Constipation is a very common problem. Each year more than 2.5 million Americans visit their healthcare provider. They do this for relief from symptoms. This condition refers to a change in bowel habits, but it has varied meanings. Stools may be too hard or too small, difficult to pass, or infrequent (less than three times per week). People with constipation may also notice a frequent need to strain and a sense that the bowels are not empty. Many factors can contribute to or cause constipation, although in most people, no single cause can be found. In general, constipation occurs more often as you get older or as a side effect of medications. Diseases like Diabetes Mellitus, Hypothyroidism, Parkinson’s Disease and Multiple Sclerosis are also associated with constipation.
How does one avoid constipation? First, it is important to consume a diet high in fiber. Generally, you need 20-35 grams of fiber a day. This can be achieved with fruits and vegetables. This can also include whole grains. If you don’t like these foods, there are over the counter fiber supplements that can help. Be sure to start these slowly to help avoid side effects of gas. Second, drink plenty of fluids – at least 64 ounces daily. Third, listen to your body. The bowels are most active after meals. If you feel the urge to have a bowel movement, don’t hold it! If you ignore your body’s signals, they become weaker. Fourth, if you are feeling constipated, take an over the counter laxative to prevent symptoms from getting worse. Be sure to let your doctor know if you are taking a laxative on a regular basis.
When should one seek medical attention for constipation?
Symptoms are new (ie, represents a change in your normal pattern)
Constipation lasts longer than three weeks
Symptoms are severe (days between bowel movements)
Constipation is associated with any other concerning features such as blood on the toilet paper, weight loss, fevers, or weakness
What tests will a doctor perform for evaluation of constipation? Your doctor will talk to you. They will then decide which tests you should have based on your age, other symptoms, and individual situation. There are lots of tests, but you might not need any. You may need blood work or a rectal exam. Additionally, you may need a colonoscopy, x-rays or MRI. You may also need a manometry (a test that allows the doctor to measure the pressure inside the rectum to help the doctor find out if muscles are working correctly).
How does one treat severe constipation? If lifestyle and behavioral changes do not help constipation, medications may help. Often, doctors will recommend fiber supplementation with increased fluids. They reccomend this as a 1 line therapy. If that does not work or is not tolerated, then there are laxatives that can be used. Miralax is a common laxative to start with. Magnesium based laxatives can also be used. However, they are often associated with high blood concentrations of magnesium. Therefore, they should be used with caution. There are prescription medications that can also be used for constipation. At times, people may need enemas. They may also need suppositories to stimulate bowel movements. In more severe cases, biofeedback or even surgery may be indicated.
Please remember that constipation is a common condition and sometimes, can lead to more serious conditions. Don’t be afraid to talk to your doctor if you are having symptoms