Susquehanna Endoscopy Center

• Home
• Go Back
•  
• The High Fiber Diet
• Heartburn and Reflux
• Esophagitis and Stricture
• Diverticulosis & Diverticulitis
• Hemorrhoids
• Constipation
• Diarrhea
• FAQs
• Helpful Links
• American Gastroenterological Association
• WebMD
• Susquehanna Health System
• Geisinger Health System

Constipation

Constipation is characterized by infrequent or hard pellet stools or difficulty in evacuating stool. Passing one or more soft, bulky stools every day is a desirable goal for everyone. While troublesome, constipation is not usually a serious disorder. However, there may be underlying problems or causes of constipation and, therefore, testing is often recommended.

What Causes Constipation?

The stomach churns and mixes food that is eaten so it can be digested and absorbed in the small intestine. Then the colon, or large intestine, withdraws water from the liquid material, producing a formed, soft stool. If the colon removes too much water, the stool becomes hard and constipation results. Constipation is often caused by a lazy colon that does not contract properly and move the stool on to the rectum. The colon also can become spastic and remain in a contracted state for a prolonged time. In this case, stool cannot move along and again too much water is absorbed. Constipation also can result from a mechanical obstruction, such as occurs from tumors or advanced diverticulitis (a disorder which can distort the lower sigmoid colon).

Other conditions that can produce a sluggish, poorly contracting bowel include: pregnancy, anal fissures and hemorrhoids, certain hormone deficiencies, the abuse of laxatives and travel.

Diagnosis

The patient's medical history is the most important factor in diagnosing constipation. The physician also will perform an abdominal exam and certain blood tests. A barium X-ray exam of the lower bowel or colon often is warranted. In addition, a “pronto,” or sigmoidoscopic exam (using a lighted rigid or flexible tube), is necessary to rule out a mechanical blockage of the lower bowel, such as a tumor. This exam allows the physician to visualize the bowel wall and biopsy (tissue sample) any suspicious areas.

Treatment

Because there are many causes of constipation, treatment depends on the physician's findings and diagnosis. After serious problems are excluded, chronic constipation can respond to simple measures, such as adding fiber, bran or a bulking agent to the diet. General guidelines for treating constipation include eating regularly, drinking plenty of liquids each day, and walking or exercising (aerobic). Specific recommendations are: do not delay when the “urge” to defecate occurs, and avoid prolonged straining at stool.

Diet

Foods that are high in roughage, bran and fiber are essential in correcting and preventing constipation. In parts of the world where unprocessed grain (bran) is used, there is little constipation, and passing one or two large, soft stools a day is the norm. The following foods should be eaten daily, especially bran:

• Whole grain breads (whole wheat), Bran cereals.
• Vegetables — Root (potatoes, carrots, turnips), Leafy green (lettuce, celery, spinach), Cooked high residue (cabbage)
• Fruit — Cooked or stewed (prunes, applesauce), Whole fruit (skin and pulp)
• Bulking Agents — Bulking agents are naturally growing products which absorb and hold water. This action results in larger, bulkier stools which, in turn, increase colon activity. One or both of these primary bulking agents should be used daily:
  1. Bran -- In cereals, breads and muffins
  2. Psyllium seed products, available as Metamucil, Effersyllium and Per Diem Plain

Do Laxatives Help?

There are two main types of laxatives: stimulants (chemical) and saline (liquid or salt). They occasionally help temporary constipation problems; however, chronic use of laxatives is discouraged because the bowel becomes virtually dependent on them. Bowel regularity must occur without laxatives. An occasional enema is preferred to the chronic use of laxatives.

What if None of these Methods Work?

Simple, but resistant, chronic constipation may require a more formal treatment program. The following bowel retraining program is often effective:

Bowel Retraining Program

• 1. Do not use laxatives.
• 2. Eat a diet high in roughage, such as bran cereals and leafy vegetables.
• 3. Drink six (6) ounces of prune or apricot juice each morning.
• 4. Eat two (2) large servings of stewed fruit each day.
• 5. Take one (1) tablespoon of Metamucil, Effersyllium or Per Diem Plain at night.
• 6. Eat a normal breakfast.
• 7. Set aside 15 minutes after breakfast to sit on the toilet, but do not strain at stool.
• 8. If you do not have a bowel movement by the third day, take a small tap water enema and repeat the above steps.

Summary

Constipation usually is a short-term disorder that is easily treated by simple measures; however, the condition may reflect an organic or serious underlying disorder that can only be detected and treated by the physician. For chronic constipation, the patient's understanding of how the bowel works and the positive steps that can be taken usually results in improved and satisfactory bowel function.

 

This material does not cover all information and is not intended as a substitute for professional medical care.