Constipation

What is constipation?
Constipation is defined as infrequent bowel movements, hard to pass stools or straining during bowel movements that is troubling to the individual.  Frequency of bowel movements among healthy people varies widely from three bowel movements each day to three bowel movements a week.

What causes constipation?
Many factors can lead to constipation including a diet that is low in fiber, inadequate fluid intake, low levels of physical activity, medications, and poor bowel habits.  Medical problems that can cause constipation include diabetes, hypothyroidism, neurologic and connective tissue disorders, and colorectal cancer.  Alterations in bowel motility or the coordination of the muscles involved in having a bowel movement can also cause constipation.

What are the signs and symptoms of constipation?

• Passing stool fewer than 3 times per week
• Abdominal bloating or discomfort
• Straining frequently during bowel movements
• A sensation of incomplete bowel movements
• Having to apply manual pressure to have a bowel movement.

How is constipation diagnosed?
Diagnosing the cause for constipation often requires a medical history and  physical exam. Your doctor will determine if an underlying disorder is causing constipation, and treatment will be directed toward the specific causes.

What are the treatment options?
For many people, lifestyle and dietary changes are all that are needed to relieve constipation.

• Dietary: Choose foods that are high in fiber including fruits and vegetables, beans and high fiber cereals and breads.  Make sure you drink plenty of non-caffeinated beverages.
• Bowel Habits: Sufficient time should be set aside to allow for undisturbed visits to the bathroom. This is often most productive after breakfast.  The urge to have a bowel movement should not be ignored
• Increase physical activity: Try to exercise regularly, including actives such as walking, biking, or swimming

Along with lifestyle changes your doctor may recommend other treatment options including:

• Fiber supplements: Metamucil®, Konsyl® or Citrucel® are natural supplements that help make stools softer and are safe to use every day.
• Laxatives:  Laxative is a general term for medications that can promote bowel movements.  Some work by stimulating the bowel or rectum while others change the consistency of the stool. An example includes Miralax® which works by drawing water into the colon.  Some patients require combinations of medications for their type of constipation.
• Medical Tests:  A colonoscopy, a motility study, or even special tests to look at the muscles involved in having a bowel movement may be indicated. 
• Biofeedback or Surgery:  Rarely, patients with pelvic muscle abnormalities may require biofeedback or surgery.

When to seek medical Advice:
You should contact your doctor if you experience an unexplained change in bowel habits or if you have any of the following signs and/or symptoms:

• Pain and straining with bowel movement that does not improve with diet and lifestyle  changes
• Blood in your stool
• Rectal pain
• Constipation that alternates with diarrhea
• Thin-pencil like stools
• Unexplained weight loss
• Tissue protruding from the rectum when you bear down.

Additional Resources:
American Gastroenterological Association www.gastro.org