| Constipation
 Constipation
can be defined as infrequent or hard pellet stools, or difficulty in evacuating
stool. Passing one or more soft, bulky stools every day is a desirable goal.
While troublesome, constipation is not usually a serious disorder. However,
there may be other underlying problems causing constipation and, therefore,
testing is often recommended.
What Causes Constipation?
The stomach churns and mixes food so it can be digested. The near-liquid food
then enters the small intestine which extracts calories, minerals and vitamins.
The small intestine ends in the right-lower abdomen where it enters the colon.
The colon, or large bowel, is 5 to 6 feet long. Its function is to withdraw
water from the liquid stool, so that by the time it reaches the rectum there is
a soft formed stool. If an excessive amount of water is extracted, the stool can
become hard and difficult to expel.
 Constipation
is often caused by a lazy colon that does not contract properly and fails to
move the stool to the rectum. The colon also can become spastic and remain
contracted for a prolonged time. In this case, stool cannot move along. Too much
water is absorbed and hard pellet-like stool develops. Constipation also can
result from a mechanical obstruction, such as tumors or advanced diverticulosis,
a disorder which can distort and narrow the lower-left colon. Other conditions
that can produce a sluggish, poorly contracting bowel include: pregnancy,
certain drugs, thyroid hormone deficiency, the chronic abuse of laxatives,
travel, and stress.
Diagnosis
 The
patient's medical history is the most important factor in diagnosing
constipation. The physician will perform a physical exam and obtain certain
blood tests. A barium x-ray exam of the lower bowel or colon often is warranted.
In addition, a sigmoidoscopic exam (using a lighted, flexible endoscope) is
necessary to rule out a mechanical blockage of the lower bowel, such as a tumor.
This exam allows the physician to view the bowel wall and obtain biopsies
(tissue samples) of any suspicious areas. Colonoscopy may be indicated. This is
the visual exam of the inside of the entire colon using a flexible endoscope.
The exam is usually performed under mild sedation. A marker test may be done
whereby the patient swallows a capsule containing markers. Some days later an
x-ray is taken to analyze the pattern and distribution of markers in the colon.
In some cases, pressure measurements of the rectum and lower colon can provide
valuable information. This exam is called manometry. 
Treatment
Because there are many causes of constipation, treatment depends on the
physician's findings and diagnosis. After serious problems are excluded, chronic
constipation usually responds 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, regular walking and performing aerobic
exercise. In particular, patients should respond to the urge to defecate.
Retaining stool at this point will aggravate the condition.
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 is used
and where large amounts of fiber are consumed, there is little constipation, and
passing one or two large, soft stools a day is normal. The following foods
should be eaten daily in adequate amounts:
Whole grain breads (whole wheat)
Bran cereals
Vegetables -- Root (potatoes, carrots, turnips), leafy green
(lettuce, celery, spinach), or cooked high residue (cabbage)
Fruit -- Cooked or stewed (prunes, applesauce) or fresh fruit (skin
and pulp)
Bulking Agents -- Fiber is the undigested part of plant food that
passes into the colon. Certain types of fiber can absorb and hold large
amounts of water. This, in turn, results in a larger, bulkier stool which is
soft and easier to pass. Adequate fiber in food or from supplements is
recommended daily. This type of water-retaining fiber generally is easily
obtained each day by one of the following:
Food bran -- This is available as wheat, oat or rice bran.
Processing of wheat and other grains removes this valuable fiberous part of
the food so these processed products should be avoided.
Psyllium bran -- The psyllium plant is remarkable because its ground
seeds can retain so much water. This product is available as Metamucil, Konsyl,
Effersyllium, Per Diem Fiber, or the less expensive generic preparation in
drug and health food stores. Although labeled a laxative, it really is not a
laxative.
Methylcellulose -- This is another fiber derived from wood which
also retains water. It is available as Citrucel.
Exercise
Regular exercise, particularly walking and jogging help prevent constipation. Be
sure to drink plently of water.
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, especially stimulant laxatives is discouraged because
the bowel becomes dependent upon them. Bowel regularity should occur without
laxatives. An occasional enema is preferrable over the chronic use of laxatives.
Surgery
With certain medical conditions, such as severe diverticulosis, and with extreme
constipation in some younger patients, surgery may provide relief.
Bowel Retraining Program
- Do not use laxatives.
- Eat a diet high in roughage, such as bran cereals and leafy vegetables.
- Drink six (6) ounces of prune or apricot juice each morning.
- Eat two (2) large servings of stewed fruit each day.
- Take one (1) heaping tablespoon of a psyllium-based bulking agent twice a
day. Use the nutraSweet® product to avoid excessive calories.
- Eat a normal breakfast.
- Set aside 15 minutes after breakfast to sit on the toilet, but do not
strain to have a bowel movement.
- If you do not have a bowel movement by the third day, use an enema and
repeat the above steps.
Summary
Constipation usually is a short-term disorder which is easily treated by simple
measures. However, the condition may reflect a serious underlying disorder that
can only be detected and treated by the physician. For chronic constipation, it
is important that the patient understands how this occurs. By the intake of
proper foods and fiber supplements, it is usually possible to retrain the colon
so that normal regularity occurs.
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