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Constipation 101

    • What is constipation?

    • According to Dr. Shetler, patients tend to believe they are “constipated” when they have most any difficulty with bowel movements. But the true definition of constipation is this:

      • Decreased frequency of bowel movements – fewer than 3 in a week.
      • Difficulty having a bowel movement, with straining and a sense of incomplete evacuation of stool.
      • Very firm, dry bowel movements, no matter how often.

      The old myth that a daily bowel movement is necessary is simply not true, says Dr. Shetler. “If your bowel movements are soft, effortless to pass, and leave you feeling that they have all been eliminated, it doesn’t matter how often they happen.” It’s also true, though, that even a daily bowel movement can be a problem if the stools are very hard, small, and difficult to pass.

      Dr. Shetler notes that smooth elimination requires a coordinated effort of several parts of the body – performing roles we may not understand and probably do not sufficiently appreciate. The colon (large intestine) has a role in transporting food waste outside of the body – absorbing enough fluid to make it easy to pass, and moving it along through the abdomen to the rectal and anal canal. Colon “motility” describes the ability of the colon to move stool along its length and deliver it for elimination. The rectal and anal canal, at the tail end of the intestines, is designed to move the stool out of the body – when needed, but not a moment too soon. The rectosigmoid area recognizes that stool is present and gives us the urge to go to the bathroom. We cooperate by using coordinated efforts of pelvic floor muscles to eliminate waste – hopefully without significant straining or difficulty.

    • Is constipation dangerous?

    • Constipation is a very common problem. Occasionally it can indicate a serious medical condition, so it should not be ignored, especially if you have not had the symptoms of constipation before and suddenly do. Rectal bleeding, abdominal pain or weight loss should also be evaluated by physician.

      Constipation can be the result of disorders of metabolism, obstructions of the bowel, cancer, problems with nearby pelvic organs such as pelvic prolapse, or a side effect of medications.

      The best approach is to discuss your symptoms with a medical professional in order to assess your risks for other diseases, and to undergo appropriate evaluation.

    • How is constipation treated?

    • If constipation does not represent a serious medical condition, most of us can resolve it with these healthy habits:

      • Eating enough fiber to help the bowels move as they should. Fiber is best provided via your food (fruits, vegetables, whole grains), but some patients may need to take a supplement. (See tips for getting more fiber.)
      • Drinking enough water to keep the system functioning well. This is usually the recommended 8 glasses of water each day.
      • Exercising, since moving the body stimulates the colon and helps your digestive system move, too.

      Dr. Shetler also recommends paying attention to your body’s signals. If you have the urge to have a bowel movement, follow through on that urge. After a meal or after a walk is a good time to visit the bathroom, as the colon is most active then.

      If these measures do not improve the pattern of bowel movements, Dr. Shetler says a trial of laxatives may be appropriate. The laxatives should be mild. The first step is stool softeners, which are designed to allow the stool to absorb more water, making it easier to pass. They can be tried for 3-4 weeks, on a daily basis, to see if the constipation improves.

      If these remedies or other over the counter medications do not work, or if there is significant bloating, abdominal pain, rectal bleeding or other symptoms, see your doctor.

      Dr. Shetler notes that there are many evaluations and procedures that can help patients who have structural problems that cause constipation. A specialist can provide an evaluation of the structure of the pelvic floor and the reflexes of the anal sphincter, which may be a problem in the inability to comfortably eliminate stool.

      While the ultimate goal is to have regular, normal bowel movements without the use of laxatives, Dr. Shetler notes that certain medications cause constipation that will need to be treated, as long as the medications are required.

      Bottom line? Help your body eliminate waste with fiber, water, exercise and good habits. If constipation does not resolve, or has other troubling systems, see your doctor. Help is available.