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As Embarrassing As It Is Common, Constipation Isn’t Hard to Treat

January 23th, 2004

By Ken McGrath : eCureMe Staff Writer
January 18th, 2004 : Physician Reviewed

It isn’t polite to talk about, but chances are you’ve been constipated. The amalgam of symptoms - bloating, sluggishness and straining - will strike most Americans occasionally. Three million are frequently constipated each year, while the condition accounts for roughly two million annual doctor’s visits.

The $725 million dollars Americans spend on over-the-counter laxatives each year would seem to imply that that most know how to treat the occasional incident. The truth, however, isn’t as clear. Constipation isn’t exactly what many think it is, and treating it often doesn’t require the laxatives many take.

What It Is

In and of itself, constipation isn’t a disease. It’s a condition, which, like a stomach or headache, can have a variety of different causes. Technically, someone is constipated when they pass hard, dry stool in small amounts at abnormally long intervals. Though, what "normal" intervals are isn’t that straightforward. Some normally have bowel movements three times a day. Some have them three times a week. Anywhere between could be considered normal. Often, according the American Gastroenterological Association, "misperceptions about what is normal and what is not" causes people to imagine they’re constipated when they aren’t.

When constipation does occur, it’s because of what’s happening (and not happening) in the large intestine. As digested food material moves through the large intestine (otherwise known as the colon), it’s processed into waste material; politely known as stool. Normally, as stool continues through the large intestine, it absorbs water. When the stool reaches the rectum, the water it has absorbed has turned it into a solid material, ready to be passed.

Occasionally, the colon can absorb too much water. When it does, the stool doesn’t absorb as much. Not enough water content can harden the stool and make it smaller, thus making it difficult for rectal muscles to expel from the body. The less frequent and more difficult passing stool becomes, the more constipated someone is.

Behind Constipation…

…is a simple culprit; a lack of dietary fiber is the most common cause of constipation. Fiber is a substance - found mostly in fruits, vegetables and grains - that the body’s digestive system can’t break down; so it passes through the large intestine, and ends up in stool, largely unchanged. Fiber adds bulk to stool, making it larger, denser and easier to pass.

Though it’s only an apple away, dietary fiber isn’t something that comes readily to most - which is why constipation does. On average, Americans eat between 5 and 14 grams of fiber a day. The American Dietetic Association says that number should be between 21 and 35 grams a day. A fast food lifestyle doesn’t help. Oats, citrus, barley, carrots, bran and whole wheat are typical of high-fiber food: rough and raw. Foods high in fat and full of meats, cheeses and eggs are just the opposite: soft, processed and often leached of fiber.

What you drink can be just as important as what you eat. Water and juices can add bulk to stool. Alcohol and caffeinated beverages like coffee and cola have a dehydrating effect on the body, and can thus draw water away from stool.

Less frequently, constipation can result from other conditions. Certain medications can cause constipation, as can many diseases and conditions (ranging from problems with intestinal functioning to Parkinson’s). Evolutions in the body’s functioning - such as aging (which can cause a loss of intestinal muscle tone) and pregnancy (which can alter hormones and compress the colon) - can cause irregularity as well.

Getting Over Constipation

Working more fiber into a diet is the best way to ward off constipation over the long-term. Raw vegetables, dried peas, beans and whole grain products are the best sources. In addition to keeping you regular, they can also lower cholesterol levels and help to prevent colon cancer. While food is the best source of fiber, supplements can work as well. Available over-the-counter, products such as Metamucil and Fibercon don’t come with the nutrients that a bran muffin does, but can supply a jolt of fiber and are generally considered safe.

If you’re looking for a quicker fix, you might be tempted to reach for a commercial laxative; but it isn’t necessarily the best choice.

Widely available, different laxatives work in different ways. Stool softeners, also known as emollients, help liquids in the colon mix with stool, and can thus make it easier to pass. Lubricating laxatives help stool retain moisture, and can coat bowels with an oily film that makes for smoother passage. Saline laxatives increase the amount of water in stool by dehydrating nearby organs and tissues. Stimulants are the most powerful. Sold under brand names such as Dulcolax and Ex-Lax, stimulant laxatives induce colon contractions meant to push the stool outwards.

Each has their disadvantages. Stool softeners can take a day or two before they start working. Lubricants block the intestine’s absorbtion of vitamins and minerals. Some saline laxatives are made with ingredients that can be toxic at higher doses. Stimulants can produce unpleasant side effects: diarrhea, nausea and cramps. None are recommended for long-term use.

Routine usage can cause the colon to become reliant on a laxative in order to properly pass stool. It may also mask potentially serious, underlying causes of recurring constipation.

Spokesmen for the International Foundation for Functional Gastrointestinal Disorders, an educational and research organization in Milwaukee, put laxatives in perspective. " We wouldn’t counsel people to take them on a regular basis. If [constipation] is something you’re getting regularly, you might want to try it. But if you still get the sense that you’re uncomfortable with [your constipation], seek a doctor’s diagnosis."

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