Many residents of Anguilla deal with constipation on a regular basis. While women are the most frequent constipation sufferers, men and children also suffer from this problem. In most cases, simple changes in your diet and lifestyle can help relieve symptoms and manage constipation, but in a few cases constipation might be associated with serious medical disorders and prove more difficult to treat.
What is constipation?
Constipation is infrequent bowel movements or difficult passage of stools.
The definition of constipation can be different for you than it is for other people. Some individuals naturally have a bowel movement a few times a day, while others go just a few times a week. What’s considered normal frequency for bowel movements varies widely. In general, however, you are probably experiencing constipation if you pass fewer than three stools a week, and your stools are hard and dry.
How do you know that you are constipated?
Contrary to what most Anguillians believe,not having a bowel movement everyday does not necessarily mean you are constipated. You likely have constipation, however, if you have had at least two of the following signs and symptoms for at least three of the past six months:
• Pass fewer than three stools a week
• Experience hard stools
• Strain excessively during bowel movements
• Experience a sense of rectal blockage
• Have a feeling of incomplete evacuation after having a bowel movement
• Need to use manual maneuvers, to have a bowel movement, such as finger evacuation or manipulation of your lower abdomen
When to see your doctor?
Although constipation may be bothersome, in the vast majority of cases it is usually not serious. Most people who have constipation do not seek a doctor’s care. However, chronic constipation may lead to complications or be a sign of a serious underlying disorder.
I strongly urge you to see your doctor if you experience an unexplained onset of constipation or change in bowel habits, or if symptoms are severe and last longer than three weeks. Also, seek medical care if you experience any of the following signs or symptoms, which might indicate a more serious health problem:
• Bowel movements occurring more than three days apart, despite corrective changes in diet or exercise
• Intense abdominal pain
• Blood in your stool
• Constipation that alternates with diarrhoea
• Rectal pain
• Thin, pencil-like stools
• Unexplained weight loss
Why do you get constipated?
Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract causing it to become hard and dry.
When there is not enough fluid or fibre-rich food in your diet — or if the colon’s muscle contractions are slow — the stool hardens, dries and passes through your colon too slowly. This is the root cause of constipation.
You may also experience constipation if the muscles you use to move your bowels aren’t properly coordinated. This problem is called pelvic floor dysfunction (anismus), and it causes you to strain with most bowel movements — even soft ones.
A number of factors can cause an intestinal slowdown:
• Inadequate fluid intake or dehydration
• Inadequate amounts of fibre in your diet
• Ignoring the urge to have a bowel movement or delaying it until later
• Lack of physical activity (especially in older adults)
• Irritable bowel syndrome
• Changes in lifestyle or routine, including pregnancy, aging and travel
• Illness
• Frequent use or misuse of laxatives
• Specific diseases such as stroke, diabetes, thyroid disease and Parkinson’s disease
• Problems with the colon and rectum such as intestinal obstruction or diverticulosis
• Certain medications including pain medications, diuretics and those used to treat Parkinson’s disease, high blood pressure and depression
• Hormonal disturbances such as an underactive thyroid gland
• Anal fissures and hemorrhoids which can produce a spasm of the anal sphincter muscle
• Loss of body salts through vomiting or diarrhoea
• Injuries to the spinal cord which can affect the nerves that lead to and from the intestine
In rare cases, constipation may signal more-serious medical conditions such as colorectal cancer, hormonal disturbances or autoimmune diseases. In children, constipation might indicate Hirschsprung’s disease – a congenital condition that results from missing nerve cells in the colon.
Children may also become constipated if they are afraid of or unwilling to use the toilet. Older children may ignore or forget to attend to bowel movements.
Constipation Treatments
Start with good habits
One way to keep things moving is by getting enough fibre in your diet which makes stool bulkier and softer so it’s easier to pass. Gradually increase the amount of fibre in your diet until you’re getting at least 20 to 35 grams of fibre daily. The following are good sources of fibre:
• Bran and other whole grains found in cereals, breads, and brown rice
• Vegetables such as Brussels sprouts, carrots, and asparagus
• Fresh fruits, or dried fruits such as raisins, apricots, and prunes
• Beans
If you are suffering from constipation, you should limit foods that are high in fat and low in fibre, like cheese and other dairy products, processed foods, and meat as they can make constipation worse.
Drink lots of fluids
Water is important for preventing constipation. Try to drink at least 8 glasses of water a day, especially on hot days in June to September.
Exercise
You should exercise regularly. Moving your body will keep your bowels moving too and prevent constipation.Engage in regular physical exercise, such as walking, dancing, biking or swimming, to help stimulate intestinal function. Getting at least 150 minutes of moderate exercise each week is recommended.
Laxatives
Not all individuals with constipation require laxatives. In fact, in some cases laxatives can make constipation worse.
You should reserve laxatives for constipation that does not improve after you have added fibre and water to your diet.
If your doctor recommends laxatives, ask what type is best for you, and for how long you should take them. Laxatives are best taken short-term only, because you do not want to start relying on them to go to the bathroom. Also ask how to ease off laxatives when you no longer need them. Stopping them too abruptly can affect your colon’s ability to contract.
Laxatives come in several forms, including, bulk-forming, lubricants, osmotic, stimulant and stool softeners. All these laxatives can have side effects. Avoid giving children laxatives without a doctor’s approval.
Enemas are sometimes used to relieve constipation, but they can have side effects as well. In general, doctors do not recommend using mineral oil or castor oil. Mineral oil can cause problems such as vitamin deficiencies, and castor oil can lead to long-term constipation.
When Constipation Is a Regular Problem
Regardless of what constipation treatment you use, give yourself enough time to sit on the toilet when you need to go. Holding in the urge can make your constipation worse. Set aside a regular time of the day when you know you will be left undisturbed for several minutes.
Also do not ignore the problem. Untreated constipation can lead to real problems such as hemorrhoids and tears in the skin around the anus (called fissures) that make you bleed. If you strain too hard, you might even cause part of your intestines to push out through the anus — a condition called rectal prolapse that can sometimes require surgery.
See your doctor as soon as possible if you have any of these symptoms with constipation:
• Stomach pain
• Blood in your stools
• Unexplained weight loss
• Inability to have a bowel movement
Also contact your doctor if you have been having trouble going for more than three weeks and constipation treatments are not working.
Conclusion
Constipation affects many individuals here in Anguilla. In many cases, simple changes to your lifestyle and diet can help relieve the symptoms of constipation. If constipation persists you should seek medical advice for treatment and to rule out more serious underlying disorders.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over twenty nine years in clinical practice. Dr Hodge has a medical practice in the Johnson Building in The Valley.
