No. 2

No one likes to admit or talk about it, but bowel movements are an important part of our daily function – or for some of us, not-so-daily.  Constipation is a hard problem in more ways than one, and it more commonly affects women.

Let’s talk about what is normal.  You may be surprised to know that going at the same time every day once a day, while pleasantly predictable, is not the only normal.  Depending on the person, bowel movements may happen three times a day or three times a week.  And you may be wondering, “if I only go three times a week, then how do I know when I’m constipated?”  The definition of constipation varies among people.  Generally, you are considered constipated if you strain during defecation (pooping), have stools that are frequently lumpy or hard, or often get a sensation of incomplete evacuation (still needing to go).  If none of these describe your bowel habits on a semi-regular basis, then consider yourself constipation-free.  As long as you are comfortable during your movement ritual and are not experiencing any abdominal bloating or pain, then your frequency is normal for you.

At some point in their lives most people get constipated.  So what is the big deal?  Being constipated more than just every once in a while can lead to unpleasant consequences like hemorrhoids, anal fissures (small tears of the anus), rectal prolapse (rectum protrudes through the anus), and fecal impaction (feces so hard and large that it cannot pass through the anus).  And right about now you are probably fairly motivated to know what causes constipation and how to prevent and treat it.

Constipation happens when the stool hardens, dries, and moves through your gastrointestinal tract too slowly.  Assuming that you are not pregnant or have a medical condition causing constipation, the cause is usually multifactorial and often not found.  Many sources site that constipation is often caused by inadequate fluid intake, a diet too low in fiber, ignoring the urge to have a bowel movement, medications, and lack of physical activity.  However, research has not proven that increasing your dietary fiber, fluid, or exercise are effective for constipation.  Instead, try some behavioral changes.  The bowels are most active following meals (especially in the morning), and this is often the time when stools will pass most readily.  Learn to listen to your body’s signals to have a bowel movement.  If you ignore them, they may become weaker over time.  Not getting the signal?  Trying going to the powder room for a bit after you eat anyway, you may awaken them.  It will not necessarily harm you to increase the fiber in your diet (recommended amount is 25 grams of fiber per day).  Read the labels on what you are eating or go for an over the counter bulking fiber (Metamucil, Benefiber, FiberCon, Citrucel, etc.).  Caution: fiber may [initially] cause gas and bloating, and in some cases worsen constipation.  Start with a small dose of fiber and increase until you have soft, comfortable bowel movements.

Been there, done that and still no success?  Not all that surprising, and you are not alone.  Many people require laxatives.  There are basically two categories of laxatives: hyperosmolar and stimulant.  The hyperosmolar laxatives (MiraLax,GoLytely, and others) are agents that draw water into the bowel, thereby making the stool softer, as well as promote movement of the stool.  Hyperosmolar laxatives are over the counter medications and frequently used in healthcare as they have few risks and tend not to cause abdominal cramping.  Stimulant laxatives, on the other hand, stimulate the propelling action of the bowel.  As you can imagine these medications are associated with cramping and potentially harmful side effects.  And in the natural category, prunes and citrus work for some people as laxatives, too.

It is time to see your provider when you have bowel movements that are outside your normal, significant pain with defecation, constipation lasting more than two weeks, blood in your stool, or other alarming symptoms.  It would be helpful to your provider if you kept a bowel movement log for your constipation as well as a list of what you have tried, when, and for how long.

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