Relieve and Prevent Constipation
With more than 2.5 million Americans visiting the doctor for this malady annually, constipation is the most common digestive complaint. It can happen for many reasons, but the holidays can be especially troublesome.
“Constipation can occur around the holidays for several reasons, including travel and changes in daily routines,” says gastroenterologist Melissa Munsell, MD, UCLA Division of Digestive Diseases. “A healthy diet that includes plenty of fiber (20 to 25 grams daily) may help to prevent it.”
What’s Normal and Not
A “regular” bowel movement (BM) is personal: Some people may have three BMs in a day, whereas others may have three in a week. Both scenarios can be normal. How you experience regularity will differ due to variations in diet, physical activity, health status, and age.
Constipation is broadly defined as a change in bowel habits that includes such symptoms as hard or small stool, difficulty passing a stool, infrequent BMs (less than three times a week), or incomplete defecation. Constipation is frequently accompanied by bloating, gas, and sometimes nausea. Most of the time, it can be self-managed. But the following symptoms warrant a visit to your physician:
- Constipation longer than three weeks
- Fever
- Weakness
- Severe abdominal pain
- Weight loss
- Rectal bleeding or blood on toilet tissue.
Causes and Prevention Strategies
Your gastrointestinal (GI) tract, just like the rest of your body, ages. And that can slow down digestion and motility, the medical term for the contraction of muscles that mix and move contents along the GI tract. These are the most common culprits that trigger constipation, along with suggestions for overcoming them.
Food and Drink. Because thirst sensations diminish with age, older adults are more susceptible to being underhydrated. Fluid is essential to staying regular, as is adequate fiber intake. During the holidays, stress can rise, meals may not be regular, and people are more likely to eat (and perhaps overeat) rich desserts, cheese, and high-fat meats—all of which can cause digestive distress. It doesn’t mean you can’t enjoy holiday foods, but just be mindful of portions and counterbalance heavier food/beverage choices by drinking plenty of water and including high-fiber veggies, fruits, and whole grains. These foods may not always be the stars of holiday spreads, but they often make an appearance.
Medications and Supplements. Some supplements as well as prescription and over-the-counter (OTC) medications are notorious for causing or contributing to constipation. Those that are most commonly associated with the symptom include: antihistamines, antispasmodics, antidepressants, antipsychotics, antacids with aluminum, pain meds (opiates), high blood pressure pills, some drugs that treat Parkinson’s disease, and iron and calcium supplements. Pay close attention to how you feel whenever you start taking something new. If you experience digestive distress, consult with your physician to determine options appropriate to your specific situation.
Medical Conditions. There are a number of diseases and conditions that can make it difficult to have a BM. These include diabetes, hypothyroidism (low thyroid), hypercalcemia (high calcium) and neurologic diseases. Of course, there are also diseases of the digestive system, such as irritable bowel syndrome that can affect the GI tract. Pelvic floor dysfunction is a problem with the muscles that control voiding. The muscles don’t tighten and relax properly to allow for normal evacuation. A physical therapist can help people retrain those muscles.
The bowel can also be obstructed, which makes going difficult or impossible. When only pencil-thin fecal matter can be squeezed through, or only a small amount of liquid is passed, these are symptoms of obstruction and require medical attention.
Constipation Treatments
There are many approaches and products that treat constipation, and they vary in how they achieve results. It will take some trial and error to discover which is best for you. Your physician can more thoroughly explain the pros and cons of each one relative to your health status.
Behavior changes. If you don’t exercise much, know that physical activity stimulates the GI tract. The recommendation is to get at least 30 minutes of exercise on most days of the week. Also, if you have the urge to go, don’t ignore it or hold it in. According to Dr. Munsell, doing so may weaken these signals over time and make it more difficult to have a BM. Your position on the toilet can make a difference, too. Squatty Potty is a stool designed to create a squatted position with the knees higher than the hips. This position opens the colon and can make elimination more effective and complete.
Try a Laxative. There are several types of laxatives that work in different ways. Try only one at time. Fiber-based laxatives such as Metamucil, Citrucel, and Benefiber stimulate BMs by adding bulk to the stool. Know, however, that gas and bloating can occur if you take too much too quickly. The key, says Dr. Munsell, is to start low and go slow. Try powdered formulas rather than the pills because you can control the dose. For example, start with a teaspoon in water and work your way up to more, if needed. Bulk laxatives can take anywhere from a few hours to a few days to work.
Hyperosmolar laxatives work by drawing water into the colon. They include MiraLAX and GlycoLAX, and usually work within one to three days. Saline laxatives, such as Milk of Magnesia, also work by drawing more fluid into the colon, but they tend to act faster, commonly within six hours.
Stimulant laxatives include bisacodyl-based laxatives such as Ex-Lax, Senokot, Correctol, and Dulcolax, which encourage motility and fecal movement through the colon. These laxatives can cause cramping and an urge to rush to the bathroom. They typically work within six to 12 hours.
Finally, there are stool softeners, which may take 24 to 48 hours to work. They include docusate sodium-based products, such as Docusate and Colace, glycerin suppositories, and enemas—all of which soften the stool and can make it easier to go.
The above strategies often work for many people. But if they don’t work for you, it’s time to see your doctor. Be ready to share details about what your stool is like, how often you go, symptoms such as straining, and what you’ve tried to address the problem. Your doctor will also want to know about your diet, medications, and any medical conditions. The details will help inform the next steps in diagnosis and treatment.
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