Constipation is an extremely common problem. Each year millions of Americans visit their doctor for help. A number of factors can influence this:
1- Constipation occurs more frequently as you get older.
2- Constipation may be a side effect of one of your medications.
3- A sedentary lifestyle can contribute. Remember: “If the body doesn’t move, the bowel doesn’t move!”.
4- Dehydration can cause or worsen constipation.
5- And, of course, your diet plays a very important role in the health of your colon.
How should you manage your constipation?
1- Remember that the bowels are most active following meals, but if you ignore your body’s signals to have a bowel movement, the signals become weaker and weaker over time. By paying close attention to these signals, you may have an easier time moving your bowels.
2- Increasing fiber in your diet. The recommended amount of dietary fiber is 20 to 35 grams of fiber per day. You may need to supplement this with commercial fiber preparations, but do it gradually to avoid bloating.
3- Osmolar laxatives. My patients have had the best experience with what we call osmolar laxatives, like Polyethylene glycol (MiraLax®, Glycolax®), Lactulose and Sorbitol. A great advantage of polyethylene glycol is that it does not cause gas or bloating. It is actually the same medication that we use to clean the colon before a colonoscopy…but in a smaller dose. Dissolve it in a big glass of water and take it regularly at night to have daily, formed and easy-to-pass bowel movements.
4- Stimulant laxatives include senna (eg, Black Draught, Ex-lax®, Fletcher’s® Castoria®, Senokot®) and bisacodyl (eg, Correctol®, Doxidan®, Dulcolax®. Some people overuse stimulant laxatives. Taking stimulant laxatives regularly or in large amounts can cause side effects, including low potassium levels. Thus, you should take these drugs carefully if you must use them regularly.
5- Lubiprostone (Amitiza®) is a new prescription medication that treats severe constipation. It is expensive compared to other agents. However, it may be recommended if you do not respond to other treatments.
When should you ask your doctor about it?
• When it is new (i.e., represents a change in your normal pattern)
• When it lasts longer than three weeks
• When it is very severe
• When it is associated blood on the toilet paper
• When it is associated with weight loss
• When it is associated with fever
The doctor will evaluate you; decide if you need to have blood tests, X-rays and possibly a colonoscopy or a sigmoidoscopy. Sometimes other tests are necessary to figure out why your colon is not working right, since some patients have a colon that moves very slowly, and some patients involuntarily squeeze (rather than relax) their muscles while having a bowel movement. Those uncommon conditions require specific treatment.
Author: Dr. Caterina Oneto, she serves as Co-Director of the Women’s Health Center, Brooklyn Gastroenterology and Endoscopy Associates. Fluent in Spanish, wth expertise in endoscopy, colonoscopy, liver and pancreatic disease, Dr. Oneto recently joined the practice after completing her Fellowship in Gastroenterology at Montefiore Medical Center, Albert Einstein College of Medicine.