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Constipation occurs when you have a change in your normal bowel movements, going less frequently than you usually do; passing hard, dry stools; or straining when you defecate. Constipation can be acute (coming on suddenly but infrequently) or chronic (long lasting). Almost everyone experiences constipation at some point. Often dietary changes are all that's needed to relieve the problem. However, constipation can also be a sign of illness -- some people with irritable bowel syndrome (IBS) experience alternating constipation and diarrhea, for example.
What are "normal" bowel movements vary from person to person. Some people go every day, or even three times a day; others may go only three times a week. By the same token, the consistency of stool varies from person to person. Some healthy people may have soft or near-runny stools, while others have firm stools, but have no trouble passing them.
Signs and Symptoms
Many times constipation can be treated with over the counter remedies. However, you should see your doctor if you have any of the following symptoms:
Constipation is most often caused by a low fiber diet, lack of exercise, dehydration, or delay in going to the bathroom when you have the urge to defecate. Stress and travel can also contribute to constipation or other changes in bowel habits.
Other times, diseases of the bowel (such as irritable bowel syndrome), pregnancy, certain medical conditions (like an underactive thyroid or cystic fibrosis), mental health problems (such as depression), neurological diseases, metabolic disorders, or medications may be the reason for your constipation. More serious causes, like colon cancer, are not common.
More women than men seek help for constipation, suggesting that a hormonal imbalance may play a role.
Among the medications that can cause constipation are:
Constipation in children often occurs if they hold back bowel movements when they aren't ready for toilet training or are afraid of it.
Your doctor will perform a physical examination, which may include a rectal exam and a pelvic exam if you are a woman. He will check your medications to make sure they are not causing the problem, and may run several tests to diagnose any underlying illness. The following tests may help diagnose the cause of constipation:
Avoiding constipation is easier than treating it but involves the same lifestyle measures:
Most mild cases of acute constipation can be treated with over the counter laxatives. However, these medications are only designed for short term use. Chronic constipation can often be prevented or treated with a combination of changes in your diet (like eating more fiber), drinking more water, and getting enough exercise. Your health care provider may talk with you about your bowel habits: For example, if you consistently delay going to the bathroom when you feel the urge, you could make constipation worse. Your doctor may have you use a laxative or stool softener or suggest a bulk forming agent, such as psyllium, bran, or methylcellulose. In addition, certain herbs may help promote bowel activity. Use laxative herbs with caution because, like medications, they may become less effective if you use them constantly.
At least three studies support the use of biofeedback for obstructive constipation. One study found that obstructive constipation was corrected in 79% of patients who received biofeedback compared to only 4% of those who received placebo treatment.
Getting enough fiber in your diet (20 - 35 g per day) helps prevent constipation. Vegetables, fresh fruits (especially dried fruits) and whole grains, including wheat and bran, or oatmeal cereals are excellent sources of fiber. To reap the benefits of fiber, you must drink plenty of fluids (especially water) to help pass the stool. If adding more fiber to your diet causes gas or bloating, try adding fiber gradually.
Regular exercise also helps maintain good bowel movements. Even if you are in a wheelchair or bed, you can change position frequently and perform abdominal contraction exercises and leg raises. A physical therapist can recommend a program of exercises that's right for you.
Additional tips include:
Your doctor may suggest that you use a laxative to relieve temporary constipation. However, laxatives should not be used long term to treat chronic constipation. There are a number of laxatives available, both over the counter and by prescription. Laxatives can interact with a number of medications, so talk to your doctor before taking one if you also take other medications.
Bulk forming laxatives -- Often prescribed first for constipation, they can work as quickly as 12 hours after use. They swell in the intestines, softening the stool and making it easier to pass. Bulk forming laxatives are made of indigestible fiber and are safe for long term use, but must be taken with enough water or they can cause obstructions in the intestines. In some people they may cause bloating and abdominal pain. Bulk forming laxatives include those made from psyllium (Metamucil, Fiberall), methylcellulose (Citrucel), and polycarbophil (FiberCon).
Stimulant laxatives -- work by causing the muscles in the intestines to contract, moving the stool along. They are designed for short term use, and can cause dehydration and problems with the body's electrolyte balance. Stimulant laxatives include Dulcolax, Correctol, Ex-Lax, castor oil, Senna, and Senokot.
Osmotic laxatives -- increase the amount of water in your intestines, making stool softer. They can be quick acting, but can cause fluid loss and electrolyte imbalances. Osmotic laxatives include lactulose (Cephulac), available by prescription, and polyethelyne glycol (MiraLAX); and saline laxatives, such as magnesium citrate and milk of magnesia.
Stool softeners -- Often recommended after surgery, these laxatives make the stool softer. They are generally used in combination with stimulant laxatives, and can three days to work.
Lubricant laxatives -- coat the stool and help it move through the intestine. The most common lubricant laxative is mineral oil. Mineral oil can have side effects; if it is accidentally aspirated (breathed in), it can cause pneumonia.
Suppositories -- Suppositories, which are inserted into the rectum, may make it easier to pass hard stools (glycerin suppositories) or can be a stimulant laxative which is absorbed into the body (Dulcolax suppositories).
Enemas -- Saline enemas work like osmotic laxatives; while mineral oil enemas work like lubricant laxatives. Enemas should not be used on a regular basis, and can cause electrolyte imbalances.
Tegaserod (Zelnorm) -- a prescription drug used to treat constipation in people with IBS. Because if an increased risk of cardiac problems (including heart attack and stroke), Zelnorm is restricted by the Food and Drug Administration (FDA) to people who have found other treatments unsafe or ineffective.
Never give laxatives or enemas to children unless your doctor tells you to. People with any kind of bowel obstruction, abdominal inflammation, or kidney or heart failure should never take over the counter laxatives without talking to their physician.
Nutrition and Dietary Supplements
Adding more fiber to your diet and drinking adequate water usually helps relieve constipation. It is important to take any fiber supplement with plenty of water to avoid intestinal obstruction.
The use of herbs is a time honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner.
Herbs used for constipation fall into two categories: bulk forming laxatives and stimulant laxatives.
Bulk forming laxatives
Flaxseed (Linum usitatissimum) contains soluble fiber and is available as a powder or as whole or crushed seeds, which can be mixed with water or juice. Flaxseed is different from flaxseed oil, which is not used for constipation.
Other bulk forming laxatives include:
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of constipation based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
Constipation is common in pregnancy and is usually relieved by changing your diet and drinking more water. If you are pregnant, do not take any herbs or over the counter laxatives that are stimulant laxatives, because they might cause contractions. In fact, you should talk to your doctor before using any laxative if you are pregnant.
Prognosis and Complications
Passing large, wide stools may tear the mucosal membrane of the anus, especially in children. This can cause bleeding and the possibility of an anal fissure.
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Review Date: 11/20/2009
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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