Health Care and Constipation

Constipation is one of those topics few like to talk about, according to WebMD.com. If you've suffered from this problem, though, you know it can be both painful and frustrating. Almost everyone gets constipated at some time during his or her life. It affects approximately 2% of the population in the U.S. Women and the elderly are more commonly affected. Though not usually serious, constipation can be a concern. Constipation occurs when bowel movements become difficult or less frequent. The normal length of time between bowel movements ranges widely from person to person.

According to WebMD, some people have bowel movements three times a day; others, only one or two times a week. Going longer than three days without a bowel movement is too long. After three days, the stool or feces become harder and more difficult to pass. You are considered constipated if you have two or more of the following for at least 3 months:
--Straining during a bowel movement more than 25% of the time.
--Hard stools more than 25% of the time.
--Incomplete evacuation more than 25% of the time.
--Two or fewer bowel movements in a week.

What's considered normal frequency for bowel movements varies widely, according to MayoClinic.com. In general, however, you're probably experiencing constipation if you pass fewer than three stools a week, and your stools are hard and dry. Fortunately, most cases of constipation are temporary. Simple lifestyle changes, such as getting more exercise and eating a high-fiber diet, can go a long way toward alleviating constipation. Constipation may also be treated with over-the-counter laxatives.

According to the Mayo Clinic, although constipation may be bothersome, it is usually not serious. Most people who have constipation don't seek a doctor's care. However, chronic constipation may lead to complications or be a symptom of a serious underlying disorder. See your doctor if you experience an unexplained onset of constipation or change in bowel habits, or if symptoms are severe and last longer than three weeks. Also seek medical care if you experience any of the following signs or symptoms, which might indicate a more serious health problem:
--Bowel movements occurring more than three days apart, despite corrective changes in diet or exercise.
--Intense abdominal pain.
--Blood in your stool.
--Constipation that alternates with diarrhea.
--Rectal pain .
--Thin, pencil-like stools.
--Unexplained weight loss.

According to WebMD, constipation is usually caused by a disorder of bowel function rather than a structural problem. Common causes of constipation include:
--Inadequate water intake.
--Inadequate fiber in the diet.
--A disruption of regular diet or routine; traveling.
--Inadequate activity or exercise or immobility.
--Eating large amounts of dairy products.
--Stress.
--Resisting the urge to have a bowel movement, which is sometimes the result of pain from hemorrhoids.
--Overuse of laxatives (stool softeners) which, over time, weaken the bowel muscles.
--Hypothyroidism.
--Neurological conditions such as Parkinson's disease or multiple sclerosis.
--Antacid medicines containing calcium or aluminum.
--Medicines (especially strong pain medicines, such as narcotics, antidepressants, or iron pills).
--Depression.
--Eating disorders.
--Irritable bowel syndrome.
--Pregnancy.
--Colon cancer.
In some cases, lack of good nerve and muscle function in the bowel may also be a cause of constipation.

According to FamilyDoctor.org, there are ways to help prevent constipation by observing certain diet options. Eat plenty of fiber. At least 2 cups of fruits and 2 1/2 cups of vegetables per day is recommended. It is suggested that men age 50 and younger consume at least 38 grams of fiber per day, while women age 50 and younger should consume at least 25 grams per day. Add extra fiber to your diet by eating cereals that contain bran or by adding bran as a topping on your fruit or cereal. If you are adding fiber to your diet, start slowly and gradually increase the amount. This will help reduce gas and bloating. Make sure to drink plenty of water, also. You may have to retrain your body to go without laxatives or enemas if you've been using them for a long period of time. This means eating plenty of fiber, possibly using a bulk-forming laxative, drinking plenty of water, exercising and learning to give yourself time to have a bowel movement. If you've used laxatives and enemas for a long time, your family doctor may suggest that you gradually reduce the use of them to give your body a chance to return to normal. Be patient because it may take many months for your bowels to get back to normal if you've been using laxatives or enemas regularly. Talk with your family doctor about any concerns you have. Additionally, more info can be found at http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/.

According to MedicineNet.com, The goal of treatment in constipation should not be a bowel movement every day, but a bowel movement every two to three days without difficulty (without straining). Start with the simple things.
--Don't suppress urges to defecate. When the urge comes, find a toilet.
--With the assistance of your physician and pharmacist, determine if there are drugs that you are taking that could be contributing to the constipation. See if the drugs can be discontinued or changed.
--Increase the fiber in your diet by consuming more fruits, vegetables, and whole grains. (There are other health benefits from this recommendation as well.)
--It may be difficult to get enough fiber in the diet to effectively treat constipation, so don't hesitate to take fiber supplements if necessary (wheat bran, psyllium, etc.).
--Use increasing amounts of fiber and/or change the type of fiber consumed until there is a satisfactory result.
--Don't expect fiber to work overnight. Allow weeks for adequate trials.

What if constipation does not respond to these simple, safe measures? According to MedicineNet, these efforts should not be discontinued but other measures should be added. If the constipation is infrequent, that is, every few weeks (as it can be when due to the menstrual cycle), it probably doesn't matter what other measures are added-emollient, saline, or hyper-osmolar laxatives, enemas, and suppositories. Even stimulant laxatives every four to six weeks are unlikely to damage the colon. Unfortunately, the tendency when using stimulant laxatives is to unconsciously increase the frequency of their use. Before you know it, you're taking them every week, or more often, and permanent damage might result. If constipation is a continuous rather than an intermittent problem, probably the safest laxatives to take on a regular basis are the hyper-osmolar laxatives. They require a prescription and, therefore, necessitate a call to a physician. As with fiber, increasing doses of different hyper-osmolar laxatives should be tried over several weeks until a satisfactory type and dose of laxative is found. Hyper-osmolar laxatives, however, can be expensive. Milk of magnesia is the mildest of the saline laxatives, is inexpensive, and provides a good alternative. Most patients can adjust the dose of milk of magnesia to soften the stool adequately without developing diarrhea or leakage of stool.

According to MedicineNet, prunes and prune juice have been used for many years to treat mild constipation. There is no evidence that the mild stimulant effects of prunes or prune juice damage the colon. Stronger stimulant laxatives usually are recommended only as a last resort after non-stimulant treatments have failed. Many people take herbs to treat their constipation because they feel more comfortable using a "natural" product. Unfortunately, most of these herbal preparations contain stimulant laxatives and their long term use raises the possibility that they also may damage the colon. Each part of the intestine (stomach, small intestine, and colon) has a network of nerves that controls its muscles. A great deal of research is being done in order to gain an understanding of how these nerves control each other and ultimately the muscles. Much of this research involves the study of neurotransmitters. (Neurotransmitters are chemicals that nerves use to communicate with each other.) This research is allowing scientists to develop drugs that stimulate (and inhibit) the various nerves of the colon which, in turn, cause the muscles of the colon to contract and propel the colonic contents. Such drugs have great potential for the treatment of constipation that is due to colonic inertia. The first of these drugs is in clinical trials and is likely to be available soon. These drugs are an exciting development because they offer a new treatment for a difficult-to-treat form of constipation.

If a primary doctor is not comfortable performing the evaluation or does not have confidence in doing an evaluation, he or she should refer the patient to a specialist. Gastroenterologists evaluate constipation frequently and are very familiar with the diagnostic testing described previously. If you are suffering from an ongoing and long term problem with constipation, please see your doctor instead of using home remedies.

Until next time. Let me know what you think.