Information for patients : what you should know about constipation

Journal of Family Practice, June, 2002

Your doctor may test or treat you for constipation if you have 2 or more of the following problems for several weeks or longer:

* Hard, lumpy stools

* Difficulty pushing stool out of your body when you are on the toilet

* Feeling like you need to have a bowel movement even when you've already had one

* A sense that the anal area (where stool comes out) is blocked

* Having fewer than 3 bowel movements in 1 week

Causes of constipation

To digest food and get rid of waste, the large intestine (or colon) has to mix together food and water. The intestines need to contract to move waste products through the intestine and out of the body when you go to the bathroom.

If there isn't enough water in the colon, or your intestines don't contract well, you may get constipated. Some diseases or medical conditions cause constipation, for example, being pregnant or having diabetes. Some medications can cause constipation. So can having emotional problems, poor diet, or lack of exercise.

Diagnosis: What you can expect

Your doctor may be able to tell that you have constipation just by asking about your symptoms and examining you. You may also need blood tests to see if there is anything keeping the bowel from working well. You may have x-rays to show whether there is stool blocking the intestines.

If no cause is found, more tests may be needed. You may have one or more of the following tests, which create pictures of the intestines:

Barium enema--A material called barium, which acts like a dye, is passed into the colon. Then special x-rays are taken.

Flexible sigmoidoscopy--A thin tube is placed in the rectum and passed into the colon. A tiny light and viewer are attached The tube allows the doctor to see about one third of the colon. You may be given medicine before the test to help reduce any discomfort.

Colonoscopy--This procedure is similar to flexible sigmoidoscopy, but the tube used is longer so that the doctor can see the whole colon. You may be given medicine before the test to help reduce any discomfort.

Treatment

Diet and laxatives

You may be told to eat a high-fiber diet or take medication called laxatives, or both. There are many kinds of laxatives. If one kind doesn't work well for you, the doctor may choose another.

Laxatives can cause side effects such as gas, bloating, or cramping. Drinking plenty of water daily can reduce these problems.

Other treatments

Your doctor may suggest enemas or suppositories. Do not start using these without your doctor's recommendation.

There are other treatments for certain types of constipation. For example, there is behavioral therapy (training yourself to behave differently), biofeedback (learning to recognize your body's signals), and, in some cases, surgery.

Helping yourself

There are many ways to fight constipation.

* Always go to the bathroom soon after you feel the urge.

* Set a routine for using the toilet, for example, after breakfast every day.

* Don't drink alcohol and caffeine. They make stools drier and harder.

* Walk, bike, or swim for at least 30 minutes daily. Physical activity keeps the intestines working well.

* Drink at least four 8-ounce glasses of fluid (other than alcohol) daily, in addition to whatever you drink with meals.

* Eat 20-35 grams of fiber daily. Increasing the fiber in your diet is the easiest way to do this. Try for 3-5 vegetables, 2-4 fruits, and 2-4 servings of whole grain cereal or bread every day.

Types of laxatives

                       Example            Dose *
Bulk
  Wheat bran            --         8 oz/day
  Psyllium           Metamucil     1-6 teaspoons/day
  Methylcellulose    Citrucel      1-3 tablespoons/day
  Calcium            FiberCon      2-4 tablets/day
    polycarbophil

Saline
  Magnesium          Citroma       4-8 oz/day
    citrate
  Magnesium          Milk of       24 tablespoons/
    hydroxide          Magnesia    day (half this dose
                                   for concentrate)
Osmotic
  Polyethylene       MiraLax       1 tablespoon/day
    glycol
  Sorbitol           Generic       2-10 tablespoons/day
  Lactulose          Chronulac     1-2 tablespoons/day

Stimulant
  Castor oil         Emulsoil      1-4 tablespoons/day
  Bisacodyl          Dulcolax      1-3 tablets/day
  Cascara            Generic       1 tablet/day
  Senna              Senokot       2-4 tablets/day

                      Onset of
                       action
Bulk
  Wheat bran         12-72 hours
  Psyllium           12-72 hours
  Methylcellulose    12-72 hours
  Calcium            24-48 hours
    polycarbophil

Saline
  Magnesium          1/2-3 hours
    citrate
  Magnesium          1/2-3 hours
    hydroxide

Osmotic
  Polyethylene       24-48 hours
    glycol
  Sorbitol           24-48 hours
  Lactulose          24-48 hours

Stimulant
  Castor oil         2-6 hours
  Bisacodyl          6-12 hours
  Cascara            6-10 hours
  Sienna             6-12 hours

* Most laxatives should be taken with 8 oz of juice water and some
are mixed in juice or water. Therefore it is important to read
the directions that come with the laxative.