I think I may be constipated – How do I know?

shutterstock_136335587Constipation is a common condition that I see in the clinic.  It’s a topic that few people enjoy talking about but is very common.  In fact, almost everyone gets constipated at some time during his or her life.  Women and the elderly are more commonly affected.  Though not usually serious, constipation can be a concern.

Constipation:  A bowl motility disorder that occurs when bowl movements become less frequent.  The normal time between bowl movements varies widely from person to person – some people having a bowl movement 3 times a day, and others only 1 to 2 times per week.  In general, going more than 3 days without a bowl movement can cause pain.  After 3 days, the stool becomes harder and more difficult to pass.

Some signs that you may be constipated (2 or more during 3 months at least):  Straining during bowl movement more than 25% of the time, lumpy or hard stools more than 25% of the time, sensation of anorectal obstruction, sensation of incomplete evacuation more than 25% of the time, manual maneuvering required to defecate, three or fewer bowl movements in a week.

Symptoms of constipation:  Infrequent bowel movements and/or difficulty passing stool, swollen abdomen or abdominal pain, vomiting.

Some causes of constipation:  Medications (especially strong pain medications such as narcotics, antidepressants or iron pills), low fiber diet, dehydration, disruption of regular diet or routine (traveling), inadequate activity or exercise, eating large amounts of dairy products, stress, resisting the urge to have a bowl movement (sometimes the result of painful hemorrhoids), overuse of laxatives, hypothyroidisms, Parkinson’s disease or Multiple Sclerosis, antacid medications containing calcium or aluminum, depression, eating disorders, irritable bowl syndrome, pregnancy and colon cancer.

Treatment options:

Increase hydration – drink 1.5 – 2 quarts of water each day

Add fruits and vegetables to your diet

Eat prunes and/or bran cereal

A mild stool softener or laxative may be used

Medication choices:

1)   Bulk forming laxative:  Metamucil, Citrucel, Fibercon or Benefiber

2)   Surfactants – Lower the surface tension of stool, thereby allowing water to more easily enter the stool.  Docusate/Colace is an example

3)   Osmotic agents: Cause intestinal water secretion and thereby increase stool frequency.  Examples are Polyethylene glycol (PEG) which is also known as Miralax.  Excessive use of these agents may result in electrolyte and volume overload in patients with renal or cardiac dysfunction.  Lactulose is a synthetic disaccharide that is not metabolized in the intestine, thus water and electrolytes remain in the lumen of the intestine. Sorbitol is a less expensive alternative.   Saline laxatives such as milk of magnesia and magnesium citrate are poorly absorbed and act as hyperosmolar solutions.

4)   Stimulant laxatives:  Dulcolax, senna and sodium picosulfate primarily exert their effects via alteration of electrolyte transport by the intestinal mucosa.

5)   Suppositories:  For treatment of functional defecation disorder – glycerin or bisacodyl suppositories may help liquefy stool and thereby overcome the obstruction.

Other treatments for Constipation:  Behavioral approaches (habit training has been especially successful for children), biofeedback – a behavioral approach that can be used to correct inappropriate contraction of the pelvic floor muscles and external anal sphincter during defecation in patients with functional defecation disorder.

Warning about constipation:  Since constipation can be a sign of possible bowl obstruction or even cancer – I recommend calling your doctor if this is a new problem for you, if you have blood in your stool, you are losing weight even if you’re not dieting, you have severely painful bowl movements, your constipation has lasted more than two weeks.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com


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