Constipation. It’s a problem that’s difficult to discuss, but it shouldn’t be as there are a number of misconceptions about this common ailment. One of these is that a bowel movement every day is necessary. Another erroneous belief is that wastes stored in the body are reabsorbed and are dangerous to your health, that they produce medical diseases or shorten life span. These misconceptions have led to a marked overuse and abuse of laxatives and procedures such as colonic irrigation. Constipation means that a person has fewer than three bowel movements in a week or has hard stools that are difficult to evacuate. At one time or another, almost everyone gets constipated. Although it may be extremely bothersome, constipation itself usually is not serious. However, particularly if symptoms persist or recur, it may be a symptom of another underlying disorder such as low thyroid hormone levels or even colorectal cancer.
Not a disease
Constipation is often thought of as a decrease in frequency of stools and many people believe they are constipated if they do not have a bowel movement each day. This is wrong, as many people have as few as three bowel movements each week and are perfectly healthy. For many, constipation means having to strain to have bowel movements, passage of small hard stools or a sense that they have not completely emptied after bowel movements. The American College of Gastroenterology defines constipation based upon symptoms, including unsatisfactory defecation with either infrequent stools, difficult stool passage or both. In most cases, constipation is a symptom, not a disease and can be caused by many different conditions. Any significant change in bowel habits, if persistent, may be cause for concern and should be reported to a doctor. In most cases an occasional episode of constipation will correct itself with time, proper hydration, and a healthy diet.
Serious side effect
Opioids like hydrocodone and oxycodone are commonly prescribed to relieve chronic pain. These medications are effective because they block pain signals by attaching to receptors throughout the nervous system. Unfortunately, they can cause serious side effects like dizziness, nausea and constipation. Opioid-induced constipation, or OIC, is caused when opioids attach to the receptors in the gut, lengthening the amount of time it takes stool to pass through the gastrointestinal system. Peristalsis is the movement the muscles around the intestines make to squeeze stools through the gut. Opioids can slow or stop peristalsis by sending messages along the nerves inside the intestines and spine. OIC is different from the kind of constipation caused by not getting enough fiber in your diet or by not drinking enough water. Certain medications can be prescribed to treat OIC and stop opioids from attaching to opioid receptors in the gut.
A well-balanced diet
When evaluating constipation, it’s important to realize that not everyone has the same frequency when it comes to bowel movements. When symptoms develop, it is important to rule out systemic conditions or medications which may be the cause of constipation. When other causes have been excluded, chronic constipation can generally be thought of as either slow movement of stool through the colon or difficulty evacuating it once it reaches the rectum, sometimes both. Testing can help determine which type of constipation is present. Slow stool transit is managed with medications to help move stools through the colon. For most people however, a healthy diet and lifestyle can lessen the chances of constipation. A well-balanced diet that includes fiber-rich foods, such as wholegrain bread, and fresh fruits and vegetables, is recommended. Drinking plenty of fluids and exercising regularly will help to stimulate intestinal activity.
Dietary fiber from fresh vegetables, whole grains, and legumes, as well as bulk laxatives such as psyllium seed are the most effective initial treatment for occasional constipation. Dr. Conan Mustain of the UAMS Division of Colon and Rectal Surgery says that fiber will also prevent problems with hemorrhoids and may even help with weight loss. If stools are excessively hard or dry, pulling in extra water with an osmotic laxative such as Miralax is safe and effective. Dr. Mustain says that stool softeners are generally recommended for patients after childbirth or surgery. Unfortunately, they are not very effective for severe types of chronic constipation. Stimulant laxatives such as Dulcolax and Senna pull electrolytes and water into the colon as well as stimulating the muscles in the bowel wall to contract. These are generally safe and very effective but prolonged daily use can cause electrolyte imbalance. It’s important to report significant changes in bowel habits to a doctor as tests may be needed to determine the cause and rule out more serious conditions.
Trusted by thousands of listeners every week, T. Glenn Pait, M.D., began offering expert advice as the host of UAMS’ “Here’s to Your Health” program in 1996. Dr. Pait began working at UAMS in 1994 and has been practicing medicine for over 20 years.