Eliminating Constipation Is Vital to Digestive Health

Constipation among adults is hardly the most glamorous topic imaginable, but getting the better of it is a vital part of overall digestive health.

The definition of constipation is a highly individual one, varying according to each person's history of bowel habits. There is no specific number of bowel movements that doctors regard as ideal for adults, with "normal" ranging anywhere from three times per day to three times per week.

But when there is a clear reduction in frequency and resulting discomfort, that defines constipation for each particular patient, says Benson T. Massey, MD, Associate Professor of Medicine (Gastroenterology and Hepatology) at the Medical College of Wisconsin. Dr. Massey practices his specialty at the at the Froedtert & The Medical College of Wisconsin Gastroenterology and Hepatology Clinic.

Typical constipation symptoms include hard stools, bloating, abdominal pain, a need to strain for release, or a combination of these. "Occasional constipation is very common," Dr. Massey notes. "When it occurs, try increasing your intake of fiber and fluid. If there is not a quick remedy from these, then you need to see a doctor.

Age, Activities, Illness Can Alter Digestion
The occurrence of constipation increases with age. "It's much more common as people get older," observes Dr. Massey. "Their diet changes toward more prepared foods as many elderly eat alone, there is less physical activity, and certain conditions such as diabetes, Parkinson's disease, stroke, MS, Alzheimer's disease, and injuries to the spinal cord all contribute to constipation." Also, previous abdominal surgery can be the cause of problems," he notes. Even gender might play a role: women have more problems with constipation than men do.

The causes of the onset of a bout of constipation are often uncertain. "For many people, the specific cause is not found," Dr. Massey notes. "We pay attention to a change in the patterns, and then start to look at what can be done."

Although treatment depends on the cause, severity, and duration of the constipation, in most cases dietary and lifestyle changes will help relieve symptoms and help prevent them from recurring.

For many, common over-the-counter treatments such as fiber supplements or laxatives are sufficient to restore what is normal bowel activity for them. Most people who are mildly constipated do not need laxatives, but natural fiber supplements like Metamucil, Citrucel, and Benefiber can be beneficial, says Dr. Massey. "The fiber holds on to fluid to increase softness and bulk. If an over-the-counter treatment is working well, there's no reason to change" to prescription medications, he stresses.

"However, by the time a patient is seeing me, the old solutions are no longer working well," he says. "How far we look depends on how severe the symptoms are."

Particular warning signs that clearly require medical attention include a sudden weight loss or blood in the stool. "While blood in the stool might be due to, for example, hemorrhoidal irritation from chronic straining in a patient with constipation, one would never assume that is the case, because it could also be due to a more serious problem, such as colon cancer."

Medications are another important factor to consider. Drugs for arthritis, blood pressure, and diuretics are among the medications that can contribute to constipation.

Testing
Once it is clear that laxatives are not producing a return to normal patterns, a set of tests is in order. "We will probably do a colonoscopy to see if there is a tumor or stricture that is causing a blockage," Dr. Massey explains. The colonoscopy involves gently inserting a tube with a microscopic camera and light source in the patient's rectum to view the colon for abnormalities.

One relatively new test involves the patient swallowing "Sitzmarker" capsules, which contain tiny plastic rings that show up on an X-ray machine. A normally-functioning digestive system will excrete most of the rings fairly quickly; if too many are seen on x-ray observation it could indicate a problem.

In addition, "We may use what's called a manometry test to look at the function of the muscles," says Dr. Massey. The manometry test, like the colonoscopy, involves insertion of a tube into the rectum. Water is pushed through the tube and muscle response is recorded. The purpose is to measure the workings of the muscles in the lower colon.

In some cases, this test reveals a problem with the sphincter muscles. This type of problem can often be corrected by biofeedback, a type of coaching, "to show the patient how to relax their muscles. The success rate is fairly high," says Dr. Massey. "We essentially teach the patient simply to relax. "

"In most people, the results of these tests prove normal, but you need to do them," explains Dr. Massey. "And if these tests are normal but they're not responding to therapy, we need additional tests.

Only a tiny percentage of cases turn out to be complex. "In a very small group of people, we find that the colon moves very slowly. These cases can be very difficult. When there is a rare nerve-related dysfunction, we may have to remove part of the colon, but these cases occur perhaps twice a year."

Diet, Fluids, and Fiber Promote Good Health
To maintain good digestive health, adults need a steady intake of fluids and fiber, Dr. Massey stresses. "There is no hard and fast rule, but probably four glasses of water a day is a minimum," he advises. Engaging in daily exercise is also helpful, and the urge to have a bowel movement should not be ignored.

Many foods, including beans, whole grains and bran cereals, fresh fruits, and vegetables such as asparagus, Brussels sprouts, cabbage, and carrots, supply healthy amounts of fiber. "Good sources of fiber include pears, corn, fruits, celery, broccoli, and cauliflower," notes Dr. Massey.

Adults should try to consume an average of about 30 grams of fiber daily, which helps the body form soft, bulky stool. Surprisingly, many cereals and salads are actually low in fiber, and starches and meats lack fiber. When possible, check labels for fiber content.

For people prone to constipation, limiting foods that have little or no fiber, such as ice cream, cheese, meat, and processed foods, is also important.

"Nothing works for everyone," says Dr. Massey, "But sometimes you can make a very big difference in someone's quality of life with a

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.