Constipation

Help! I’m Feeling Constipated!

How do you know when constipation is a medical problem?

This part’s easy: when it becomes distressing, uncomfortable, or inconvenient for you it can be something that your doctor can help you with. Some people have bowel movements daily, some only a few times a week. As long as you’re not straining to pass stool and it’s not interfering with your life, it isn’t a problem.

First, let’s take a look at the anatomy:

  • Stomach - the stomach continues what the mouth begins: breaking down food with acids and churning.

  • Small Intestine - consisting of the duodenum, jejunum, and ileum, this is where the vast majority of the “digestion” and absorption of nutrients from your food occurs.

  • Large Intestine (colon) - This is most likely the cause of your discomfort. The purpose of the colon is to reabsorb water and fluids from your gastrointestinal (GI) tract.

How do I know constipation is causing what I feel?

Common symptoms of constipation can include a classic sense of bloating or “fullness,” in addition to a feeling of incomplete voiding after having a bowel movement, but these symptoms can be more subtle as well. Patients have also reported feeling nauseated, achy, or even just a general sense of unwellness.


Tell your doctor or nurse if you:

  • Have bleeding from your rectum. Try to pay attention to whether it’s in/around your bowel movement, on the toilet paper when you wipe, or dripping into the bowl. This could be something as simple as a small case of hemorrhoids, or it could be diverticuli (small constipation-caused outpouchings in the colon) which can be more serious.

  • Are having constipation that is different from your regular rhythm. Changes in long-standing patterns are what doctors look for in determining the severity of a patient’s symptoms.

  • Have had constipation for several weeks without change. Everybody goes through spells where they don’t have regular bowel movements. If these periods last longer than two weeks though, that’s something that you should get checked out!

Is there anything I can do on my own to feel better?

Yes! In fact the first line treatments for constipation are non-pharmacological (not medicine). Think of regular bowel movements as being helped by even thirds: Drinking plenty of water, eating enough fiber, and getting exercise.

  • Water: cutting out things like juices and colas will help you to stay hydrated. Water being absorbed into your intestines is what keeps bowel movements soft - not enough water, and stool gets harder to pass! Your goal is 5-8 big glasses of water a day.

  • Fiber: This can be difficult for a lot of people, but is good motivation to eat a healthy diet! Fiber comes primarily from vegetables, whole grains (such as brown rice or raisin bran), and beans. Make sure to have at least 5 servings of vegetables a day, and use meat (especially red meat) sparingly.

  • Exercise: This doesn’t have to mean entering into a bodybuilding competition or running a marathon! Staying active, especially using multiple muscle groups, is the best way to keep your gut flowing. Walking for 30 minutes a day at a brisk pace is a great way to not only keep yourself regular, but also to improve your heart health as well!


Be careful of your medicines and supplements!

  • Things like opioid pain medicines or narcotics can slow down your gut. Offset this by taking them sparingly when necessary, as well as staying hydrated and asking your doctor for help managing other contributing factors.

  • Even over-the-counter medications can cause constipation. Things such as Pepto-Bismol can cause constipation, and only mask symptoms of heartburn. Try Maalox or ask your doctor for more long-term solutions to other conditions you have.

  • Be careful when taking things over the counter for constipation! Miralax (or its generic, Polyethylene Glycol) is safe, but avoid taking other things like Colace, and Milk of Magnesia long-term. Colace (or its generic, docusate), has been shown to be a placebo. Milk of Magnesia can be effective for short doses, but can cause absorption issues over longer periods.

  • If you believe you are not getting enough fiber in your diet and want to supplement that further, try natural sources such as Metamucil, or anything that contains “psyllium” in it. Psyllium is natural roughage which will help get things moving.

  • Take things slow when starting fiber supplements too! It’s counterintuitive, but too much fiber too fast can lead to further bloating and difficulty passing stools. This is especially true if you don’t increase your water intake to match the fiber!

None of this has helped! What do I do?

If you’ve tried all of this on your own and it hasn’t made a difference, it’s time to talk to your doctor. There are many things that can cause constipation, and they can be difficult and frustrating to deal with on your own. Chronic Idiopathic Constipation (CIC) is a very manageable condition that can be managed with a mixture of medication, behavioral modifications, and regular check-ups.