Constipation
Constipation
18 Solutions to a Common Problem
What goes up must come down. Sir Isaac Newton proved that, sitting under an apple tree.
What goes in must come out. You proved that, sitting on the toilet this morning.
Well, didn't you?
Or was it yesterday morning that you had your last bowel movement? Or the day before? Or one cold but memorable day early last December?
Constipation is no fun. Sometimes it can be painful. But the cause of your sluggish bowels is often easy to find. It may include a lack of fiber in the diet, insufficient liquid intake, stress, medications, lack of exercise, and bad bowel habits, says Paul Rousseau, M.D., chief of the Department of Geriatrics at the Carl T. Hayden Veterans Administration Medical Center in Phoenix, Arizona.
We take a look at all of these factors, and ways to remedy the situation below.
Are you really constipated? You think you have a problem, but do you really? Like all of us, you have been bombarded most of your life by laxative advertisements that try to give you the impression that a daily bowel movement is essential to good health, and this just isn't so, says Marvin Schuster, M.D., chief of the Department of Digestive Diseases at Francis Scott Key Medical Center in Baltimore, Maryland.
Many Americans, he says, are subject to perceived constipation—they think they are constipated when they are not. In reality, the need to defecate varies greatly from individual to individual. For some, a bowel movement three times a day may be considered normal, for others three times a week may suffice.
Are you getting enough fluids? Our experts agree that the first thing a constipated individual should do is check his diet. The foremost menu items for battling constipation are dietary fiber and liquids. Lots of both are essential to keep the stool soft and to help it pass through the colon.
How much liquid and how much fiber do you need? Let's start with the liquid. A minimum of six glasses of liquid, and preferably eight, should be part of every adult's diet, says Patricia H. Harper, a registered dietitian in the Pittsburgh, Pennsylvania, area, and spokeswoman for the American Dietetic Association. While any fluid will do the trick, "the best fluid is water," she says.
Eat lots more fiber. Most Americans don't get enough fiber in their diets, says Harper. The American Dietetic Association recommends a daily consumption of 20 to 35 grams of dietary fiber for all adults and at least 30 grams for those who suffer from constipation.
The Alternate Route
Bypass the Oil Slick Eliminate from your diet all oils that have been removed from their sources, such as liquid vegetable, olive, or soy oil, and it may help relieve chronic constipation, says Grady Deal, D.C., Ph.D., a nutritional chiropractor in Koloa, Kauai, Hawaii. "It's not oil per se, but eating it in its free state that causes constipation and many other digestive problems," says Dr. Deal, who bases his theory on the work of turn-of-the-century health reformer John Harvey Kellogg, M.D. (brother of the breakfast cereal magnate). The problem with these oils, explains Dr. Deal, is that they form a film in the stomach, which makes it difficult to digest carbohydrates and proteins there and in the small intestine. "Adequate digestion is delayed up to 20 hours causing putrefaction, gas, and toxins," which back up in the colon and large intestine, he says. But oils eaten in their natural form, locked up in such things as whole nuts, avocados, and corn, are released slowly into the body, so that no oil slicks occur to block digestion and create constipation problems. These oils, as opposed to the separated kind, are "a wholesome and nutritious element of food," says Dr. Deal. |
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Where does fiber come from? "From your complex carbohydrates—such as those in whole grains, fruit, and vegetables," says Harper. It's not difficult to get 30 grams in your daily diet if you choose foods carefully. One-half cup of green peas, for instance, will give you 5 grams; one small apple supplies 3 grams, and a bowl of bran cereal can give you as much as 13 grams. Tops among the fiber heavyweights, however, are cooked dried beans, prunes, figs, raisins, popcorn, oatmeal, pears, and nuts. One word of caution, though, increase your fiber intake slowly to avoid gas attacks.
Take time to go to the gym. You know that exercise is good for your heart, but did you know that it's good for your bowels? "In general, we feel that regular exercise tends to combat constipation by moving food through the bowel faster," says Edward R. Eichner, M.D., professor of medicine and chief of hematology in the Department of Medicine at the University of Oklahoma.
Take a walk, and bring your baby. Any form of regular exercise will tend to alleviate constipation, but the one mentioned most often by our experts is walking. Walking is particularly helpful for pregnant women, many of whom experience constipation as their inner workings are altered to accommodate the growing fetus.
Anyone, including mothers-to-be, should walk a "good, hearty 20 to 30 minutes" a day, suggests Lewis R. Townsend, M.D., clinical instructor of obstetrics and gynecology at Georgetown University Hospital in Washington, D.C. Pregnant women should take care not to get too winded as they walk.
Toilet train yourself. Throughout our lives, many of us condition ourselves to go to the bathroom not when nature calls but when it's convenient. Ignoring the urge to defecate, however, can lead progressively to constipation. But it's never too late to improve your bowel habits, says Dr. Schuster. "The most natural time to go to the toilet is after a meal," he says. So pick a meal, any meal, and every day following that meal sit on the toilet for 10 minutes. In time, says Dr. Schuster, you will condition your colon to act as nature intended.
MEDICAL ALERT
Play It Safe; See a Doctor Constipation itself is usually not serious, says Marvin Schuster, M.D. You should call your doctor, however, when symptoms are severe, last longer than three weeks, are disabling, or if you find blood in your stool, he says. Although it's rare, constipation can signal a serious underlying disorder. In addition, contact your doctor if your constipation is accompanied by a distended abdomen, which may signal an intestinal obstruction, says Paul Rousseau, M.D. |
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Slow down and take it easy. When you're frightened or tense, your mouth dries and your heart beats faster. Your bowels stop up as well. "It's part of the fight-or-flight mechanism," says John O. Lawder, M.D., a family practitioner specializing in nutrition and preventive medicine in Torrance, California. If you suspect tension is at the bottom of your constipation, take time to relax, perhaps by listening to relaxation tapes.
Have a hearty laugh. A good belly laugh can help with constipation in two ways. It has a massaging effect on the intestines, which helps to foster digestion, and it's a great reliever of stress, says Alison Crane, R.N., president of the American Association for Therapeutic Humor. Heard any good constipation jokes lately?
Reconsider laxative tablets. Commercial laxatives often do what they are intended to do, but they are terribly addicting, warns Dr. Rousseau. Take too many of these chemical laxatives, "and your bowel gets used to them, and your constipation can get worse," he says. When should you take laxatives from a bottle? "Almost never," says Dr. Rousseau.
Know that not all laxatives are the same. In most pharmacies, right next to the chemical laxatives, you'll find another category of laxatives, often marked "natural," or "vegetable" laxatives, whose main ingredient is generally crushed psyllium seed. This is a superconcentrated form of fiber, which, unlike the chemical laxatives, is nonaddictive and generally safe, even taken over long periods, says Dr. Rousseau. He cautions, however, that these must be taken with lots of water (read the instructions on the box), or they can gum up inside you.
Try one doctor's special recipe. A problem with many of the psyllium-based laxatives is that they can be expensive. But you can make your own by buying the psyllium seeds in a health food store and crushing them yourself. Dr. Lawder suggests you grind two parts psyllium with one part flax and one part oat bran (also available in health food stores) for a super-high-fiber concoction. "Mix the ingredients up with water, and have it as a little mash every night around 9 o'clock," says Dr. Lawder.
Get fast relief—once in a while. If you're really miserable, nothing will work faster to move your bowels than an enema or a suppository. For occasional use, they are perfectly all right, says Dr. Rousseau. Use them too often, however, and you risk creating a lazy colon. That is, you could wind up worse off.
Use only clear water or saline-solution enemas, never soapsuds, which can be irritating, says Dr. Rousseau. And when shopping for a suppository, pick up only glycerin ones, avoiding the harsher chemical selections on the market.
Review your medications and supplements. There are a number of medications that can bring on or exacerbate constipation, says Dr. Rousseau. Among the common culprits are antacids containing aluminum or calcium, antihistamines, anti-Parkinsonism drugs, calcium supplements, diuretics, narcotics, phenothiazines, sedatives, and tricyclic antidepressants.
Beware of certain foods. Some things may constipate one person but not another. Milk, for instance, can be extremely constipating to some, while it gives others diarrhea. Foods that tend to produce gas, such as beans, cauliflower, and cabbage, should be avoided by those whose constipation is the result of a spastic colon, says Dr. Schuster. You should suspect a spastic colon if your constipation is sharply painful.
Eat small meals. Those with spastic colons should also avoid large meals that distend the digestive tract, thus worsening constipation, says Dr. Schuster.
Be caution about herbs. Herbal remedies for dealing with constipation abound. Among those touted are aloe (juice, not gel), senna, rhubarb (medicinal), cascara sagrada, dandelion root, and plantain seeds. Some, such as cascara sagrada, can be very effective, says Dr. Lawder, but you need to be careful. Certain herbal laxatives, just as chemical ones, should not be overused.
Don't strain. As tempting as it may be to huff and puff your way out of constipation, it is not wise to do so. You risk giving yourself hemorrhoids and anal fissures, which not only are painful, but can also aggravate your constipation by narrowing the anal opening. Straining can also raise your blood pressure and lower your heartbeat. Dr. Rousseau says he has known several elderly patients to black out and fall off the toilet, sometimes suffering fractures as a result—which brings us back one again to Sir Isaac Newton and those immutable laws of gravity.
PANEL OF ADVISERS
Alison Crane, R.N., is president of the American Association for Therapeutic Humor. She is also vice president of Strombach, Crane & Associates, a consulting firm in Skokie, Illinois, that specializes in stress reduction programs for hospitals.
Grady Deal, D.C., Ph.D., is a nutritional chiropractor and psychotherapist in Koloa, Kauai, Hawaii. He is also the founder and owner of Dr. Deal's Hawaiian Fitness Holiday health spa in Koloa.
Edward R. Eichner, M.D., an expert in the effects of exercise on the human body, is a professor of medicine and chief of hematology in the Department of Medicine at the University of Oklahoma in Oklahoma City.
Patricia H. Harper, R.D., is a spokeswoman for the American Dietetic Association and a nutrition consultant in the Pittsburgh, Pennsylvania, area.
John O. Lawder, M.D., is a family practitioner specializing in nutrition and preventive medicine in Torrance, California.
Paul Rousseau, M.D., is chief of the Department of Geriatrics at the Carl T. Hayden Veterans Administration Medical Center in Phoenix, Arizona. He is also an adjunct professor in the Adult Development and Aging Section of Arizona State University in Tempe.
Marvin Schuster, M.D., is chief of the Department of Digestive Diseases at Francis Scott Key Medical Center in Baltimore, Maryland, and professor of medicine and psychiatry at Johns Hopkins University School of Medicine in Baltimore.
Lewis R. Townsend, M.D., is in private practice in Bethesda, Maryland, and is a clinical instructor of obstetrics and gynecology at Georgetown University Hospital and director of the physician's group at the Columbia Hospital for Women Medical Center, both in Washington, D.C.
