Constipation
WHEN TO SEE YOUR DOCTOR
* You're uncomfortable from not having a bowel movement.
* Your bowel habits suddenly change.
* You're also suffering from abdominal pain or vomiting.
What Your Symptom Is Telling You
Let's see now: Once a week you do your laundry, water your plants and go to the grocery store. Not a bad schedule. But if your bowel movements have suddenly joined this list of weekly activities, and you're feeling bloated and uncomfortable, you're probably constipated.
"Generally speaking, your comfort level is probably the best indicator of constipation," says Barry Jaffin, M.D., a motility disorder specialist and clinical instructor in the Department of Gastroenterology at Mount Sinai Hospital in New York City. "But if you've gone from making a trip to the bathroom once a day to once a week, that's a pretty sure sign also." Other symptoms of constipation, according to Dr. Jaffin: Straining, small hard stools and hemorrhoids.
A lot of everyday things can turn down the volume on nature's call—certain medications, lack of fiber or water, lack of exercise and too much iron. But a number of digestive problems can also cause constipation. These range in severity from irritable bowel syndrome to more serious conditions like colon cancer, colitis, Crohn's disease, diverticulitis and ischemia (decreased blood flow to the colon). One digestive disease, colonic inertia, can keep a person from having a bowel movement for more than two weeks. In colonic inertia, the colon fails to squeeze properly.
Just don't try to blame constipation on aging. As far as doctors can tell, with a little care your digestive system is built to perform for the life of your chassis.
"There's no evidence that the bowel stops working as you get older," says Nicholas J. Talley, M.D., an associate professor of medicine at the Mayo Clinic Medical School in Rochester, Minnesota. "In fact, it probably works just as well whether you're old or young."
Symptom Relief
If you're not suffering from abdominal pain, you can probably treat your constipation yourself. Try these tips.
Fill up on fiber. Fiber—the nondigestible bulk found in whole-grain products, fruits and vegetables—works in at least two important ways to help prevent constipation, says Peter Holt, M.D., chief of the Division of Gastroenterology at St. Luke'sRoosevelt Hospital Center and professor of medicine at Columbia University College of Physicians and Surgeons in New York City. Instead of immediately turning into soup during digestion, fiber acts like a sponge, sopping up liquid in your intestines and colon, resulting in firmer stool, says Dr. Holt.
But fiber's benefits don't stop there: Fiber's arrival gives your colon the green light to contract. And because the colon is the last stop on your meal's digestive tour, you'll soon get the signal that it's time to find a bathroom.
So how much fiber is enough? Aim for about 25 grams a day, he says. "If you were to adhere to the recommendation of 5, one-ounce servings of fruits and vegetables a day, then you should have more than enough fiber in your diet," he adds.
Add an OTC fiber product. If you're unwilling or unable to crunch through all that fiber, you can occasionally add one of several over-the-counter fiber products like Metamucil, Citrucel or Perdiem to your diet. But use them carefully: If you don't add them to enough fluid, you could end up more constipated than when you started, says Dr. Talley. That's why it's important to follow directions on the label carefully.
Don't forget fluids. Whether you prefer juice or water, most doctors recommend that you drink between six and ten eight-ounce glasses of fluids a day to prevent constipation, says Dr. Jaffin.
Avoid artificial laxatives. Are you using stimulant laxatives once a week to keep yourself regular? Be careful—there's evidence that you could be damaging your colon, says Dr. Talley. "Sustained use of these products—if you were to use one daily for a year or more, for example—is one of the worst things you can do in the long run," he says.
Get some exercise. Here's yet another reason to put on your walking shoes: Exercise can help prevent constipation by stimulating the colon, says Dr. Holt.
Keep your eye on iron. While iron is an important mineral—especially for women—too much can cause constipation. Unless you're under doctor's orders, you can probably meet your iron needs with a good multivitamin rather than taking a separate iron supplement, says Dr. Jaffin.
Check medications. Certain drugs can cause constipation by blocking the creation of a chemical that helps push waste through your bowel, says Dr. Jaffin. These include medications to relieve high blood pressure, antipsychotic drugs and even some over-the-counter antihistamines and pain relievers. If you're taking any over-the-counter remedies, give them a rest and see if that makes a difference. Before going off any prescription drugs, however, see your doctor.
Try an enema. Stubborn causes of constipation may require an enema—an over-the-counter product containing fluid that's inserted in the rectum and causes the colon to contract, thereby inducing a bowel movement. Use only occasionally and as directed, says Dr. Holt.
See your doctor. If you're faithfully following dietary guidelines and not taking any drugs that may cause constipation and are still having trouble, ask your doctor to perform a sigmoidoscopy or other tests to look at the colon. This simple office procedure will allow your doctor to get a closer look at your colon and anything in it that might be causing a problem, says Dr. Jaffin.
