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 ferment