Constipation is a term used interchangeably to mean different things to different people. Most commonly it refers to infrequent bowel movements. However, it may also refer to hard stools, a decrease in the volume of stool, the need to strain to have a bowel movement, a sense of incomplete evacuation, or the need to use laxatives, enemas, or suppositories to maintain regular bowel movements.
In general, anywhere between 3 bowel movements a day to one bowel movement every 3 days is considered normal. The widespread belief that everyone should have a bowel movement at least once a day has lead to overuse and abuse of laxatives.
Constipation may be diagnosed when bowel movements occur less frequently than once every 3 days on an ongoing basis and are associated with a feeling of bloating or discomfort associated with the inability to move ones bowels.
What causes constipation?
There are many causes of constipation. The most common cause is inadequate fiber and fluid intake. The average American diet includes 12 to 15 grams of fiber per day when 25 to 30 grams of fiber and 8 to 10 glasses of water per day are recommended. Thus, for most individuals suffering from constipation the condition can be corrected by increasing fiber (bran, whole grains, fresh fruits and vegetables) and fluids in ones diet. In addition, increasing your physical activity will help propel stool through your GI tract.
More serious causes of constipation include cancers, scarring or narrowing of your colon. If constipation persists despite increased fiber and water intake, make an appointment to be evaluated by a physician. Patients with other conditions such as diabetes, spinal cord injury and various neurological problems may also suffer from constipation. In addition, certain medications and vitamins may also cause constipation such as pain-killers, antidepressants, blood pressure and cholesterol medicines, anti-nausea medications, and iron and calcium supplements.
How can the cause of constipation be determined?
After a thorough evaluation and physical exam Dr. Zaghiyan will have a better understanding of the possible causes of constipation. A digital rectal exam, anoscopy or proctoscopy may be performed in the office to evaluate your distal GI-tract. Dr. Zaghiyan may recommend a colonoscopy to exclude an anatomical cause of constipation such as polyps, cancers or diverticular disease, if you have not had a colonoscopy in the recent past. If an anatomical cause is not identified, your gastroenterologist or colorectal surgeon may recommend various over-the-counter or prescription medications to help with the constipation. In cases where constipation persists despite medical therapy, further testing may be recommended to identify a functional problem to help direct treatment.
Special x-ray tests such as a “sitz-marker” study, in which the patient swallows a capsule containing markers that show up on x-ray, followed by x-rays repeated over several days may be recommended to evaluate the motility of your colon. Other tests including defecography or dynamic MRI, which evaluate your GI tract during defecation or anorectal manometry, which measures the pressures generated by your anus and rectum may provide further clues about how your GI tract functions.
What is the treatment for constipation?
In most patients, the addition of fiber-rich foods, increased fluid to one’s diet and increased physical activity are sufficient to alleviate constipation. Some individuals may want to add a fiber supplement containing indigestible vegetable fiber to help reach the recommended 25 to 30 grams/day of fiber. It is important that you drink plenty of fluids (8 to 10 glasses/day) while you are consuming a high fiber diet.
Other laxatives, suppositories, and enemas may be harmful and habit forming if used regularly.
In very severe cases of constipation surgery may be necessary.
Make an appointment for a private consultation with Dr. Zaghiyan in her office in Los Angeles to find out which treatment options are best fitted for your specific condition.