Constipation

---

Constipation

Do you take War and Peace into the bathroom instead of Reader's Digest? If so, you're probably constipated.

Constipation actually has two forms. Some people have to strain to move their bowels every time they want to go. But others just feel the urge too seldom.

How often is often enough? Routines vary. But if you have to go fewer than three times per week and each time it's a strain, there's a mighty good chance you're constipated. Here's how to get things moving again.

Lotion the motion with fiber. "Go on a high-fiber diet," says Edward P. Donatelle, M.D., professor emeritus of the Department of Family Practice and Community Medicine at the University of Kansas School of Medicine in Wichita. Soluble fiber, found in grains, legumes and fruits, is particularly effective. Oatmeal, rice, wheat germ, corn bran, prunes, raisins, apricots, figs and an apple a day are all good sources, Dr. Donatelle says.

Try a natural laxative. For a concentrated constipation buster, go for a fiber supplement that will budge that balky bowel. One of the best is psyllium, which is sold in health food stores. Marvin M. Schuster, M.D., chief of the Department of Digestive Diseases at Francis Scott Key Medical Center in Baltimore, recommends one teaspoon of psyllium with meals. Add the teaspoonful to a glass of water or juice and stir thoroughly before drinking. (You can also make a "paste" of one teaspoon of psyllium moistened with water, but be sure to drink at least a full glass of juice or water afterward.) Another alternative: Metamucil, a bowel regulator that contains psyllium and is sold in most drugstores and some supermarkets.

Use fluids to fuel the fiber. "Drink plenty of fluids," suggests John Sutherland, M.D., clinical professor of family practice at the University of Iowa College of Medicine in Iowa City and director of the Waterloo Family Practice Residency Program in Waterloo. Fluid expands and softens the fiber you're eating, allowing it to form bulk in the colon. That bulking action in turn triggers the urge to move your bowels.

"Ordinarily you need to drink about a gallon of fluid a day--the more, the better," Dr. Sutherland says.

When to See the Doctor Although constipation is usually not a serious problem, there are times when you should seek a doctor's advice. If you've had symptoms for more than three weeks and home remedies don't help--even with lots of fluid, fiber and exercise--be sure to see your doctor. You should also consult your doctor if there is blood in your stool. Although rare, constipation can sometimes signal a serious intestinal disease or disorder, including cancer, according to gastroenterologist Nicholas Talley, M.D., Ph.D., associate professor of medicine at the Mayo Clinic in Rochester, Minnesota.

Avoid milk and cheese. If you have a problem with constipation, try avoiding milk products temporarily, says Dr. Donatelle. Both milk and cheese contain casein, an insoluble protein that tends to plug up the intestinal tract.

Get your body moving and your bowels will, too. "Exercise can help that lazy bowel to function better," according to gastroenterologist Nicholas Talley, M.D., Ph.D., associate professor of medicine at the Mayo Clinic in Rochester, Minnesota. "Aerobic exercise such as walking, running and swimming is best." If you're a walker, for instance, go for a brisk 20- to 30minute arm-swinging stroll every day.

Listen when your body talks. "Sometimes people who are constipated ignore 'the urge' and wait until later This can aggravate the problem," says Dr. Sutherland. When your body tells you it's time to go, head for the bathroom as soon as possible.

Get into training. You can actually train your bowels to get on a regular schedule, says Vera Loening-Baucke, M.D., a pediatrician at the University of Iowa Hospitals and Clinics in Iowa City. Her advice: Sit on the toilet for about ten minutes after the same meal every day. The key is to stay relaxed. Eventually, says Dr. Loening-Baucke, your body will catch on.

Be Selective about Laxatives Many over-the-counter products are sold as laxatives, but not all laxatives are recommended by doctors. In fact, heavy use of some laxatives can be counterproductive and even risky, according to Ronald L. Hoffman, M.D., director of the Hoffman Center for Holistic Medicine in New York City. Heavy use of some laxatives can give you diarrhea, according to Dr. Hoffman. And many are habit-forming: If you always rely on a laxative to prompt bowel movements, your body may begin to need it to trigger the action. Laxatives containing castor oil can damage your intestinal lining, and those that have mineral oil can interfere with your ability to absorb certain vitamins and minerals, according to Dr. Hoffman. Safest are the natural or vegetable laxative products, high-fiber bulking agents such as Metamucil, Citrucel or Perdiem that are sold in most drugstores. "If you can't tolerate a high-fiber diet, these bulking agents are very safe, helpful supplements," according to gastroenterologist Nicholas Talley, M.D., Ph.D., associate professor of medicine at the Mayo Clinic in Rochester, Minnesota. Dr. Talley recommends taking the cautious approach with bulking agents. Follow the directions on the package, increasing the dosage slowly if needed.

Reach for the rhubarb. "When it's in season in early summer, fresh rhubarb is a delicious and powerful antidote to constipation," says Ronald L. Hoffman, M.D., director of the Hoffman Center for Holistic Medicine in New York City. It contains a good amount of fiber, which helps keep things moving. For a rhubarb juice refresher that will get your tract on track, try this cooling recipe: Chop three stalks of rhubarb (remove the leaves, which are toxic) and mix with one cup of apple juice, 1/4 of a peeled lemon and one teaspoon of honey. Put all the ingredients in a blender or food processor and puree until smooth. Some advice: Try a small amount of rhubarb juice at first and see how your body responds. It can be as powerful and quick-acting as prune juice. Also, depending on how you like the taste, you might want to mix it with other juices. Caution: Rhubarb should be avoided by people with a history of calcium kidney stones.

Watch out for water robbers. Coffee, tea and alcohol are all diuretics that can leave you somewhat dehydrated, says Dr. Hoffman. Since you need fluids in your system to aid bowel movements, you're more likely to have constipation if you drink these beverages. When you do have them, go for moderation and help compensate by drinking plenty of water, Dr. Hoffman suggests.

Give a high-fiber cookie to the kid in you. When you need a break from bran cereals, don't give up on fiber. Instead, try a fiber cookie supplement like Fiberall or Fibermed wafers, says Arnold Wald, M.D., head of the Gastroenterology Division at Montefiore University Hospital in Pittsburgh. "Be sure to take them with plenty of fluids--at least a six- to eight-ounce glass with each," he suggests.

Review your Rx. Medicines that can contribute to constipation include prescription antidepressants and painkillers as well as some over-the-counter remedies such as iron supplements and aluminum-containing antacids. Dr. Hoffman recommends that you check with your doctor if you suspect your medication is causing your constipation.