Constipation

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VOL 109 / NO 3 / MARCH 2001 / POSTGRADUATE MEDICINE

Our great-grandmothers would gasp to hear it, but "regularity" does not mean what it used to. Although many people still believe it is important to have a bowel movement every day--and even at the same time every day--this is not true. The time needed for food to pass through the intestine varies from person to person and from day to day in the same person.

Constipation, an interesting word derived from the Latin term "constipatus," which roughly means "really packed in there," is more often related to the consistency of the stool than to the frequency. It is usually defined as passage of hard stool fewer than three times a week or difficulty passing stool. It isn't a disease, but it is a symptom of slow movement of food through the large intestine. The problem can be caused by inadequate fluid intake, lack of fiber in the diet, inactivity, medications, bowel obstruction, surgery, prolonged laxative use, stress, or not paying attention to nature's urges.

What can be done about it?
Constipation seldom is a medical emergency. Changing what you eat and drink and getting more exercise often solve the problem. The first step might be simply to drink more fluids and eat more fiber. A word of caution here, however: Add high-fiber foods to your diet slowly to avoid bloating and gas problems. Also, stay away from fluids that contain caffeine or alcohol if you are constipated. These tend to dry out your system.

A major problem for many people these days is not being able to respond when nature calls. Few of us can comfortably leave a meeting or classroom to attend to physical urges. So we learn to "hold it." This, unfortunately, has become a major contributor to a constipated society. The solution to this problem is elusive, to say the least.

When are laxatives needed?
As a general rule, it is a good idea to check with your doctor before using a laxative, especially if constipation is an ongoing problem. If you believe you need a laxative occasionally, you might try a natural vegetable fiber supplement (for example, Citrucel, Fiberall, Metamucil), which usually works in 1 to 3 days. Be sure to drink plenty of water (at least 8 glasses a day) when you use these products. Stool softeners, such as docusate sodium (for example, Colace) or docusate calcium (for example, Surfak), are gentle and may be helpful. Avoid using mineral oil because it can block absorption of key vitamins.

Osmotic laxatives increase the water content in the stool. Examples are magnesium hydroxide (Milk of Magnesia) and lactulose (such as Cholac or Chronulac). These agents are safe to use a few times a month. However, they should not be used too often because they can flush valuable minerals out of your body.

Stimulant laxatives are the most powerful and should be used only with great caution. Check the label for ingredients like senna, sennoside, and cascara, which are powerful stimulants. It is best not to use these laxatives except as directed by a physician.

When is constipation dangerous?
Laxative dependence can become a problem for some people, and it's important to let your doctor know if constipation lasts longer than 3 weeks. Unexplained weight loss, blood in the stool, and changes in bowel patterns also can be clues to more serious problems. Your doctor might want to check for other disorders sometimes associated with constipation, such as an underactive thyroid gland, diabetes, or depression.

In severe cases, constipation can result in fecal impaction, which occurs when the hardened stool cannot be eliminated through the rectum. In most cases, the mass must be broken up and extracted manually by a doctor. This is another good reason for not waiting too long when you suspect a serious problem. Get help early.

Is your medicine making you constipated?

Some medications are likely to cause drying or hardening of the stool or delay emptying of the intestine. Among them are:

• Antacids that contain aluminum or calcium
• Antihistamines, especially if they contain diphenhydramine
• Blood pressure or heart medicine (such as calcium channel blockers)
• Calcium supplements
• Cough syrups and medications that contain codeine or other narcotics
• Diuretics ("water pills")
• Iron supplements
• Sedatives
• Some antidepressant drugs

Where to get more fiber

These foods are excellent sources of fiber that can help eliminate constipation:

Fruit
Apples, peaches, raspberries, tangerines

Vegetables
Acorn squash, raw broccoli, Brussels sprouts, cabbage, raw carrots, raw cauliflower, spinach, zucchini

Legumes, cereals, and breads
Black-eyed peas, kidney beans, lima beans, whole-grain hot or cold cereals (oatmeal, bran flakes), whole-wheat or multigrain breads

This information is not a substitute for medical treatment.

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