Dear Doctor Column, September 27, 2004

Prevention Key to Avoid Constipation

Question:

I frequently suffer from constipation, sometimes only having a bowel movement two to three times a week. Is this normal? What can I do to prevent this? It's very uncomfortable and sometimes painful.

Answer:

An estimated 25% of Americans complain of constipation, prompting 2.5 million doctor visits and 92,000 hospitalizations a year. Prevention is the best treatment for constipation, which is defined as the infrequent and difficult passage of stool. As your colon removes water from waste products, a stool is formed and moved through the intestine by contractions of muscles in the colon wall. Changes in the speed at which waste passes through the colon or in the amount of water removed from the waste can affect normal bowel function.

The frequency of bowel movements among healthy people varies greatly, ranging from three movements a day to three a week. As a rule, if more than 3 days pass without a bowel movement, the intestinal contents harden causing difficulty or pain during elimination, as you describe.

Many people believe they must have a bowel movement every day to be healthy, but this is not true. Another common fallacy is that waste products stored in the body are absorbed and are dangerous to your health. These misconceptions, among others, have led to a marked overuse and abuse of laxatives. Most are not needed, and excessive use can disrupt the body's normal balance of fluids and minerals. Excess use also can overcome the body's natural mechanisms of elimination, causing constipation and dependence on laxatives to have a bowel movement.

Constipation is a symptom, not a disease. Like a fever, it can be caused by a variety of conditions. Most people have occasional constipation that corrects itself with diet and time. Common causes of constipation include:

• Poor diet and exercise habits. Not including enough high-fiber foods, such as whole-grain cereals and breads and fruits and vegetables, is a common cause of constipation, as is the failure to get enough exercise. Remember, however, an abrupt increase in fiber intake can cause bloating, gas, and possibly cramping, so add fiber-rich items to your diet gradually.
• Medications. Common medications that can cause constipation include pain medications (especially narcotics), antacids that contain aluminum, antihistamines, some antidepressant drugs, iron supplements, and tranquilizers.
• Bad bowel habits. You can start a cycle of constipation by ignoring the urge to defecate. Some people do this to avoid using public toilets, others because they are too busy. After a period of time, you may stop feeling the urge to have a bowel movement altogether.
• Laxative abuse. People who habitually take laxatives become dependent upon them and may require increasing dosages until the intestine becomes insensitive and fails to work properly.
• Diseases and medical conditions. Many diseases that affect the body tissues, such as scleroderma or lupus, and certain neurological or muscular diseases, such as multiple sclerosis, Parkinson disease, and stroke, are associated with constipation. Certain hormonal disturbances, such as an underactive thyroid gland, can produce constipation, as can pregnancy. Irritable bowel syndrome is one of the most common causes of constipation in the U.S. In addition, injuries to the spinal cord and tumors pressing on the spinal cord can produce constipation by affecting nerves that lead to the intestine.
• Travel. A common complaint of travelers, constipation is probably related to changes in schedule, diet, and amount of fluid consumed.

Although bothersome, constipation usually is not serious. However, on occasion, it can signal an underlying serious disorder. You should see your physician when symptoms are severe, when any changes in bowel habits last longer than 3 weeks, or when any other symptoms are associated, such as abdominal pain, nausea, fever, or bleeding.

Try these recommendations to avoid constipation:

1. Drink six to eight glasses of water or other liquids (not alcohol) every day.
   
2. Eat plenty of high-fiber foods, such as fresh fruits and vegetables (a minimum of 5 servings per day is recommended) and whole-grain cereals and breads.
   
3. Set aside time after breakfast or dinner for undisturbed visits to the toilet.
   
4. Don't ignore the urge to defecate.
   
5. Exercise regularly (at least 30 minutes a day).