About Constipation

Constipation is a symptom, not a disease. It is defined as having fewer bowel movements than usual, with a long or hard passing of stools.

Older people are more likely than younger people to have constipation. But experts agree that older people often worry too much about having a bowel movement every day. There is no right number of daily or weekly bowel movements. “Regularity” may mean bowel movements twice a day for some people or just twice a week for others.

Questions to Ask

Some doctors suggest asking these questions to decide if you are really constipated.

• Do you often have fewer than three bowel movements each week?
• Do you often have a hard time passing stools?
• Is there pain?
• Are there other problems such as bleeding?

If the answers are yes, you probably do have a problem. Otherwise, you probably do not.

What Causes Constipation?

Doctors do not always know what causes this problem. Eating a poor diet, drinking too little, or misusing laxatives can be causes. Some medicines can lead to constipation. These include some antidepressants, antacids containing aluminum or calcium, antihistamines, diuretics, and antiparkinsonism drugs.

The role of diet. People may become constipation if they start eating fewer vegetables, fruits, and whole grains. These foods are all high in fiber, and, according to some studies, high fiber diets can help prevent constipation. Eating more high fat meats, dairy products, and eggs can be another cause of constipation. So can eating more rich desserts and other sweets high in refined sugars.

People who live alone may lose interest in cooking and eating. As a result they start using a lot of convenience foods. These tend to be low in fiber, so they may help cause constipation. In addition, bad teeth may cause older people to choose soft, processed foods that contain little, if any, fiber.

People sometimes do not drink enough fluids, especially if they are not eating regular meals. Water and other liquids add bulk to stools, making bowel movements easier.

Misuse of laxatives and enemas. Many people think of laxatives as the cure for constipation. But heavy use of laxatives is usually not necessary and often can be habit forming. The body begins to rely on the laxatives to bring on bowel movements and, over time, forgets how to work on its own. For the same reason, if you use enemas often you may lose normal bowel function. Another side effect of heavy laxative use is diarrhea.

Overuse of mineral oil-a popular laxative-may reduce the body’s ability to use vitamins (A, D, E, and K). Mineral oil may also interact with drugs that prevent blood clots (anticoagulants), causing undesired side effects.

Other causes of constipation. Lack of exercise or lengthy bedrest, such as after an accident or illness, may cause constipation. For people who stay in bed and who suffer from chronic constipation, medications may be the best solution. But simply being more active, when possible, is best.

If people ignore the natural urge to have a bowel movement, they may become constipated. Some people prefer to have their bowel movements only at home, but holding a bowel movement can cause ill effects if the delay is too long.

In some people, constipation may be caused by abnormalities or a blockage of the intestines. These disorders may affect the muscles or nerves responsible for normal bowel movements. A doctor can perform a series of tests to see if a problem like this is the cause of constipation. If so, the problem can often be treated.

Treatment

If you become constipated, first see the doctor to rule out a more serious problem. If the results show that there is no disease or blockage, and if your doctor approves, try these remedies:

• Eat more fresh fruits and vegetables, either cooked or raw, and more whole grain cereals and breads. Dried fruit such as apricots, prunes, and figs are especially high in fiber.
• Drink plenty of liquids (1 to 2 quarts daily), unless you have heart, blood vessel, or kidney problems. But be aware that some people become constipated from drinking large amounts of milk.
• Some doctors recommend adding small amounts of unprocessed bran (“miller’s bran”) to baked goods, cereals, and fruit. Some people suffer from bloating and gas for several weeks after adding bran to their diets. Make diet changes slowly, to allow the digestive system to adapt. Remember, if your diet is well balanced and contains a variety of foods high in natural fiber, it may not be necessary to add bran to other foods.
• Stay active.

Do not expect to have a bowel movement every day or even every other day. “Regularity” differs from person to person. If your bowel movements are usually painless and occur regularly (whether two times a day or three times a week), then you are probably not constipated.

Source: National Institute on Aging, National Institutes of Health, 1994