Getting the facts on constipation

While sometimes the solution is simple, for example, short-term use of a laxative or eating more fiber, relieving constipation sometimes can be more difficult. For many older adults, constipation is a chronic problem that requires an individualized treatment plan.

The August issue of Mayo Clinic Health Letter sorts myth from fact on a health concern that affects virtually everyone at some point — constipation.

Myth: An absence of daily bowel movements indicates constipation.

Fact: Constipation is most accurately defined as the infrequent or difficult passing of stool. Normal bowel movement frequency in adults can range from three times a day to three times a week.

Myth: Constipation causes the body to absorb toxins from stools.

Fact: Not true. This belief causes some people to unnecessarily take laxatives when a daily bowel movement doesn’t occur. Others try colon cleansing to remove supposed toxins. These practices aren’t helpful and may be harmful.

Myth: An unhealthy diet causes constipation.

Fact: A low-fiber diet may contribute to constipation, but chronic constipation often involves other factors. Constipation can be a complication of another disease or condition, or a side effect from a drug or supplement. In women, constipation can be caused by pelvic floor dysfunction — a lack of coordination of the complex muscular actions that allow bowel movements. This condition is most common in those who have had surgery of the rectum or anus or who have given birth vaginally.

Myth: Laxatives shouldn’t be used long term.Fact: New studies indicate that long-term laxative use prescribed by a physician can be safe and effective for some forms of constipation.

Because side effects may occur, laxatives should be taken under a physician’s supervision.

Myth: Laxatives and surgery are the only two ways to treat chronic constipation.

Fact: There are many treatment options and many of them depend on a patient’s circumstances.

Laxative medications are an option, as well as treating any underlying diseases or adjusting medications that could be contributing to the condition. Surgery is used rarely and as a last resort.

In recent years, pelvic floor rehabilitation (biofeedback therapy) has worked well for women with constipation due to pelvic floor dysfunction. Biofeedback involves using sensors to detect contractions and relaxation of the muscles used for bowel movements. Working with a therapist, patients relearn how to control and coordinate the necessary muscles for a bowel movement.

When constipation involves new symptoms, is associated with bleeding, significant abdominal pain or nausea, the advice is to seek prompt medical care.

When persistent cramping, abdominal pain, bloating, gas, diarrhea and constipation are causing distress and frequent bathroom trips, the next stop should be a visit to the doctor. These symptoms, commonly caused by irritable bowel syndrome (IBS), often can be minimized with diet and lifestyle changes.

The walls of the intestines are lined with layers of muscles that contract and relax in a coordinated rhythm as they move food from the stomach through the intestinal tract and to the rectum.

With IBS, the contractions may be stronger and last longer than normal, causing bloating and diarrhea. Sometimes, the opposite occurs. Slow food passage causes hard, dry stools.

What causes IBS is not clear, so treatment typically focuses on avoiding triggers and on symptom relief. Mild signs and symptoms may be controlled by managing stress; many people’s symptoms are aggravated by stress symptoms. Diet changes also are helpful.

Chocolate, milk and alcohol might cause constipation or diarrhea.

Carbonated beverages and some fruits or vegetables may lead to bloating or discomfort.

When symptoms are moderate to severe, a doctor may recommend fiber supplements or anti-diarrheal medications. Some people with diarrhea may benefit from anticholinergic medications to relieve painful bowel spasms. However, the same medication can worsen symptoms for people with constipation. Low-dose antidepressant medications may be appropriate, because they inhibit the activity of neurons that control intestinal muscles.

Seeking a doctor’s care is important when experiencing chronic bowel symptoms. Because there are no physical signs to definitively diagnose IBS, diagnosis is often a process of elimination. And cramping, diarrhea, constipation and other bowel symptoms also can indicate more serious conditions such as ulcerative colitis or Crohn’s disease, forms of inflammatory bowel disease, or colon cancer.