Q: My girlfriend thinks it’s weird that I typically only have a bowel movement a few times a week. She believes everyone should have a bowel movement every morning or something is wrong. Do I need to be concerned, and if I am constipated, what should I do?
Constipation is more common than many people realize because, not surprisingly, it is typically not something people discuss at parties or with friends and colleagues.
Each person has a unique bowel pattern. Typically, constipation is defined as having fewer than three bowel movements a week, hard stools, excessive straining, prolonged time spent on the toilet, a sense of incomplete evacuation and abdominal discomfort or bloating.
Constipation can last a short time or it can be chronic problem. Constipation could be a concern for you if you have bowel movements that are infrequent, and if they become uncomfortable, hard and difficult to pass. Other common symptoms of constipation include vomiting, itching, swelling, bleeding or pain around the opening of where stool passes.
Constipation has many causes often relating to one’s lifestyle. These include diets low in fiber, too much dairy, not drinking enough liquids and lack of exercise or physical activity. Changes in daily routine, pregnancy, aging, work, travel, frequent misuse of laxatives and a conscious delay in having a bowel movement also contribute to constipation.
Some medicines such as iron supplements, pain medicines, antacids, antidepressants and calcium supplements can cause constipation, too. Certain diseases can cause constipation including irritable bowel syndrome, bowel obstructions, stroke, diabetes, thyroid disease, Parkinson disease, hemorrhoids and colon cancer.
If constipation is not treated, complications may arise. Potential complications of constipation include hemorrhoids, rectal bleeding from hemorrhoids, hernias, dependency on laxatives, chronic constipation, fecal impaction, bowel obstruction or perforation.
Eating a high-fiber diet that is high in fruits (pears, raisins, apples, prunes, apricots) and vegetables (lentils, kidney beans) and other high fiber cereals and grains can help reduce constipation. Gradually increase your diet over six weeks to get at least 25 or more grams of fiber per day.
There are two types of fiber, insoluble and soluble, and they both help alleviate constipation.
Insoluble fiber, found in whole grains, cereals, apple skin, corn and carrots, may reduce your risk for certain types of cancers. Soluble fiber in oats, beans, strawberries and peas may help lower your risk for heart disease and help control blood sugar levels.
Fiber adds bulk and absorbs water to soften the stool, and this allows the stool to pass through the colon more easily. Increase your fiber intake slowly to avoid side effects such as bloating.
Be sure to drink more water as you increase your fiber intake. The average healthy adult needs at least two liters of water a day. Bulking agents such as psyllium, methylcellulose or polycarbophil should be accompanied with adequate hydration.
Stool softeners such as docusate sodium help soften the stool. Other medications known as laxatives or enemas may be needed for a short amount of time to help move the stool along.
Exercising can also help ease constipation. If you haven’t been active, gradually increase your activity level. Get some form of physical activity every day, even if it’s using the stairs instead of the elevator or walking instead of taking the bus.
If your bowel movements are not on a daily schedule, in general, this is not cause for alarm. Similarly, episodes of occasional constipation while traveling or when your diet is altered is not a major concern, unless other symptoms are present.
However, if you are often constipated and have additional symptoms, like those mentioned above, schedule an appointment with your health care provider. Unlike your friends and family, they are keenly interested in the details of your bowel movements.
Sometimes medications are needed. Constipation pared with other symptoms such as fever, weight loss, feeling weak or blood in the toilet or on the toilet paper after having a bowel movement could be a sign of a more serious problem. Based on your age and symptoms, tests may be performed including a colonoscopy, sigmoidoscopy or X-ray.
Michelle Napral is a nurse practitioner at the University of Minnesota Health Nurse Practitioners Clinic, 3rd Street & Chicago. Send questions to [email protected].
