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Straight, No Chaser: Constipation (Part 1)

By Jeffrey Sterling, MD November 14, 2018

al-bundy-newspaper

If you remember the Al Bundy character from the TV show Married With Children, you know much of what you need to know about constipation (and hemorrhoids for that matter). When it came time to have a stool, he’d take a newspaper, fold it under his arm, and tell his wife Peggy “I’ll be back in about 30 minutes!” I’ve always found it fascinating that folks are so obsessed with what comes out of them but not equally attentive to what they put inside of their mouths. Yes, Virginia, one has to do with the other! Let’s keep the topic flowing (no pun intended) by addressing some frequently asked questions.
What is constipation? Constipation is the condition of difficulty in emptying the bowels, typically reflecting either infrequent or hardened stools. Constipation is not a disease. It is a symptom.

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Well how often should I normally have a bowel movement? If you were in perfect health, the thought is you’d have a bowel movement for every regular meal you had. Actually perfect can’t be the definition of normal, so a reasonable standard is between 3 times a day and 3 times a week. It’s important for you to think about changes in your stool relative to your norm.

constipation

What causes constipation? To understand constipation, you should understand normal. The body extracts water and nutrients from food as it travels through the digestive tract. Food travels via contractions of the muscles of the digestive tract. Thus disorders of these processes can cause constipation. These may include the following:

    • Diet: Not enough liquid can cause stools to be drier than ideal.  Not enough fiber affects the consistency of stools (as an aside, you should be eating between 20-35 grams of fiber per day).
    • Exercise: Maintaining adequate blood flow affects every functioning part of your body.
    • Medicines: There are medicines that slow the motility within the digestive system, such as narcotics (opiates). Laxatives themselves can be counterproductive as the body becomes dependent on them in order to have a bowel movement.
    • Diseases and intestinal problems: You know this all too well if you suffer from irritable bowel syndrome (IBS), bowel obstruction or tumors involving the abdomen. Other diseases such as diabetes, hypothyroidism, lupus, multiple sclerosis and stroke can also cause constipation.

Are there other symptoms of constipation? Here are the most common symptoms of constipation:

Constipation-Symptoms-and-Signs

    • Hard, dry stools that are difficult to pass
    • Having less than 3 bowel movements in a week
    • Needing to strain in order to have a bowel movement
    • Having a sensation of incomplete stooling (i.e. feeling like you still need to have a bowel movement when you’ve just finished having one)

When should I see a physician?
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    • Your efforts at home aren’t working.
    • You’ve just begun having symptoms of constipation.
    • You’ve been constipated for 3 weeks.
    • You have abdominal pain with your constipation.
    • You have bloody stools with your constipation.
    • You have weight loss with your constipation.

A subsequent Straight, No Chaser will address treatment considerations and constipation in children.
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