WEEKLY HEALTH TOPIC:”Constipation: Causes, symptoms and treatments”

Constipation

Constipation occurs when bowel movements become less frequent and stools become difficult to pass. It happens most often due to changes in diet or routine, or due to inadequate intake of fiber. You should call your doctor if you have severe pain, blood in your stools, or constipation that lasts longer than three weeks.

What is constipation?

Having fewer than three bowel movements a week is, technically, the definition of constipation. However, how often you “go” varies widely from person to person. Some people have bowel movements several times a day while others have them only one to two times a week. Whatever your bowel movement pattern is, it’s unique and normal for you – as long as you don’t stray too far from your pattern.

Regardless of your bowel pattern, one fact is certain: the longer you go before you “go,” the more difficult it becomes for stool/poop to pass. Other key features that usually define constipation include:

• Your stools are dry and hard.
• Your bowel movement is painful and stools are difficult to pass.
• You have a feeling that you have not fully emptied your bowels.

How common is constipation?

You are not alone if you have constipation. Constipation is one of the most frequent gastrointestinal complaints in the United States. At least 2.5 million people see their doctor each year due to constipation.

People of all ages can have an occasional bout of constipation. There are also certain people and situations that are more likely to lead to becoming more consistently constipated (“chronic constipation”). These include:

• Older age. Older people tend to be less active, have a slower metabolism and less muscle contraction strength along their digestive tract than when they were younger.
• Being a woman, especially while you are pregnant and after childbirth. Changes in a woman’s hormones make them more prone to constipation. The baby inside the womb squishes the intestines, slowing down the passage of stool.
• Not eating enough high-fiber foods. High-fiber foods keep food moving through the digestive system.
• Taking certain medications (see causes).
• Having certain neurological (diseases of the brain and spinal cord) and digestive disorders (see causes).

How does constipation happen?

Constipation happens because your colon absorbs too much water from waste (stool/poop), which dries out the stool making it hard in consistency and difficult to push out of the body.

To back up a bit, as food normally moves through the digestive tract, nutrients are absorbed. The partially digested food (waste) that remains moves from the small intestine to the large intestine, also called the colon. The colon absorbs water from this waste, which creates a solid matter called stool. If you have constipation, food may move too slowly through the digestive tract. This gives the colon more time – too much time – to absorb water from the waste. The stool becomes dry, hard, and difficult to push out.

Pathway of food waste through colon, rectum and anus.

Can constipation cause internal damage or lead to other health problems?

There are a few complications that could happen if you don’t have soft, regular bowel movements. Some complications include:

• Swollen, inflamed veins in your rectum (a condition called haemorrhoids).
• Tears in the lining of your anus from hardened stool trying to pass through (called anal fissures).
• An infection in pouches that sometimes form off the colon wall from stool that has become trapped and infected (a condition called diverticulitis)
• A pile-up of too much stool/poop in the rectum and anus (a condition called fecal impaction).
• Damage to your pelvic floor muscles from straining to move your bowels. These muscles help control your bladder. Too much straining for too long a period of time may cause urine to leak from the bladder (a condition called stress urinary incontinence).

Does not having regular bowel movements cause toxins to build up in my body and make me sick?

Don’t worry, this usually isn’t the case. Although your colon holds on to stool longer when you are constipated and you may feel uncomfortable, the colon is an expandable container for your waste. There is possibly a slight risk of a bacterial infection if waste gets into an existing wound in the colon or rectum.

What causes constipation?

There are many causes of constipation – lifestyle choices, medications, medical conditions, and pregnancy.

Common lifestyle causes of constipation include:

• Eating foods low in fiber.
• Not drinking enough water (dehydration).
• Not getting enough exercise.
• Changes in your regular routine, such as traveling or eating or going to bed at different times.
• Eating large amounts of milk or cheese.
• Stress.
• Resisting the urge to have a bowel movement.

Medications that can cause constipation include:

• Strong pain medicines, like the narcotics containing codeine, oxycodone (Oxycontin) and hydromorphone.
• Nonsteroidal anti-inflammatory drugs, like ibuprofen and naproxen).
• Antidepressants, including the selective serotonin reuptake inhibitors (like fluoxetine [Prozac®]) or tricyclic antidepressants (like amitriptyline [Elavil]).
• Antacids containing calcium or aluminum, such as Tums.
• Iron pills.
• Allergy medications, such as antihistamines (like diphenhydramine [Benadryl®]).
• Certain blood pressure medicines, including calcium channel blockers (like verapamil [Calan SR], diltiazem [Cardizem®] and nifedipine [Procardia®]) and beta-blockers (like atenolol [Tenormin®]).
• Psychiatric medications, like clozapine (Clozaril®) and olanzapine (Zyprexa®).
• Anticonvulsant/seizure medications, such as phenytoin and gabapentin.
• Antinausea medications, like ondansetron (Zofran®).

Many drugs can cause constipation. Ask your doctor or pharmacist if you have any questions or concerns.

Medical and health conditions that can cause constipation include:

• Endocrine problems, like underactive thyroid gland (hypothyroidism), diabetes, uremia, hypercalcemia.
• Colorectal cancer.
• Irritable bowel syndrome (IBS).
• Diverticular disease.
• Outlet dysfunction constipation. (A defect in the coordination of pelvic floor muscles. These muscles support the organs within the pelvis and lower abdomen. They are needed to help release stool.)
• Neurologic disorders including spinal cord injury, multiple sclerosis, Parkinson’s disease, and stroke.
• Lazy bowel syndrome. The colon contracts poorly and retains stool.
• Intestinal obstruction.
• Structural defects in the digestive tract (like fistula, colonic atresia, volvulus, intussusception, imperforate anus, or malrotation.)
• Multiple organ diseases, such as amyloidosis, lupus, and scleroderma.
• Pregnancy.

What are the symptoms of constipation?

Symptoms of constipation include:

• You have fewer than three bowel movements a week.
• Your stools are dry, hard and/or lumpy.
• Your stools are difficult or painful to pass.
• You have a stomach ache or cramps.
• You feel bloated and nauseous.
• You feel that you haven’t completely emptied your bowels after a movement.

Constipation Treatments

You have a lot of options for treating constipation. What you choose will depend on why you’re blocked, and whether it’s a new or a long-term problem for you.

Constipation Home Remedies

You may be able to solve your constipation problem yourself, without your doctor’s help. It may seem obvious, but your diet has a big impact on how you poop.

• Eat more fiber. Fiber makes stool bulkier and softer so it’s easier to pass. Gradually increase the amount of fiber in your diet until you’re getting at least 20 to 35 grams of fiber daily. Good sources include whole grains found in cereals, breads, and brown rice, beans, vegetables and fresh or dried fruits. Prunes and bran cereal are tried and true constipation remedies.
• Stay hydrated. Water is important for preventing constipation, too. Try to drink at least 8 glasses of water a day.
• Try coffee. While caffeinated drinks and alcohol can make you dehydrated, there’s evidence a cup of coffee of tea in the morning may help you poop.
• Limit high fat/low fiber food.Cheese and other dairy products, processed foods, and meat can make constipation worse.
• Watch your FODMAPs.Certain carbohydrates cause digestive problems, including constipation, in some people. The names of the carbohydrates are abbreviated “FODMAPs.” Foods that contain them include dairy, apples, broccoli, wheat, and lentils. You might try cutting individual foods from your diet, but do it carefully. A lot of them are good sources of fiber and other nutrients you need.

Other things you can do to relieve constipation include:

• Exercise regularly. Moving your body will keep your bowels moving, too.
• Adjust your toilet posture. It may be easier to poop if you squat, raise your legs, or lean back.
• Check your meds. Many prescription drugs can cause constipation. Ask your doctor if this might be the problem and if there’s an alternative.   
• Biofeedback. Some people get constipated because they unconsciously clench their muscles when they try to poop. A therapist can help you train your pelvic floor muscles to relax.
• Massage. Massaging your own abdomen in a certain pattern can help encourage bowel movements.
• Enemas. You can irrigate your colon with either tap water or an over-the-counter preparation to soften and flush out the contents.
• Suppositories. Some over-the-counter constipation medications are meant to be inserted directly into the rectum. They typically work faster than laxatives you take by mouth.
• Prebiotics and probiotics. You may have digestive issues, including constipation, because of an imbalance in the bacteria that live naturally in your intestines. Supplements or foods containing prebiotics, like bananas and oatmeal, and probiotics, like yogurt and fermented foods, may help.            

Laxatives for constipation treatment 

A box of laxatives shouldn’t be the first place you turn to relieve constipation. Reserve laxatives for constipation that doesn’t improve after you’ve added fiber and water to your diet.

If your doctor recommends laxatives, ask what type is best for you, and for how long you should take them. Laxatives are best taken short-term only, because you don’t want to start relying on them to go to the bathroom. Also ask how to ease off laxatives when you no longer need them. Stopping them too abruptly can affect your colon’s ability to contract.

Laxatives come in several forms:

• Bulk-forming fiber supplements include calcium polycarbophil(Equilactin, Fibercon), methylcellulose fiber (Citrucel), and psyllium (Fiber-Lax, Konsyl, Metamucil), and wheat dextrin (Benefiber). Unlike other laxatives, you can take these every day. They make the stool bigger and softer. Although they are safe to use regularly, fiber supplements can interfere with your body’s ability to absorb certain medicines, and they may cause bloating, cramps, and gas. Drink a lot of water with them.
• Lubricant laxatives, including Zymenol, help the stool pass more easily through the colon. In general, doctors do not recommend using mineral oilor castor oil. Mineral oil can cause problems such as vitamin deficiencies, and castor oil can lead to long-term constipation.
• Osmotic laxativessuch as lactitol (Pizensy), lactulose (Kristalose), magnesium hydroxide (Milk of Magnesia), polyethylene glycol (Miralax), and Sorbitol help fluids move through your intestines. If you have diabetes, ask your doctor before taking osmotics because they can cause electrolyte imbalances.
• Stimulant laxativessuch as bisacodyl (Correctol, Dulcolax, Feen-a-Mint) and sennosides (Ex-Lax, Senokot) make the muscles in your intestines contract to help push stool out. These laxatives work quickly, but they can cause side effects, including cramping and diarrhea, so use them for as short a period of time as possible.
• Stool softeners such as docusate calcium (Surfak) and docusate sodium(Colace) make stools easier to pass by adding fluid to them. Having softer stool can prevent you from having to strain during bowel movements. Your doctor may recommend one of these products if your constipation is due to childbirth or surgery.

Medical Treatment for Constipation

Medicine

If over-the-counter treatments don’t do the job, your doctor may prescribe a different kind of medication.

• Prescription laxatives such as linaclotide, (Linzess) lubiprostone, (Amitiza) and plecanatide (Trulance) work by increasing the amount of water in your intestines and speeding up the movement of stool. Note that Amitiza is approved for use only in women.
• Serotonin 5-hydroxytryptamine 4 receptors. Prucalopride (Motegrity) is a powerful stimulant that’s used for chronic constipation without a known cause.
• PAMORAs. This is a shorter way of saying “peripherally acting mu-opioid receptor antagonists.” These work on constipation that’s caused by opioid pain medicines. These drugs  include methylnaltrexone (Relistor) and naloxegol (Movantik.) 

Surgery for constipation treatment

Sometimes constipation is caused by a structural problem in your colon or rectum. Your colon may be blocked or unusually narrow, or you may have a partial collapse or a bulge in the wall of your rectum. In that case, surgery can correct the problem.

Surgery may also be a last resort if your colon just works too slowly and treatments haven’t helped. You may need to have a section of your colon removed.

When Constipation Is a Regular Problem

Regardless of what constipation treatment you use, give yourself enough time to sit on the toilet when you need to go. Holding in the urge can make your constipation worse. Set aside a regular time of the day when you know you’ll be left undisturbed for several minutes.

Also, don’t ignore the problem. Untreated constipation can lead to real problems, such as haemorrhoids and tears in the skin around the anus (called fissures) that make you bleed. If you strain too hard, you might even cause part of your intestines to push out through the anus — a condition called rectal prolapse that can sometimes require surgery.

Call your doctor right away if you have any of these symptoms with constipation:

• Stomach pain
• Blood in your stools
• Unexplained weight loss
• Inability to have a bowel movement

Also, call if you’ve been having trouble going for more than three weeks and constipation treatments aren’t working. You may have a condition called Chronic Idiopathic Constipation (CIC) which means your constipation may be caused by something other than physical or physiological.