Constipation

Constipation

So Easy to Avoid

It's been days since your last bowel movement. Your head aches and you're feeling gassy. What's worse, you're bloated--as if there's a clogged drainpipe in your abdomen that's growing larger and larger.

Gulping down a quick mug of coffee, you slip on a loose-fitting dress and rush to the office.

On the way, you think about one of those fast-acting laxatives advertised on TV; that might get things moving. But the ladies room at the office is a little too public to deal with this kind of private problem--and besides that, there's just no time today to deal with constipation.

Maybe you should make time.

Giving your body ample time to have a bowel movement is as crucial in the battle against constipation as eating enough high-fiber foods, drinking plenty of fluids and getting exercise, says Susan Stewart, M.D., a gastroenterologist in New York City and associate medical director at Morgan Guaranty Trust.

A lot of us don't have much extra time, but we do have constipation. An estimated 50 million Americans get that all-blocked-up feeling at least once in a while. And 18 million people--12 million women and 6 million men--are bothered by this uncomfortable problem frequently.

In fact, constipation is something of a national obsession. In 1993 alone, Americans spent $740 million on over-the-counter laxatives.

The funny thing is, many laxative users may not need one at all. Doctors say too many of us have fallen for the myth that anything less than one bowel movement a day means we're constipated. It just isn't so.

When It's Really Constipation

"Regularity is different for everyone," says Dr. Stewart. "If a person has a well-formed stool, not too hard and not too watery, and they go just twice a week without pain or discomfort, I'm not going to worry about them.

"Then again, some people go twice a day. The important things are the comfort of the person and the form of the stool."

Bowel-movement frequency varies for many reasons, including age, diet and differences in your body's natural rhythms.

Constipation comes in two uncomfortable varieties: When relieving yourself is difficult or painful, with hard, dry feces, and when the urge to go is so infrequent--every three days or less--that you get that bloated, all-blocked-up feeling.

Doctors aren't sure why more women than men come to them with complaints about constipation. But factors that can leave you straining on the toilet include hormonal changes during the menstrual cycle, pregnancy, crash diets, depression and side effects from medicines such as antidepressants, codeine and iron and calcium supplements.

Any alteration in your daily routine, from not drinking enough fluids to changing the kind of food you eat to getting less exercise, can also cause it.

That's why many people become constipated while on vacation. Eating patterns change, and in exotic locales you may avoid the local water--not to mention those dirty restrooms. Your body may simply balk at using a different or unclean toilet. Even a public--or unfamiliar--restroom can cause your system to go on hold.

"The act of defecation is a conditioned reflex," says Henry D. Janowitz, M.D., clinical professor emeritus of medicine and a consultant in gastroenterology at Mount Sinai School of Medicine in New York City and author of Your Gut Feelings. "Even if you travel and go to a hotel with a nice private bathroom, it might be hard to move the bowels. The long-established reflex that sets off normal bowel movements is being interrupted," he says.

Then there's the fast-forward pace of daily living.

"In some people, the intestinal tract is not a demand performer," says Dr. Stewart. "If you have one ideal time in the day to have a bowel movement and that time arises when you're on the train or walking through the subway station or talking to the boss, you may not get the urge to go again for another 24 hours."

Ignore the call of nature long enough and you won't even notice it anymore. The result can be constipation.

When Constipation Is a Symptom

Chronic constipation can also signal something more serious than a changed bowel-movement schedule or unease with a different bathroom. It can be a symptom of irritable bowel syndrome or Hirschprung's disease, a rare condition in which key nerves in the colon that control the movement of feces through the bowels are lacking.

Researchers also see a link between sexual abuse and severe constipation. In some abuse survivors, pelvic muscles tighten during defecation instead of relaxing. "The harder they strain, the harder it is to evacuate," says Douglas A. Drossman, M.D., professor of medicine and psychiatry in the Division of Digestive Diseases and Nutrition at the University of North Carolina School of Medicine at Chapel Hill.

Such cases can be tough to treat, Dr. Drossman says. People with this condition may respond to biofeedback sessions that teach them how to relax specific muscles.

But for garden-variety constipation, the big four--fiber, fluids, exercise and time--usually spell relief, according to Steven Peikin, M.D., professor of medicine and director of gastroenterology at the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Cooper Hospital/University Medical Center in Camden.

Fix It with Fiber

Fiber-rich foods such as fresh fruits, vegetables, grains and beans increase the bulk and water content of your stools. Bigger, wetter stools pass more quickly through the intestines, though doctors are not entirely sure why that is. The National Cancer Institute recommends getting 20 to 30 grams of fiber a day. But most of us eat highly refined foods--white bread instead of whole-wheat, for example, or a chocolate brownie instead of an apple--and get only about a third of the fiber we need every day.

"A high-fiber diet helps 90 percent of the people I see with constipation," says Dr. Peikin. "Our great-grandparents used to come back from grocery shopping with baskets full of fresh fruit and raw vegetables. Today it's processed food and fast food. We've lost the fiber. So you have to change the way you eat. And that can also mean changing the way your family eats, if you're cooking for other people."

A study of elderly patients at a Virginia nursing home found that most cut their laxative use by half or more after just four weeks on a high-fiber regimen combined with more fluids, exercise and scheduled time on the toilet. "If it works in older people, it should work even better in younger people," says Dr. Janowitz. That's because most younger people have better muscle tone and higher activity levels and are less laxative dependent.

Some doctors say fiber supplements such as Metamucil, Perdiem or others containing a high-fiber source like psyllium seeds are an acceptable way to boost your daily fiber intake. But the supplements have a downside, says Carol Walsh, R.D., a clinical dietitian at the University of California at San Diego Medical Center.

If your main source of fiber is a supplement, this can be a problem, says Walsh, because the supplement lacks nutrient content. Walsh suggests instead that you eat foods that are sources of nutrients as well as fiber.

As for laxatives, resist the quick fix. Stimulants such as Ex-Lax, Dulcolax and Fletcher's Castoria work by causing rhythmic, muscular contractions of the small or large intestine. Though they promise prompt relief, such laxatives can lead to dependency and can damage your bowels with repeated daily use.

"Jump-starting" your bowels with harsh laxatives can eventually damage the colon, says Dr. Peikin. "You can end up with lazy bowel syndrome, where your intestines don't want to work anymore."

Preventing Constipation

Here are ways to put more fiber into your diet, as well as other tips for coping with constipation.

Go for five a day. Have five servings a day of fresh fruits and vegetables and six servings of whole grains. Starting the day with a half-cup of high-fiber breakfast cereal and an apple can give you up to 16 grams of fiber. "You can also take dried fruit to work, make your sandwich for lunch with whole-grain bread, snack on a carrot and have some kidney beans with your dinner," suggests Walsh.

If all that fiber gives you gas, back off for a while and add fiber-filled foods more slowly.

Wash it down. Walsh counsels people to drink eight to ten eight-ounce glasses of fluids a day. "I would include water, juice and milk," she says. "But keep coffee or sodas or tea with caffeine to a minimum. Caffeine is a diuretic that can make you urinate more. And you need the water to bulk up all the fiber you're eating." Also, tea contains substances called tannins, which can cause constipation.

Skip low-fiber no-nos. Chocolate bars, cheese and other high-fat, no-fiber foods are notorious cloggers and can make you feel so full you don't reach for high-fiber choices. Eating lots of meat, refined sugar, pastries, candy and anything made with all white flour has the same effect, says Dr. Peikin.

Move it. If you move, so will your bowels. Walk at least 20 minutes a day three times a week. "Any kind of aerobic activity, such as swimming or running or an aerobics class, seems to improve intestinal transit," says Dr. Drossman.

Take a time-out. Take advantage of the "gastrocolic reflex." Your best chance for having a bowel movement comes 20 to 30 minutes after a meal, when this reflex causes your bowels to start moving. Make sure you're sitting on the toilet then--even if you don't feel the call of nature. "Sitting on the toilet, even if you don't have the urge, may give your body the chance to sense that signal," says Dr. Peikin. "It's a way to retrain your bowels. People with constipation should do this no matter what. Unless you're in the most important board meeting of your career, excuse yourself."

Be prepared. Carry paper seat covers or a small can of disinfectant in your purse if the cleanliness of public bathrooms is a concern. And don't be shy about using them.

"A lot of people wait till they're home," says Nancy Norton, founder of the International Foundation for Bowel Dysfunction, a support group based in Milwaukee. "They don't want to use a ladies' room. It's not private. But it's important to pay attention to the urge to defecate."

Switch your calcium supplement. "It's a well-known phenomenon that calcium carbonate can cause constipation," says Dr. Stewart. Try brands that use calcium phosphate and calcium citrate instead; they're available in most drugstores. Or drink orange juice that contains calcium. And don't forget calcium-rich foods such as dairy products, canned salmon with bones, oysters and greens such as collards, mustard and dandelion.

Choose another form of iron. If you suspect your iron supplement is to blame, consider the alternatives. Iron comes in three forms: as ferrous sulfate, ferrous fumarate and ferrous gluconate. Dr. Janowitz says none of these is considered less constipating, but different forms work best for different people. Or choose an iron-rich diet that includes lean beef, molasses, beans, raisins and dried apricots.

Drink prune juice. For a quick fix that works for nearly everyone, drink eight ounces of prune juice in the morning. "It's old-fashioned, but it gets results," Dr. Peikin says.

Add a fiber supplement. Also known as bulk-forming laxatives, products like Metamucil, FiberCon and Citrucel absorb water in the intestine and make stools softer. Always take them with at least eight ounces of water, says Dr. Peikin.

Try a natural unclogger. Ilana Goldman, M.D., a general practitioner specializing in holistic medicine at the Hoffman Center for Holistic Medicine in New York City, advises people who are constipated to take one to three tablets of magnesium citrate twice a day. "There's no toxicity," Dr. Goldman says. "Pregnant women can take it, too."

Give yourself an enema. Using an enema bag or baby syringe that you can buy at the drugstore, squeeze about a quart of warm tap water into your rectum. The water makes the colon contract, starting a bowel movement. Enemas are safe, says Dr. Peikin, provided you stick with tap water or an over-the-counter enema liquid and keep the stream of water gentle.

See your doctor. Bleeding, abdominal pain or constipation that lasts more than three weeks are reasons to consult a physician. "When someone's been regular and all of a sudden they're constipated, especially over age 40, there is the potential for serious disease like cancer," says Dr. Peikin. Constipation can also lead to complications like hemorrhoids or anal fissures.