CONSTIPATION

CONSTIPATION

By Dr. Keith E. Lewis
May 22, 2008

Constipation within our population is much more prevalent than anyone would ever suspect. I know in my clinical practice that it is not unusual to see 8 of 10 patients that are dealing with the issues of constipation. Many of our patients feel it is just a common occurrence, many patients feel that it is normal to have a bowel movement once every seven days. However, it is one of the most common gastrointestinal complaints in the US, especially amongst the older population as well as the teenage population. Both chronic and acute constipation can be a major source of discomfort for any individual.

Constipation is typically diagnosed whenever bowel movements are difficult, hard or painful, or not occurring on a regular basis. Many experts do not consider a patient constipated based on frequency of bowel movements and do not believe this is a criterion for diagnosing constipation. However, clinically we find that frequency is a major factor in dealing with constipation issues. Bowel movements typically should be fairly regular and passed with no straining or pain. The stools should be formed and pliable as opposed to pebble-like or hard or very loose.

Many people or patients with chronic constipation develop a variety of symptoms ranging from abdominal pain, rectal discomfort, abdominal fullness and bloating, nausea, loss of appetite to just a general feeling of malaise. These patients also feel that they never completely evacuate their bowels. Severe constipation which is chronic in nature may be accompanied by fecal impaction. Most patients that we have seen with chronic constipation are advised to exercise, increase their intake of fiber and liquids. While these do work for some individuals it does not work for everyone. Many patients have to use fiber supplements and sometimes fiber supplements are not even effective.

There are several risk factors for constipation. They are as follows: Lack of exercise. Constipation has been linked and shown to be related to inactivity. Medications especially narcotics can cause constipation as do some antidepressants, iron supplements, and calcium supplements. Calcium supplements typically calcium carbonate constipates many of the patients that we do see. Other medications that can cause or lead to constipation include calcium channel blocker, psychotropic drugs, and anticholinergics. Inadequate thyroid hormone supplementation also can cause or lead to constipation. Certain disease processes, tumors, and some other diseases may produce a rapid change in bowel movement and even a cessation of bowel movement altogether.

Fiber as a treatment regimen for constipation: The average American eats only 10 to 15 grams of fiber daily. Typical recommendations for most individual should range somewhere between 25 and 50 with and average of 35 grams per day. 

Fiber is excellent for overall intestinal health and alleviating chronic constipation. Although humans cannot digest fiber, the 5 pounds or so of friendly bacteria that is present in our digestive tract use the fiber for fermentation and production of short chain fatty acids that the cells of the intestine use for energy.

Most foods contain a mixture of soluble and insoluble fiber; both are important in treating constipation. Soluble fiber is contained in oats, apples, lentils, barley, breads and cereals. It is able to mix evenly with water forming a soft gel. Insoluble fiber is contained in raw wheat bran and other whole grains and fruits and vegetables. It mixes unevenly with water forming a soft bolus. Our body does not absorb soluble or insoluble fiber during digestion.  Fiber contributes volume to the stool mass, making it easier for the colon to push and propel larger and softer stools out of the body. Insoluble fiber encourages contraction of the colon. Both fiber types contain a volume to individual stool mass. The larger mass of stool is easier for the colon to push against and propel so larger, softer stools are easier to move and pass. We have found several supplements to be beneficial in the treatment of constipation by adding fiber to the diet.

Chitosan is a fiber composed of chitin. It is a component of the shell of shellfish and has ability to bind fat from food in the stomach and the intestines.  When fat content in the bowel increases, it makes the feces soft and smooth. If we do not obtain results from other commonly used fiber sources, six 500 mg capsules of Chitosan along with 1000 mg of vitamin C before each meal may help alleviate constipation. Ascorbic acid or vitamin C helps transform Chidosine in the stomach and intestine into a fast absorbing gel. Chitosan should not be used by people if they have shellfish allergies.

Glucomannan is a water soluble dietary fiber derived from the Konnyaku root. Glucomannan is considered a bulk forming laxative which promotes a larger, bulkier stool. Glucomannan generally helps produce a bowel movement within 12 to 24 hours.

Probiotics and prebiotics also help with digestion and proper bowel movement and activity. The colon has a large population of beneficial bacteria that help digest many nutrients. Beneficial bacteria would include but not limited to lactobacillus, acidophilus, and bifidobacterium. A healthy population of the good bacteria is the essence of a proper digestion. In addition, probiotics, fructose and oligosaccharides have also been shown to promote normal bowel movements.  

As I previously stated, diet, lifestyle change has a lot to do with bowel activity. 

The following are some tips on how to improve digestion and alleviate constipation.

Increase your fiber intake, add more fruits and vegetables in addition to whole grains and bran to your diet, add legumes to your daily meals either as a side dish or a part of a casserole. They are among the foods that offer the most fiber for serving and they encourage the growth of bacteria in the colon adding to stool bulk.

Cut back a low-fiber food such as meats, cheeses, and processed foods.

Drink plenty of water about 8 full glasses a day. As you increase intake of fiber, you may also need to step up fluid intake.

Reducing caffeine containing drinks such as coffee, tea, and colas, they have mild dehydrating effect on the body but they do not promote a hydrated state. However, caffeine products do at times promote contractions in the bowel and sometimes actually facilitate bowel movements. I guess the key, ingest these in moderation.

Eat on a regular schedule to give your body a chance to regulate in the elimination. Respond to your body signals to pass stool. This will keep your movements regular.  Resisting the urge to move your bowels for too long can result in impaction and overflow incontinence in which the liquid stool bypasses the impacted stool and leaks out. 

Exercise: As with most conditions, is an extremely important factor in the management of constipation. Regular exercise, especially abdominal muscle exercises, and brisk walking are recommended according to age and physical condition of the individual.  

Just to summarize, nutritional supplements that are beneficial, Chitosan, soluble fiber, glucomannan, probiotics, and of course increased water intake, all help reduce the incidence of constipation.