Treating Constipation - Constipation: Digestive Disorders

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Treating constipation

People suffering from constipation may try a number of measures, including boosting fiber and fluid intake and increasing physical exercise. Drinking more fluids may reduce the need for the colon to rehydrate stools and is, in any case, harmless. Exercise, which is widely believed to promote regularity (although few studies have investigated this), has many other health benefits as well.

Increasing fiber

For many people, adding fiber to the diet is a highly effective way to prevent or treat constipation. Bran or other forms of fiber expand and soften the stool. Fiber will also speed gastrointestinal transit in people whose movement is slow. At least 20 grams per day of unprocessed bran and plenty of liquid are necessary to provide these benefits. Depending on the brand, a bowl of bran cereal delivers approximately 4–12 grams of fiber.

Wheat bran is an insoluble fiber, one of two types of dietary fiber that may be helpful. It appears to act as a laxative by adding bulk to the stool. Bran may be consumed in muffins, bread, or cereals, or it can be sprinkled over food or stirred into juice. Doctors recommend starting with one teaspoon per meal and increasing the amount slowly until the proper result is obtained. You should also be sure to drink plenty of water or other liquids. Be warned, however, that in some people, bran can cause discomfort and gas. Insoluble fiber can also be found in methylcellulose supplements such as Citrucel.

Soluble fiber, the other type of fiber, helps retain water in the stool, making it softer, larger, and easier to pass. Some soluble fiber is also digested by colon bacteria, which then create gas, further increasing fecal mass. Oatmeal is a good source of soluble fiber. So are psyllium seed and the pectins in fruit. The packaged psyllium sold as a natural laxative in drugstores is considered safe for long-term use. Among the best-known psyllium products are Metamucil and Perdiem.

Of course, it may not be necessary to load up on bran or fiber supplements. Simply eating plenty of whole grains, raw fruits, and vegetables does the job for many people (see "Good sources of dietary fiber"). Besides fiber content, some foods, such as prunes and figs, contain natural substances that spur intestinal evacuation.

Laxatives

Under most circumstances, laxatives should be used only when dietary and behavioral measures fail. Stimulant laxatives contain chemicals that act directly on the intestine to increase its secretion of water. Some of them also elicit more vigorous contractions from the colon.

In the past, it was thought that using stimulant laxatives daily over a period of months could decrease colonic peristalsis — the wavelike movements of the colon muscles that move the food along — possibly making the colon flabby, inert, and always in need of a chemical "fix." This condition was called "lazy bowel syndrome." This complication may have been related to the use of older agents that are not on the market anymore. Today's stimulant laxatives do not appear to cause lazy bowel syndrome (see "Oral laxatives" below).

Suppositories. Suppositories have been used to aid evacuation since the days of ancient Egypt, Greece, and Rome. Glycerin suppositories are made of about 70% glycerin, sometimes with sodium stearate (a fatty acid) added. When inserted, a glycerin suppository stimulates the reflex to defecate, in part because of its lubricating action. Suppositories with bisacodyl (Dulcolax) are more potent and usually produce a bowel movement within 20 minutes.

Enemas. Enemas are used primarily when oral laxatives don't work. The simple tap water enema distends the rectum, mimicking its natural distention by the stool and prompts the reflex by which the rectum empties itself as the sphincters open. While it isn't ideal to become dependent on artificial stimulation to kick off evacuation, an enema is probably the most benign way of doing so. Sodium phosphate enemas are available in single-dose plastic containers. These salts draw fluid into the bowel, prompting contraction. Oil-containing enemas are sometimes prescribed as softeners for feces that have become hardened within the rectum. They are generally recommended for short-term use only. Avoid soapsud enemas, which can irritate the lining of the colon.

Most laxatives are available without prescription.

Surgery

Surgical intervention as a means of treating severe constipation has fallen far out of favor, thanks to dismal results. The operation involved surgically removing the colon and connecting the small intestine directly to the rectum. But at least half of those undergoing the procedure have had to endure further surgery because of obstructions of the small intestine.

Alternative approaches

If increased fiber, liquids, and exercise are insufficient, a variety of alternative approaches are available. Solid scientific evidence for these methods is limited, but some people find flaxseed or sesame seed useful. Others have reported success using massage, acupressure, or biofeedback. Biofeedback can be helpful for severe constipation caused by dysfunction of the anal sphincter and pelvic floor muscles.

Last updated:	August 21, 2007