ASK THE DOCTOR: Constipation a symptom, not a disease
By DR. JIM MITTERANDO
The Patriot LedgerQ. I am writing about my problems with constipation. I just don’t feel regular. I use laxatives often and I read that I can be creating more problems with these. What should I do?
A. Not having a bowel movement every day doesn’t necessarily mean you’re constipated.
Many people believe that if they don’t move their bowels daily, they have a problem. Some rely on laxatives to keep them regular. What they don’t know is that having bowel movements only two times a week may be perfectly normal. More important, overreliance on laxatives might cause the very problem they’re trying to prevent - constipation. There’s a better way to manage your constipation. But first you need to know what’s regular for you.
Constipation is a symptom, not a disease. Constipation means having trouble passing bowel movements. Your stools may be very hard or you may feel like you still need to have a bowel movement even after you just have had one.
Don’t believe ads that say you must have a daily bowel movement to be ‘‘regular.’’ The average frequency of bowel movements varies widely - from three bowel movements a day to two a week. Less than two bowel movements per week can be normal if it does not represent a change in your pattern.
As the food you eat passes through your digestive tract, your body takes nutrients and water from the food. The remaining waste is moved through the intestines with muscle contractions. If too much water is absorbed, however, or if the waste moves too slowly, you may become constipated.
Constipation can occur when the passage of digested food slows in your colon due to inadequate fluid or fiber intake, irregular bowel habits, older age, lack of activity, anxiety, pregnancy, medications or illness.
The key to treating constipation is to make sure you are eating enough fiber (five to seven servings of fruits and vegetables) and drinking enough fluids. This helps your stools move through your intestines by increasing the bulk of your stools and making your stools softer.
Exercise also helps the intestines to move more rapidly and regularly.
If you’re doing all you can to stay regular and still have constipation, try a fiber supplement, such as psyllium (Metamucil) or Citrucel. These natural supplements help make stools softer and are safe to use every day. Be sure to drink at least eight to ten glasses of fluid every day. Otherwise, fiber supplements can actually make your constipation worse. Add fiber to your diet slowly to avoid problems with gas.
If your constipation continues, consult your health care provider. He or she may recommend a stool softener, such as docusate (colase) or mineral oil, to soften a bowel movement so that it passes through your intestines more easily. Mineral oil should not be used on a regular basis since it interferes with the absorption of vitamins and can cause pneumonia if it’s accidentally inhaled into your lungs.
For people who are really bound up and need quicker relief try 2 tablespoons of milk of magnesia followed with some orange juice. Or, one to two 10-ounce bottles of magnesium citrate daily for two or three days generally will clear out most people, often causing diarrhea and cramping. People with kidney disease should not use magnesium products. Lactulose or sorbitol can also be used when quick relief is needed.
Enemas and laxatives are not usually needed and should not be not used unless recommended by your doctor. Laxatives such as senna (Senokot, Ex-Lax), bisacodyl (Dulcolax), cascara (Nature’s Remedy, Peri-Colase) work by irritating the walls of your intestines. Just because laxatives are available over-the-counter doesn’t mean they’re harmless. Frequent use can damage your bowels and make constipation worse.
If you are using laxatives frequently, your colon may be dependent on laxatives to have a bowel movement. Talk to your health care provider about weaning off laxatives using these other medicines listed above.
Call your doctor if you notice blood in your stools, if constipation is new and unusual for you, if you are constipated for three weeks or more, or if you are in pain.
Although constipation may be extremely bothersome, the condition itself usually is not serious. If it persists, however, constipation can lead to complications such as hemorrhoids, impaction and cracks or tears in the anus called fissures.
In rare cases, new constipation also may signal more serious medical conditions such as colon cancer or bowel obstruction.
Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.
Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.
Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems
Copyright 2002 The Patriot Ledger
Transmitted March 12, 2002