Constipation can mean different things to different people. For many people, it simply means infrequent stools. For others, however, constipation means hard stools, difficulty passing stools (straining), or a sense of incomplete emptying after a bowel movement. The cause of each of these “types” of constipation probably is different, and the approach to each should be tailored to the specific type of constipation.
Constipation can also alternate with diarrhea. This pattern is more commonly considered as part of the Irritable Bowel Syndrome (IBS). Constipation is one of the most common gastrointestinal complaints in the United States. More than 4 million Americans have frequent constipation, accounting for 2.5 million physician visits a year. Those reporting constipation most often are women and adults ages 65 and older. Pregnant women may have constipation, and it is a common problem following childbirth or surgery.
Self-treatment of constipation with overthecounter (OTC) laxatives is by far the most common aid. Around $725 million is spent on laxative products each year in America.
Rather than rely on laxatives a high fiber diet and drinking more water are some beneficial suggestions for the control of constipation. People who eat a high-fiber diet are less likely to become constipated. Actually, the most common causes of constipation are a diet low in fiber or a diet high in fats, such as cheese, eggs, and meats.
Eat more fiber, both soluble and insoluble, which 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.
On the average, Americans eat an between 5 to 14 grams of fiber daily which is short of the 20 to 35 grams recommended by the American Dietetic Association. Both children and adults often 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 foods that are quick and easy, such as fast foods, or prepared foods, which are usually low in fiber. Difficulties with chewing or swallowing may cause older people to eat soft foods that are processed and low in fiber.
Although research shows that increased fluid intake does not necessarily help relieve constipation many people report some relief from their constipation if they drink fluids such as water and juice and avoid dehydration. Liquids add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass. People who have problems with constipation should try to increase their liquids every day. However, liquids that contain caffeine, such as coffee and cola drinks, will worsen one’s symptoms by causing dehydration. Alcohol is another beverage that causes dehydration. It is important to drink fluids that hydrate the body, especially when consuming caffeine containing drinks or alcoholic beverages.
A lack of physical activity 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. Lack of physical activity is thought to be one of the reasons constipation is common in older people.
There are many medications that can cause constipation, including pain medications (especially narcotics) antacids that contain aluminum and calcium blood pressure medications (calcium channel blockers).
At the extreme end of the constipation spectrum is fecal impaction, a condition in which stool hardens in the rectum and prevents the passage of any stool. The number of bowel movements generally decreases with age. Ninety-five percent of adults have bowel movements between three and 21 times per week, and this would be considered normal.
The most common pattern is one bowel movement a day, but this pattern is seen in less than 50% of people. Moreover, most people are irregular and do not have bowel movements every day or the same number of bowel movements each day. Medically speaking, constipation usually is defined as fewer than three bowel movements per week. Severe constipation is defined as less than one bowel movement per week. There is no medical reason to have a bowel movement every day. Going without a bowel movement for two or three days does not cause physical discomfort, only mental distress for some people.
Contrary to popular belief, there is no evidence that “toxins” accumulate when bowel movements are infrequent or that constipation leads to cancer. It is important to distinguish acute (recent onset) constipation from chronic (long duration) constipation. Acute constipation requires urgent assessment because a serious medical illness may be the underlying cause (e.g., tumors of the colon).
Constipation also requires an immediate assessment if it is accompanied by worrisome symptoms such as rectal bleeding, abdominal pain and cramps, nausea and vomiting, and involuntary weight loss. In contrast, the evaluation of chronic constipation may not require immediate attention, particularly if simple measures bring relief.