March 25, 2009

The "Unglamorous" Topic of Constipation

I have a lot of trouble with constipation. I know this is not a “glamorous” topic, but it’s one that affects a lot of people. Could you discuss it in your column?


Constipation is characterized by unsatisfactory emptying of the bowel and is often associated with straining, difficulty in passing stool, and hard or lumpy stool. It can lead to problems such as hemorrhoids and even prolapse of the rectum. Should you have complaints of constipation, we recommend that you visit your doctor for a complete examination that includes a digital rectal examination. People over age 50 (45 for African-Americans) also should have a colonoscopy and other studies as indicated.
Most constipation is “functional”; that is, not related to a specific medical condition. People with this form of constipation describe it as chronic, and symptoms usually include one or more of the following: infrequent bowel movements (fewer than three per week); straining; lumpy, hard stools; sensation of incomplete emptying; or a feeling of blockage.
2009 1509 page28While constipation is usually functional, some medical conditions are associated with the problem. These can include the following metabolic conditions: diabetes mellitus, Addison’s disease, high calcium levels in the blood, low potassium levels, under-functioning thyroid, pregnancy, and an adrenal tumor called pheochromocytoma. Also, people who have a disorder that affects the nervous control of the bowel may be constipated. Some of these conditions are spinal cord injury, Parkinson’s disease, multiple sclerosis, lead toxicity, diabetic neuropathy, and Hirschsprung’s disease. These sound exotic—and they are—but those who have them will recognize a relationship with constipation.
Some folk are constipated as a consequence of the medications they are taking for other conditions. People taking pain-killing medication that contains opiates are often constipated, but antidepressants, Parkinsonian medication, antihypertensives, anticonvulsants, antacids, calcium supplements, iron supplements, and antihistamines all may cause constipation.
Should investigations rule out these possible underlying causes, your doctor may tell you that you have functional constipation. This does not necessarily fill you with joy, but it does mean you have a better chance of regulating your bowels.
Three functional lifestyle measures bring relief to the vast majority who will follow them faithfully:
• Be sure to include sufficient fiber in the diet. This requires the consumption, on a daily basis, of an adequate amount of fruits, vegetables, and legumes. Whole grains, bran, and nuts also contribute fiber to the diet.
• Be aware of the need for lots of fluid to keep the fiber in the bowel soft. While we often select eight as a good number of glasses of water to drink per day, in hot climates one or two more may be required.
• Walk daily for at least half an hour. More vigorous exercise may help, but a minimum of 30 minutes walking will improve bowel regularity.
If put into practice, these recommendations will cure more than 90 percent of functional constipation.
Those who have underlying metabolic or other problems should beware of laxatives that are irritants—especially phenolphthalein, which is recirculated through the liver and leads to chronic constipation itself. Bulk-forming laxatives, such as psyllium (Metamucil), calcium polycarbophil (Fibercon), and methylcellulose (Citrucel), are more physiological in their action. Osmotic laxatives draw water into the bowel and also help soften stool. Examples are polyethylene glycol (Miralax) and lactulose (Chronulac). Stool softeners, such as docusate sodium (Colace) or docusate calcium (Surfak), act in a similar way.
Enemas, suppositories, and lubricants may also be used, but it is best to speak first with your doctor, who knows your individual needs and problems.

Fortunately for most, a few minor adjustments make for a ready solution.   

Allan R. Handysides, M.B., Ch.B., FRCPC, FRCSC, FACOG, is director of the General Conference Health Ministries Department; Peter N. Landless, M.B., B.Ch., M.Med., F.C.P.(SA), F.A.C.C., is ICPA execu-
tive director and associate director of Health Ministries.
Send your questions to: Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland 20904. Or you may send your questions via e-mail to [email protected] While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend that you consult with your personal physician on all matters of your health.