, by the time they are 30 years old, in America, has between 10 to 15 pounds of hard compacted fecal matter in their bowel.

The intestinal tract is composed of the small intestine which is attached to the lower part of the stomach then moves into the large intestine and finally the colon. Whatever you eat has to be properly digested and then move its way through a long, approximately 35 feet in length, intestinal lining to finally exit the rectum. So don’t you think the most important area to keep clean in your body would be that 35 feet of food storage wasteland?

Constipation & Bowel Movements

It is time that people realize how the digestive track breaks down food into smaller particles and then ultimately into the vitamins, minerals and nutrients that you need to survive. As we age we develop a thick coating that is hard as wood and which literally sticks to the sides of our intestinal walls. When this coating adheres to the walls of your intestinal lining and your food then moves through, it is hard for your body to absorb the proper nutrients that it needs into the bloodstream so the blood can then in turn carry these vital nutrients to all the organs and tissues in your body. This is why it is essential to not only clean the colon but to purify and keep the whole intestinal lining clean at all times and free from any plaque or debris. You must have a minimum of one bowel movement a day---actually, we recommend two a day.

After years of research and studying bowel habits, constipation and different bowel disease we have found that keeping the bowel clean will not only reduce or prevent most types of disease but will also eliminate chronic bloating, symptoms of fatigue, headaches, nausea and a whole list of other symptoms. We recommend and use a product called Oxy-Powder that will focus on cleansing and keeping clean your whole intestinal tract. By using Oxy-Powder every other evening you can ensure that you will have regular bowel movements and keep your intestinal lining clean and functioning properly. You must have regular bowel movements to prevent toxic chemicals from leaking through the walls of the intestinal tract into the blood. I also recommend drinking at least 64 ounces of purified water daily to help the intestinal tract move the toxic residue out of the body.

Constipation is a sneaky, undiagnosed, disabling epidemic that is sweeping America as we speak. Perhaps all of this doesn’t surprise you. Let’s take a look at the following categories of disease and disorders that can be related either directly or indirectly to the colon and constipation: heart disease, high blood pressure, fatigue, irritability, varicose veins, gas, heart burn, bloating, obesity, diabetes, arthritis and more. Some of these side effects or symptoms are a hundred times worse than the constipation itself. So if your doctor is treating you with traditional drugs or surgery he is most likely covering up your symptoms and possibly making your condition worse.

I recommend the following to ensure a healthy clean colon, easily and naturally without any drugs, surgery or toxic side effects: a good diet, lots of live foods, a lot of pure water, the product Oxy-Powder and exercise.

What Your Doctor Doesn't Know About Constipation
By: Dr. Edward F. Group III

I have decided to break the silence and reveal the truth about constipation that most doctors don't want you to know!

You see, what's so dangerous about being constipated is that it’s not an injury like a broken bone or a cut or scrap. Constipation comes on slowly. You don't notice it at first, or maybe you just brush off not going to the bathroom thinking it's nothing, and then it slowly builds and builds. You start feeling heavy, sick and bloated. You become more irritable. You start taking pills or laxatives to get through the day, or you call in sick to work.

If you were to go to your family or company doctor complaining about fatigue, weight gain, Hemorrhoids, gas, body odor, skin problems, headaches, indigestion, depression, even abdominal pains, you'll probably hear something along the lines of…"You are probably constipated. Here are some laxatives. Come back if that doesn't take care of it."

The Constipation Alarm

This is a blaring alarm that your doctor may not be the person to talk to. You see, most doctors do great with general medicine. If you have broken bones, or need emergency care, medical science can do wonders! But when it comes to a condition like a clogged bowel, many doctors just don’t have the training or experience to properly treat the true cause of your problem and get you relieved for good.

The main problem with the kind of treatments many doctors give for conditions like constipation or colon cleansing is that they never go after the root of the problem, but focus on the symptoms, in your case; abdominal pain, not going to the bathroom in 2-4 days and other irritating symptoms. And when these treatments wear off (which they do), you'll often find they only cover up the real problem for a short time and did nothing to fix what's causing your constipation in the first place.

The Effects of Constipation

Constipation has been implicated in the cause of numerous diseases and disorders including:

Appendicitis (One of the most common abdominal emergencies here in the U.S. It has been estimated that more than 300,000 appendices are removed each year in this country), Diverticulitis/Diverticulosis, Hemorrhoids, Benign Tumors, IBS (including Spastic Colon), Ulcerative Colitis, and Crohn's disease.

And that's not all...

Perhaps this doesn't surprise you. But take a look at the following categories of diseases and disorders that can also be related either directly or indirectly to the colon: Heart Disease, High Blood Pressure, Stroke, Varicose Veins, Deep Vein Thrombosis, Pulmonary Embolism, Diabetes, Gall Stones, Kidney Stones, Obesity, Gout, Rheumatoid Arthritis, Multiple Sclerosis, Psoriasis, — Especially Diabetes Mellitus, type II—"adult onset diabetes"; It has been estimated that 3-10% of the population eventually develop known diabetes and that a much greater proportion have the disease undetected.

If you're suffering from constipation, and you don't want to get worse, then there is hope for you to get rid of your impacted bowel once and for all! There are many ways to clean a bowel and keep it moving effectively. We use a natural oxygen based cleanser called Oxy-Powder in conjunction with exercise, water and live foods and fiber.

Constipation Information
Article provided by the National Digestive Diseases Information Clearinghouse

Constipation Information

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.

 constipation information

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.
 

Constipation and Colon Cleansing

 
constipation

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Constipation: A Guide for Patients

James A. Clifton Center for Digestive Diseases
University of Iowa Hospitals and Clinics
Peer Review Status: Internally Peer Reviewed
First Published: November 1994
Last Revised: November 1994

The use of trademark names does not constitute endorsement by the University of lowa Hospitals and Clinics.

Constipation is a symptom, not a disease. It is frequently caused by a disturbance of how the colon works. The normal functions of the colon are to:

  • Remove water from the waste material that passes from the small intestine into the colon,
  • Serve as a storage area for waste material, and
  • Help move and expel stool from the body.

Constipation may occur because:

  • Too much water is removed by the colon, causing dry or hard stools,
  • Stool moves too slowly through the colon, or
  • The patient is unable to expel stools.

Normal bowel habits among healthy people vary greatly from three times a day to three times a week. In some individuals, constipation may refer to infrequent bowel movements (less than 3 per week). While troublesome, constipation is usually not serious. It should be treated and corrected to reduce abdominal discomfort and other related symptoms and to prevent the development of complications. Untreated chronic constipation may lead to or aggravate more serious problems such as hemorrhoids or fecal impaction (partial blockage due to hard stool).

Measures to Treat Constipation
The goal of treatment is to reestablish normal bowel habits without the use of laxatives or enemas. The treatment measures listed below are explain in more detail in the following paragraphs.

  • Eat a diet high in roughage (fiber).
  • Eat regular meals; it is especially important to have breakfast.
  • Take bulking agent with meals and follow with a full glass of water. Begin with:
    • 1-2 tablespoons millers bran 3 times a day or
    • 1-2 heaping teaspoons Metamucil 3 times a day
  • Do not take harsh (stimulant) laxatives except as directed.
  • Establish regular daily bowel habits; DO NOT ignore the urge to have a bowel movement.
  • Allow 15 minutes after breakfast to sit on the toilet - do not strain.
  • If there has been no bowel movement after 48 hours, take 1 or 2 tablespoons Milk of Magnesia at bedtime. If unsuccessful, the dose may be increased the next evening.
  • If no bowel movement occurs after 3 days, use a glycerin suppository or, if necessary, you may take a small tap water enema.
  • Exercise daily.
  • Whenever possible, avoid medications that contribute to constipation. DO NOT stop taking any prescribed medications unless approved to do so by your physician.

Proper Diet
The first treatment for constipation is to eat a high fiber diet to provide natural bulk in your daily food intake. Dietary fiber, often called roughage, is a portion of food that passes through the intestine and colon almost unchanged. Undigested fiber holds water to keep the stool soft and adds bulk which helps move stool to the rectum. Most Americans eat very little roughage and this is often a major factor in the cause of constipation. An increase in dietary fiber generally results in a softer and bulkier stool which can be passed more easily. Ask to see a dietitian for complete instructions.

Bulk Agents
Bulk agents are very useful in addition to dietary fiber to restore and maintain regularity. These include bran and psyllium.

Bran
Unprocessed bran, known as "millers bran," can be purchased at a health food store as an inexpensive source of fiber. Bran is the outer coating or shell on grain which is removed during processing white flour. It has very little taste. Wheat, oats, and brown rice are common sources of bran. One tablespoon of raw bran contains approximately 2 grams of dietary fiber. This may be used to supplement the fiber content of your diet.

Start with one or two tablespoons of bran in a glass of juice or water and gradually increase to three times a day with meals. If you prefer, it may be sprinkled on cereals or included in bran muffins, hamburgers, etc. Start slowly to allow your digestive system a chance to get used to increased fiber. Gradually increase the amount as necessary to achieve desired results. Bran tablets are also available - one tablet equals approximately 2 grams dietary fiber. Drink a full 8-oz glass of water with the tablets. You will find both fine bran and coarse bran available. Purchase the coarse bran because it holds water better.

With an increase in dietary fiber or the addition of bran to your diet, you may notice a temporary increase in bloating, fullness, abdominal cramps and gas. DO NOT STOP USING THE BRAN! Symptoms will lessen as bowel habits improve and usually disappear within 2-3 weeks. If discomfort is significant, it may be necessary to temporarily reduce your amount of fiber intake, then again gradually increase it as your body usually adjusts to the additional fiber. Do not give up if success is not achieved immediately.

Bran will not have any effect on stool already in the colon. It must mix with food in order to absorb water and increase stool volume. Depending on how long you have had constipation, improvement may take a few days to several months. Sometimes it is helpful to empty the bowel with a laxative before starting the high fiber and bran diet.

Commercial Bulk Agents
Commercial bulk products provide natural or synthetic fiber which softens the stool, increases the bulk and makes the stool easier to pass.

Psyllium is a natural dietary fiber made from ground husks of psyllium seed, which has the ability to hold water and form bulk. Psyllium holds water better than bran, so smaller amounts are needed to be effective. Metamucil, Effer-Syllium, Perdieum Fiber and Fiberall powder or wafers are brands of psyllium.

Synthetic or man-made bulk forming products such as Citrucel or Fiberall Chewable Tablets are similar to psyllium. They work the same way and may cause less gas. Many pharmacies sell generic brands of bulk agents which are less costly.

Begin by taking 1 or 2 rounded teaspoonfuls of powder 2 or 3 times a day with meals. These agents are very safe and if you are not getting desired results, you should increase the daily dose. Mix rapidly with water or juice and drink immediately; followed by drinking a large glass of fluid. If preferred, fiber wafers may be used. The wafers should also be eaten with 8 ounces of your favorite beverage and, for best results, followed by another glass of liquid. Start with 2 wafers a day and increase to 2 wafers 3 times a day. Again, it may be a few days to several months before the desired effects are seen. Some of the recommended bulk agents are listed below - note the difference in dosage.

Each dose listed is equal to approximately 3.4 grams of psyllium and may be taken 1-3 times a day.
 

Type

Dosage

Powder
Citrucel, orange flavor 1 level tablespoon
Citrucel, sugar free 1 heaping tablespoon
Effer-Syllium 1 rounded teaspoon
Fiberall Powder 1 rounded teaspoon
Metamucil, sugar free 1 rounded teaspooon
Metamucil, regular flavor 1 rounded teaspooon
Metamucil, orange/strawberry 1 rounded tablespoon
Granules
Perdiem Fiber Granules 1 rounded teaspoon
Serutan Toasted Granules (chewable) 2 level teaspoons
Wafers
Fiberall Wafers 1 wafer
Metamucil Fiber Wafers 2 wafers
Tablets  
Fiberall Chewable Tablets 1 tablet
Fiber Con 2 tablets

 

It is important to be aware that harsh stimulant laxatives are sometimes added to bulking agents. These are harmful to take regularly and should be avoided. You must ask your pharmacist if you are not sure a harsh laxative is included in the product you are using.

Some individuals experience increased difficulty with gas and bloating when they use these products. This becomes less of a problem when bowel habits improve. So as with natural fiber, do not give up if success does not occur immediately. Once the need for bulk agents has been established, use should continue indefinitely unless bulking agents are replaced by equal amounts of natural fiber in the daily diet.

Adequate Fluid Intake
It is especially important to drink fluids with any bulking agent; either bran or the psyllium products. Drink at least eight (8 ounce) glasses each day, including one glass before each meal. However, fluids alone will not promote normal bowel function because the small intestine can absorb all of this fluid. A high fluid intake without a high dietary fiber and bulk intake will only result in increased urination.

Use of Suppositories and Enemas
Avoid all harsh (stimulant) laxatives that contain cascara, senna and castor oil. Some of these products include Ex-Lax, Correctol, Carter's Little Pills, Perdiem, Dulcolax, Peri-Colace, and Feen-A-Mint. Prolonged daily use of these agents can be habit-forming and may damage your bowel.

A glycerin suppository may be used during the retraining period to stimulate the urge to have a bowel movement. Glycerin suppositories inserted into the rectum provide a mild irritant to help pass the stool. You should gradually decrease this practice until you no longer need it.

Sometimes the above measures alone are not effective and a laxative may be required. If a laxative is necessary, it is best to use one such as Milk of Magnesia. Other magnesium products may be recommended by your physician. These are effective, inexpensive and safe. They may be taken as needed or even regularly without fear of becoming dependent on a laxative. When using Milk of Magnesia, start with 2 tablespoons (30 ml) by mouth in the evening. Results from the laxative are likely to occur the following morning. It is very important to measure the dose carefully. Too little may not work, too much may cause watery diarrhea. You will need to experiment to find the right dose. For example, if 2 tablespoons do not work, increase the dose to 3. If 3 tablespoons cause diarrhea, try 2 tablespoons plus 1 teaspoon. It takes time and patience to find the right dose. By trial and error one can find the right amount to take, but it may take several weeks.

If you don't have a bowel movement for 3 days after beginning the retraining program, you may use a single 250 cc (one cup) enema. If an enema is necessary, use either lukewarm tap water or a mixture of one half (1/2) teaspoon salt to one pint of warm water. We recommend that you consult a physician before continuing the use of enemas.

Medications
Some medications slow the movements of the colon and may cause constipation or make it worse. Medicines that you can buy in the drugstore without a prescription that should be avoided include: antacids containing aluminum hydroxide (for example Amphogel, Alternagel) or bismuth (for example, Pepto Bismol), antihistamines (for example, Benadryl, Dristan, Chlor-Trimeton) and iron. When buying medicine off the shelf in the drugstore, ask your pharmacist for help in choosing a drug that does not make constipation worse. It is important to discuss your medications with your physician as there are a number of prescription drugs that may cause constipation. Do not stop taking any prescribed medications without approval from your physician.

Habits
It is extremely important to have regular habits to reestablish normal bowel function. Establish a regular routine based on your own schedule. Try to have a bowel movement at the same time every day. The activity of the colon increases after waking up in the morning and after eating, so the urge to have a bowel movement is usually greatest after breakfast. Get up early enough in the morning to eat breakfast, exercise, and sit on the toilet. This should become a daily routine.

Promptly obey all urges to have a bowel movement - do not delay or postpone a visit to the bathroom as the urge will disappear. Repeated ignoring of an urge will change your normal sensation in the rectum and can lead to constipation.

The squatting position is the best for having a bowel movement. Elevate your feet on a footstool in front of the toilet or bend forward so that your abdomen rests against your thighs.

Avoid excessive straining. If you feel stool in the rectum but can't expel it, you may find it helpful to apply external pressure by pushing with your hand placed in front of the rectum or just behind the rectum.

Whenever possible, plan in advance for changes in your daily routine. Constipation often occurs during travel, vacation or stressful situations. Take bulk agents and glycerin suppositories with you in case you need them.

Regular Exercise
Exercise increases muscle movements of the colon and promotes normal bowel habits.
What is Constipation. 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. Caused by a lack of fibre in the diet (fibre holds water, preventing the faeces becoming too hard).

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