Constipation

The definition of constipation is not as straightforward as it might seem. "Regularity" can differ substantially from person to person. A "normal" bowel pattern for some may be several bowel movements per day and for others once a week. Constipation might then be viewed somewhat subjectively. As a general guideline, constipation may be considered when:

• Bowel frequency less than three times per week.

• Frequency is not often enough for "comfort."

• Stools that are hard and dry and difficult or painful to pass.

• A sensation of fullness in the rectum or incomplete evacuation of fecal matter.

Causes of Constipation

The main function of the colon is to absorb fluids and process waste for removal from the body. If material is allowed to sit in the colon for prolonged periods, water continues to be absorbed further drying the stool and making it difficult to pass. Decreased peristalsis or motility of the bowel may thus cause constipation. In some, this can be part of the aging process of the digestive tract. Spastic contractions of the bowel which cannot propel material forward may contribute to constipation and can be seen in patients who suffer from irritable bowel syndrome (please see separate article on irritable bowel syndrome). The regular or intermittent use of over-the-counter stimulant laxatives (Ex-Lax, Correctol) can cause deterioration of bowel function over time, eventually worsening constipation. Dietary factors can play a role, for example, a diet low in fiber and taken with insufficient fluids can be constipating. The typical American diet contains 10 to 15 grams of fiber, significantly less than the 30 to 50 grams recommended. A lack of exercise and situational stress or anxiety can affect bowel function. Patients that ignore the urge to defecate, or have painful defecation (for example, secondary to hemorrhoids or anal fissure) can increase constipation. Many medications can have constipation as a side effect - this may be reviewed with your physician. Although constipation is more commonly caused by one of the above mentioned factors, it can also be a sign of more serious underlying medical conditions such as, colon cancer, colon polyps, diverticulitis, and partial or complete obstruction of the bowel and thyroid disorders.

Melanosis coli secondary to long-term laxative use

Prevention and Treatment

Eating regular meals and emphasizing proper amounts of fiber and hydration throughout the day are important. Fluids should be taken with food to help keep the fluids retained within the digestive tract. Fluids taken without food are mostly absorbed into the blood stream and produce urine. Establishing a regular toileting schedule is helpful and, as mentioned above, delaying a movement now may lead to significant straining and discomfort later.

Vicki Majoras, our office Physician Assistant/Dietician is available to meet with patients to help design an individualized dietary program. Regular exercise promotes intestinal motility. A bulk fiber supplement (Metamucil, Citrucel, Konsyl and others) taken on a daily basis with fluids is helpful. Other laxatives which work by stimulating the bowel (dulcolax and others) may be taken occasionally, but should be avoided on a regular basis. The use of other medications, known as osmotic laxatives, act to draw and retain fluids in the colon to soften and loosen stool. Osmotic laxatives such as PEG (Miralax) and lactulose are safe to use on a long term basis. Amitiza (lubiprostone) works by stimulating electrolyte secretion in the GI tract. 

Testing for structural and other disorders may be recommended, particularly if the onset of constipation was recent; if constipation does not improve with fiber; hydration, and dietary measures; or if there is blood with the stool or significant abdominal pain associated with these symptoms.

Tips for a High Fiber Diet

Eat more fiber! So what is fiber and what are the facts? Fiber is found in plants and consists of two types, soluble and insoluble. Soluble fiber is found in oats, peas, beans, and certain fruits. Soluble fiber helps lower cholesterol by binding with it so it's not absorbed. Insoluble fiber is found in wheat, potatoes, and certain fruits and vegetables. Insoluble fiber helps maintain regularity. The average intake of fiber per adult in the United States is 12 to 15 grams per day, the amount needed is 20 to 35 grams. Increasing your intake of whole grains, beans, fruits and vegetables gradually, one new food each week is a good plan. Along with more fiber, include plenty of water to keep the fiber moving through your digestive tract.

If you struggle to get to get your fiber servings each day, try these tips to make the change easy:

• Sneak vegetables into casseroles, stir-fries, sandwiches, and pizza.

• Choose fruit at breakfast, add fruit to your cereal or yogurt and drink a glass of juice.

Set your goals, add more fiber each week!

Achieving Adequate Fiber Intake

Food intake pattern should include a wide variety of plant foods to achieve adequate fiber intake. Include at least 2 to 3 servings of whole grains as part of the daily 6 to 11 servings of grains. Include 5 servings of fruits and vegetables daily. Consume legumes at least 1 to 2 times per week.

Breakfast: Cereal and/or whole wheat toast and fruit, such as banana slices with cereal. An alternative would be yogurt with sliced fruit and berries mixed with granola or Miller’s Bran. Consider hot oatmeal.

 

Lunch: Sandwich on whole wheat grain bread. Carrots on the side. Fruit for dessert.

 

Dinner: Have one or two side dishes of vegetables. Bread should be whole wheat bread or whole wheat rolls. Salad can have a lot of vegetables or even fresh or dried fruit.

 

Snacks: Raw vegetables with dip, fruits, and granola bars. Try to avoid snack foods, such as chips.

High Fiber Foods

• Legumes - Lima, kidney, pinto, navy beans and others.

• Whole Grains - wheat bran, oat bran such as in cereals and breads.

• Whole fresh fruits - in many, a large component of the fiber is found in the skin and pulp. Figs, prunes, and raspberries have the highest fiber content per serving.

• Cooked or stewed fruits, such as applesauce and prunes are a good source of fiber.

• Green leafy vegetables, particularly spinach, celery, lettuce and broccoli.

• Root vegetables, such as potatoes, turnips and carrots all contain a good amount of fiber.

Related Sites

American Dietetics Association, http://www.eatright.org

Vegetarian Resource Group (VRG), http://envirolink.org/arrs/VRG/home.html

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