Constipation

Constipation

To understand constipation, it helps to gain a basic grasp of the normal workings of the gastrointestinal tract. The tract’s primary purpose is to nurture the body by extracting energy, nutrition, and chemicals from food for later use. This extraction process takes place among the twists and turns of a long, winding path. After its sojourn in the stomach and the area just below—called the duodenum—digested food travels through the small intestine to the colon (also known as the large intestine). Once through the colon, waste is stored in the rectum as individual stools, before being passed through the anus. “The process is kind of like making mulch out of grass,” says Sam Sugar, M.D., doctor in private practice in Evanston, Illinois.

Constipation is a common problem, especially among people over 60, says Dr. Sugar. While your toilet-going patterns may not change much as you age, some shifts in lifestyle patterns can affect the state of your intestinal tract.

Though it’s likely that at some point in our lives we will all feel blocked, it’s generally not a cause for great concern, experts say. A sensible regimen of diet and exercise can often return you to normal.

Try This First

Add fiber. The root of the word constipation means “to press or crowd together.” Think of the freeway at rush hour with cars just inching along. Your listless gastrointestinal tract, if constipated, moves slower unless you help it out. The best way to do this is to consume more fiber. Both soluble and in soluble fiber play a role in preventing con stipation. Soluble fiber, which dissolves easily in water, takes on a soft texture in the intestines, helping to prevent dry, hard stools. Insoluble fiber passes almost unchanged through the intestines and adds bulk to the stool. “Try to get from 25 to 40 grams of fiber in your diet a day,” says Christopher Lahr, M.D., director of Complete Colon Care in Charleston, South Carolina, and the author of Shining Light on Constipation. High-fiber foods include beans, whole grains like buckwheat, bran cereals such as Kellogg’s All-Bran, fresh fruits like avocados, and vegetables such as artichokes.

Other Wise Ways

Go slow. Adding too much fiber too quickly to your diet may solve your constipation but replace it with gassiness, bloating, and diarrhea. But you can avoid these side effects by introducing fiber slowly. Each week, increase your daily intake by no more than five grams, the amount of fiber in one cup of cooked carrots, suggests Dr. Lahr.

Wash it down. While fiber provides the bulkiness of fecal matter, it alone cannot ensure adequate passage of stools through the body. To complete the job, the bowel needs water. Without it, stools dry out and become difficult to pass.

“The simplest way to influence your BM ability is to increase your intake of water,” says Dr. Sugar. To maintain good bowel movements, he advises drinking six to eight glasses of water a day.

Move around. As we get older and cut back on vigorous exercise, more sitting around directly affects the colon by making it work more sluggishly. “We generally recommend just walking,” Dr. Lahr explains. “Try to walk up to three miles a day.” He says that bedridden people, who frequently experience constipation, should at least stand up as often as possible (if their doctors say that it is safe for them to do so), letting sheer gravity aid the digestive process.

Go when you have to. On occasion, according to Dr. Lahr, people simply ignore the urge to defecate. This may happen for a variety of reasons, but a primary one has to do with habit. “Some people don’t want to go anywhere other than their own homes,” he explains.

While he sympathizes with that desire, he warns that ignor ing the urge to move the bowels could lead to constipation. So wherever you are, try to go to the bathroom when you get the urge.

Use your fingers. Overall, women report more constipation than men. Dr. Lahr says that some women experience constipation because of a rectocele—a bulge of the lower rectum into, over, or behind the vagina. A rectocele sometimes forms after a hysterectomy, as the rectum falls into the place of the uterus. Rectoceles trap stool and make evacuation extremely difficult. However, a woman can insert a finger or thumb into her vagina to spur defecation.

Pushing on the rectocele bulge through the wall of the vagina helps to push the stool out of the rectum. “There is nothing dangerous about using the fingers to aid defecation,” he says. “We manage a lot of people with rectoceles. We just tell them, ‘Put your finger in your vagina and empty out the stool.’.”

Buy in bulk. Bulk-forming laxatives, available in pharmacies and grocery stores, absorb water in the intestine and make the stool softer. Well-known brands include Metamucil and Citrucel—and you can select flavors that make them easier to swallow, says Dr. Lahr. Follow the instructions on the package. And be sure to drink as much water as recommended: The fiber in the laxative needs that liquid to “bulk up” and do its job.

Add a little more. For his part, Dr. Lahr observes that underdosing on fiber additives could be a problem for many consumers. “The label recommends one tablespoon one to three times a day,” he says. He agrees with the amount but has found that the dose is often more effective if taken all at once. “I have come upon this through trial and error over 10 years with thousands of patients. Start at the recommended level, but work up to three heaping tablespoons of the additives once a day. That will dramatically improve most people’s bowel regularity,” he observes. Just be sure that you have one 10-ounce glass of water when you take those three tablespoons.

Take a dose of encouragement—but not too often. Popular stool-moving remedies such as enemas, stool softeners, and castor oil have all shown positive effects. They mildly irritate the colon into action and slow down water absorption from the gut. Don’t use any of these habitually, though, says Dr. Sugar. Used long term, these powerful remedies can damage your colon.

Go to extremes. An alternative approach to constipation is to stimulate the central nervous system and blood flow. People can do this in their own homes using hot and cold foot baths, says Thomas Kruzel, naturopathic physician in private practice in Portland, Oregon. Spend five minutes with your feet or legs in a hot foot bath and then plunge them into cold water for a minute. As a general rule, the temperature should not be greater than 105°F, and the greater the contrast between the hot and cold temperatures, the stronger the reaction. “That really gets the circulation going,” Dr. Kruzel says. (People with diabetic neuropathy should use a thermometer to check the temperature to avoid being burned, advises Dr. Kruzel.)

Heed warning signs. According to Dr. Lahr, some people accept constipation as a fact of life, ignoring symptoms or habitually treating them with quick-acting laxatives. Either approach could have serious consequences. “Those over age 65 are at high risk for colon cancer,” he says, “and constipation can be a sign of colon cancer.” So keep your doctor informed about your bowel movement patterns—and give him a call immediately if constipation is accompanied by abdominal pain or if you see blood in your stool.