As an internist my patients commonly report bowel movement problems involving constipation. What’s important to realize is that constipation is a symptom and not a medical condition. Most people will experience constipation at one time or another, and once the cause of the issue is resolved things should return to normal. Now although there is no set mandatory number of bowel movements or how often they should be, everyone’s usual pattern is their own individualized norm. If the stools get harder or it takes longer than usual to have another bowel movement, then constipation is present. Often times, someone is done having a bowel movement but there is a lingering feeling that there is still more that needs to come out. As a result, bloating, flatulence and abdominal fullness may follow.
There are many possible causes for constipation. Obviously what a person eats or doesn’t eat will have an effect. The recommended daily fiber intake ranges from between 20-35 grams. Constipation is likely to occur if this recommended amount is not being met. Fiber may be obtained from dietary sources or from over the counter supplements. Foods high in fiber include: apples, pears, oats, lentils, chia seeds, avocado, broccoli, carrots and strawberries.
A less than optimal diet that is high in fats and sugars may also cause constipation. It is important to follow a low fat diet and watch your carbohydrate intake. The recommended daily fat intake should be no more than 20-35% of your daily caloric intake, and carbohydrates should be limited to about 45-65%. Try to choose lean proteins, fruits, vegetables and whole grains, and limit the amount of foods with added sugars and refined grains. Physical exercise also helps to get things moving. Hydrating well is also important. If despite working on all of the above the issue persists, it is important to see your physician.
When I assess constipation issues the first thing that I review after looking at diet and hydration is what medications are being taken. Certain medications may cause constipation as a side effect. Some of these include medications for bladder control, Parkinson’s, pain control and hypertension. Over the counter medications may also be the culprits. These may include calcium, iron and certain antacids. If you are taking a laxative for an extended period of time, this will cause the body to stop having bowel movements on its own as the chemical laxative has been inducing it. Your body simply becomes dependent on it in order to have a bowel movement.
Certain medical conditions need to be ruled out as the cause. Hypothyroidism, when the thyroid slows down in its thyroid hormone production, may cause constipation as a symptom. A simple blood test could diagnose this issue. Nerve issues caused by diabetes or strokes may also be a cause. An obstruction or physical structural issue present in the bowel may also need to be ruled out. Finally, there is a common condition called irritable bowel syndrome that for many sufferers causes chronic intermittent flip flopping between normal stools and constipation. Treatment for the above conditions differs. Sometimes imaging and a colonoscopy performed by a gastroenterologist are required for a more thorough diagnosis.
In summary, constipation is a symptom of an issue. It is not a condition by itself. It is important to define the cause in order to resolve it. Have a diet rich in fiber or add a supplement if needed. Hydrate well and keep physically active. Try to avoid the chronic use of chemical laxatives. If the issue persists despite the above, please make an appointment to see your physician. Sometimes chronic constipation is the first symptom of a larger problem that needs to be addressed. As I always state, it is better to be proactive as opposed to reactive. Never assume that a problem that is persisting will work itself out so please have it addressed so it may be resolved.
