Constipation, a common complaint, is usually simple to prevent and easy to treat when it occurs. However, constipation may reflect a more serious problem that will require the help of your medical provider to suggest tests, medical intervention and, rarely, surgery.
WHAT IS NORMAL BOWEL FUNCTION?
The colon and rectum (i.e., large intestine) serve to remove water and certain electrolytes and store fecal material prior to elimination. The range of “normal” is quite wide, but in general, bowel movements should occur at least every third day and no more than three per day; stool should pass easily and not require excessive straining; and lastly, one should experience a sense of completeness of elimination. The belief that one should have a bowel movement every day simply is not accurate and can lead to unnecessary concern and even abuse of laxatives.
WHAT IS CONSTIPATION?
Given the range of normal, constipation may mean different things to different people. For some, constipation may mean infrequent bowel movements. To others, it is a hard, difficult-to-pass stool that requires excessive straining and causes pain as it passes. And to others still, constipation may mean a bowel movement which does not completely evacuate and leaves the person with a sense of dissatisfaction as if they “still need to go.” Constipation is often associated with a bloating sensation, mild nausea and mild cramping pain, all of which are generally relieved by bowel movements.
WHAT CAUSES CONSTIPATION?
Most often, constipation is due to any combination of three factors: a low fiber diet, poor fluid intake, or a lack of physical activity or exercise. However, there are other causes that must be considered. First, specific medical conditions can cause constipation, including diabetes, low thyroid hormone (hypothyroidism), depression or other less common diseases. Medications may contribute to constipation, including those commonly prescribed for pain relief, high blood pressure, antidepressants, psychiatric drugs and antacids.
Unfortunately, there are serious causes of constipation that are more mechanical in nature. Diseases that cause inflammation, such as diverticulitis or Crohn’s disease, can cause excessive scarring and narrowing. In addition, tumors or growths in the colon can physically block the bowel. Although less likely to be the cause, these more serious causes should be evaluated and ruled out by your physician.
HOW IS CONSTIPATION AVOIDED OR TREATED?
Generally, constipation is avoided by following the basics of good intestinal health: healthy diet, proper fluid intake and physical activity. Twenty-five to thirty-five grams of fiber per day is the recommended daily amount of dietary fiber. Eating a diet rich in whole grain breads, cereals and fiber bars, in addition to fresh fruits and vegetables, often will improve bowel habits by adding bulk to the stool.
Drinking six to eight glasses of water per day will help keep the stool from being hard and make it easier to pass the stool. Lastly, regular exercise, which can be as simple as taking a brisk walk for 30 minutes per day, will likely improve bowel movements.
There are many different laxatives available over the counter in grocery stores and pharmacies. The way in which laxatives work varies by laxative but they can be very effective for acute relief of constipation. Although it may be necessary to take laxatives on a regular basis, you should only do so after consultation with your medical provider.
WHEN SHOULD I SEEK HELP FROM MY MEDICAL PROVIDER?
Medical attention should be sought if:
- There is a new onset of persistent constipation.
- Longstanding constipation becomes progressive either in frequency or severity, and it is not manageable with the simple measures described above.
- Constipation is associated with a change in bowel habits from the normal pattern (narrow stools or loose stools), excess weight loss or bleeding.
WHAT IS A COLON AND RECTAL SURGEON?
Colon and rectal surgeons are experts in the surgical and non-surgical treatment of diseases of the colon, rectum and anus. They have completed advanced surgical training in the treatment of these diseases as well as full general surgical training. Board-certified colon and rectal surgeons complete residencies in general surgery and colon and rectal surgery, and pass intensive examinations conducted by the American Board of Surgery and the American Board of Colon and Rectal Surgery. They are well-versed in the treatment of both benign and malignant diseases of the colon, rectum and anus and are able to perform routine screening examinations and surgically treat conditions if indicated to do so.
The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention and management of disorders and diseases of the colon, rectum and anus. These brochures are inclusive but not prescriptive. Their purpose is to provide information on diseases and processes, rather than dictate a specific form of treatment. They are intended for the use of all practitioners, health care workers and patients who desire information about the management of the conditions addressed. It should be recognized that these brochures should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtain the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient.