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Help! I’m Constipated

Why you get backed up and how to get things moving again.

Photo credit: Getty Images

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Dear Doctor,

All my life, I’ve been extremely “regular.” I’ve always had a bowel movement every day. But since I hit 50, I’m having problems with constipation. I often wait four or five days before going “number two,” and when I do, my stools are hard, they’re painful, and they take forever to come out. What can I do about it?

Sincerely,

"All blocked up"

Dear "All Blocked Up":

While it is common to develop problems with constipation as you get older, it’s also important to keep in mind that you don’t need to have a bowel movement every day in order to be “regular.” While that pattern is normal for some people, others may only go three times a week, and as long as their stools are soft and aren’t causing them any discomfort, then that’s fine.

Why is constipation more common as we get older? Part of it is because as your body is changing, your habits are changing, too. You may not be eating the same number of meals that you used to eat, and you may not be as active. In addition, there are a number of medications that can cause constipation as a side effect. All of these things, in addition to chronic illnesses that sometimes occur with advancing age, may play into you having a great chance of developing constipation.

When I meet with a patient who’s having constipation issues, the first thing I do is take a careful history to find out if the problem is primary or secondary constipation. Primary constipation is much more common, and it means that for some reason your stool is not moving through your gut as quickly as it should be. Secondary constipation means the problem is due to another issue, such as a chronic health condition, or a side effect of a medication you’re taking.

If the problem is primary constipation, I always start by recommending some behavioral modifications. For instance, maybe you’re not giving yourself enough time to have a bowel movement. If that’s the case, then pick a time when you’re not rushed and you’re able to spend some relaxing time in the bathroom without anyone disturbing you. It can also help to put your feet up on a low stool while you’re sitting on the toilet, since this position can make it easier to have a bowel movement.

Other simple things that often help are increasing the amount of exercise you’re doing (physical activity can help stimulate your bowels) and adding more fiber to your diet—fruits, vegetables, and whole grains. All of these strategies can help get your gut moving more normally again.

If those measures don’t work, then the next step would be to try an over-the-counter medication. There are different types of laxatives on the market. Some contain a type of fiber called psyllium, which helps bulk up your stool so that it moves through the gut more easily. Others are called osmotic laxatives, and they work by pulling more water into your colon to make your stools softer. There are also stimulant laxatives that will speed up the transit time of food in your gut. The caveat with the stimulant method is that it can sometimes cause cramping and diarrhea.

For stools that are extremely hard and impacted, an effective method is using either a gylcerine suppository or a warm water enema. An enema is when you introduce liquid into the lower intestine by way of the rectum. Speak to your doctor before attempting this at home. And avoid soapy enemas as the soap can actually damage the lining of your rectum.

If you try these measures and you’re still having problems—or if you’re having other symptoms such as abdominal or pelvic pain—it’s important to see your primary care doctor to rule out other causes of constipation.

“It can help to put your feet up on a low stool while you’re sitting on the toilet, since this position can make it easier to have a bowel movement.”
Dr. Tochi Iroku-Malize, family medicine specialist
Dr. Tochi Iroku-Malize, family medicine specialist | Photo credit: Jackie Molloy/The Well

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Published December 4th, 2018

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