Constipation

What is Constipation?

It is the most common complaint in the digestive system. It is highly subjective however studies suggest that a frequency of less than 3 bowel movements per week is what defines constipation. Other symptoms include sensation of incomplete evacuation, straining, having hard and dry stool and using methods to help with having a bowel movement. 

What Causes Constipation?

Many factors play a role, and can result in constipation. In general, factors that result in constipation include four main factors: movement of the stomach, intestines and colon, coordination of muscles during defecation (having a bowel movement), decreased water and fiber content, and partial or complete obstruction related to a tumor, mass or polyp. Many times it is the result of more than one factor and treating it addresses more than one component of the above. 

When to See a Doctor?

Any time you are concerned, especially if this is a new symptom. In summary the list below includes common symptoms that you have to see your doctor or a gastroenterologist for: 

  • New onset of constipation

  • Long duration of symptoms, more than 2 weeks or so. 

  • Noticing blood with the stool or dark stool

  • Weight loss

  • Fever

  • Fatigue and weakness

If you have any other concerns it is always better to ask a doctor about your symptoms 

How Can I Treat It?

There are many treatment options that are over the counter. I would recommend before starting on treatment for new onset constipation that you see your doctor and discuss the need for further evaluation before initiating symptomatic treatment. Topics to discuss is the need for colonoscopy depending on your age and medical as well as family history. It is also important to discuss other symptoms which might suggest other causes of constipation  which might need to be worked up prior to initiating treatment. Treatment is in two broad categories, lifestyle modification and over the counter medications. 


1.  Lifestyle Changes: 

This is essential in the treatment plan. It includes dietary component as well as behavioral changes. 

Diet high in fiber can be very helpful. While increasing fiber in the diet can result in bloating, slow and gradual increase in the fiber content improves tolerance which increases compliance with the high fiber diet. Hydration is important. It is recommended to drink 8 cups of water daily if you do not have any other medical restrictions. However, as the colon is very efficient absorbing all the water, excess water intake is not expected to improve constipation significantly.

Behavioral changes can make a big difference.  Never ignore your sensation or urge to have a bowel movement. Developing a habit of having a bowel movement, especially after meals can be helpful. 

Finally, our small and large intestines becomes more active if we are more active. Exercise increases the movement of the intestines and decreases the time food spends inside the intestines making it softer with higher water content. 


2.  Medications

You can easily find sufficient medications to help with constipation. It is important to understand how they work and which one will be best for you. 

  • Fiber supplements: this category of over the counter is not really a medication. It is a supplement. We need 25-35 gm of fiber daily. If we do not reach that amount those medications will help us get there. There is no specific benefit of one more than the other, however, insoluble fibers like cellulose (c) tend to improve GI symptoms slightly better.
  • Osmotic laxatives: Those laxatives add water content to the stool by adding a substance that the intestines would not absorb, maintaining water in the intestinal lumen, which improves the hydration of the stool and it becomes softer. Examples include: PEG 3350 (Miralax) and Lactulose.
  • Stimulant laxatives: This group improves constipation by stimulating the intestinal tract. It includes Bisacodyl (Dulcolax) and senna. This group, while most of the time is safe, can result in loss of potassium through the GI tract if taken more than the needed and recommended dose. 

While you can use self treatment in most cases, make sure you discuss your symptoms with your doctor. If your symptoms are new, not responding to treatment or severe you have to seek medical attention and not attempt to treat yourself. 

3/10/2020