Constipation

What is constipation?

Constipation refers to a specific change in bowel habits. The term can mean different things to different people though. Stools may be too hard or too small, they may be pebble-like, or look like “deer or rabbit poop”. They may be difficult to pass, or infrequent (less than three times per week). You may notice the sensation of incomplete emptying after a bowel movement, or the feeling as if you still have stool left in you after having a bowel movement. You may need to strain frequently with bowel movements, have increased gas, bloating, abdominal pain, fullness or discomfort.

How common is constipation?

Constipation is very common. Each year, more than 2.5 million Americans seek medical care because of constipation. Constipation occurs in all age groups but is more common with age.

What causes constipation?

Many factors can contribute to or cause constipation, although in most people, no single cause is identified.

Common causes include:

  1. A change in your diet or activity level
  2. Not drinking enough water
  3. Exercising more (and not hydrating enough to compensate for the sweat lost while exercising)
  4. Not exercising enough (or leading a sedentary lifestyle). Being active stimulates the digestive tract.
  5. Not having enough fiber in your diet to bulk your stool.
  6. Consuming too much dairy in your diet
  7. Resisting the urge to go to the bathroom (or “holding it”)
  8. Not going when you have to go to the bathroom, or ignoring the need to go to the bathroom
  9. Stress
  10. Overuse of laxatives
  11. Certain medications (narcotics, antidepressants, anti-anxiety medications, medications used to treat overactive bladder, diuretics, some high blood pressure medications, iron supplements, antacids that have calcium or aluminum in them amongst many others)
  12. Eating disorders
  13. Irritable bowel syndrome (or IBS)
  14. Pregnancy
  15. Problems with the nerves and muscles in the digestive tract
  16. Underlying neurological conditions such as Multiple Sclerosis, Parkinson’s disease, and Muscular Dystrophy
  17. Thyroid disease (primarily hypothyroidism)
  18. Hormonal imbalances
  19. An imbalance of calcium (especially having too much calcium in your blood)
  20. Colorectal cancer

How is constipation diagnosed?

Constipation is diagnosed based upon your symptoms and physical exam findings. Diagnosis may require a rectal examination, where a trained medical professional inserts a lubricated, gloved finger inside your anus and rectum to feel for any lumps or abnormalities. This test can also check for blood in the stool.

Depending upon your symptoms, family history, age and coexisting medical conditions other testing may be recommended to rule out other causes or contributing factors to your constipation. These tests may include: sigmoidoscopy, colonoscopy, CT scan, MRI, motility studies, blood work, stool studies, ultrasound, x-ray or other imaging modalities.

How can I schedule an appointment to have my symptoms evaluated?

Call our office at 908-788-8200 for a comprehensive, personalized consultation.

What symptoms should I look for?

Be sure to notify us of all of your symptoms at your initial consultation. Be sure to especially let us know if your constipation:

  1. Is new
  2. Has lasted longer than three weeks
  3. Is severe, or
  4. Is associated with any other concerning symptoms such as blood in the stool or blood noticed on toilet paper with wiping, weight loss, fevers, chills, sweats, night sweats, weakness, lightheadedness, fatigue, sluggishness, back pain, abdominal pain or cramping, pain that doesn’t go away, or any pain or symptoms that keep you up at night. These can be signs of a more serious condition.

How is constipation treated?

After identifying and treating any underlying causes contributing to your chronic constipation, your symptoms can be managed through one or more treatment options. Treatment options include:

  1. Dietary changes:
    1. Drink more water. Keep hydrated.
    2. Limit dairy, processed foods, and meats
    3. Minimize alcohol,
    4. Eliminate artificial sweeteners such as sucralose and sorbitol.
    5. Increase the fiber in your diet
  2. Lifestyle modifications:
    1. Reduce stress,
    2. Participating in a regular exercise program, and lead an active lifestyle.
      1. Exercise helps by improving overall health and wellbeing and helping to keep the digestive tract working properly, potentially improving constipation. Always talk with your doctor first before beginning any exercise routine.
    3. Stop smoking

In addition to lifestyle and dietary modifications, medications are often used to treat symptoms.

Medications include:

  1. Fiber supplements: Fiber adds form and substance to the stool. Fiber leaves your stomach undigested and ends up in your colon, where it feeds on friendly bacteria, leading to various health benefits. Certain types of fiber may promote weight loss, lower blood sugar levels and fight constipation. In patients with constipation it can help to soften the stool by increasing the water content and bulk of the stool.
    1. Daily fiber recommendations are 25 grams for women, and 38 grams for men.
    2. Caution is advised because fiber can cause gas, bloating, and diarrhea. Drink plenty of water to minimize the possibility of gas and bloating. Start slowly, gradually increasing the amount of fiber in your diet.
    3. Good sources of fiber include: whole grain breads, cereals, fruits (pear, strawberry, avocado, banana), vegetables (sweet potato, broccoli, brussel sprouts), oatmeal, flax, quinoa, popcorn, almonds, and chia seeds.
    4. As an added benefit, research suggests that fiber may help to lower your risk of developing colon polyps and colorectal cancer.
  2. Laxatives work to stimulate bowel movements. Different laxatives work in different ways. Some help to soften the stool. Others cause the colon to contract. This stimulates the lining of the intestine and pushes stool along. Still others pull water back into the colon making the stool softer and easier to pass. Caution is advised with long-term use of laxatives. Always talk with your doctor first before taking any medications including over-the-counter medicines.
  3. Other newer medicines are available today that work in different ways to improve your symptoms of constipation. Some of these medicines work by increasing fluid secretion in your small intestine. They moisten the stool and intestine so that bowel movements are easier and more frequent. Some increase the action of serotonin in your intestines. This helps to alleviate constipation. They reduce abdominal discomfort and improve bowel function.

At your office visit we can discuss if one or more of these medications may be an appropriate treatment option for you.

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