Constipation: An Uncomfortable but Important Topic

A condition we help manage is constipation, blog for September 2020 covers this topic.

Bowel movements are not always a comfortable topic to discuss, but it is important to address and understand it. I often say that constipation is rarely life-threatening, but does quite frequently interfere with the quality of your life. Did you know that about 16% of adults overall and 33% of adults over the age of 60 suffer from constipation? Since it is such a common issue for many patients, let’s start by first understanding what constipation is and isn’t.

Some people believe that if you do not have a bowel movement every day you are constipated. Others believe that if you do have a bowel movement daily, you cannot be constipated. These statements are not always true. Although the frequency of stools is important, another important factor is stool quality.

So, what is normal?

Normal can be anywhere from having a bowel movement 3 times a day to 3 times a week, as long as the stool is soft and easy to pass. Constipation is usually defined as fewer than 3 bowel movements a week. However, if you are having bowel movements more frequently or even daily, but you also have frequent symptoms of bloating, abdominal distension, hard stools, the need to strain, lower abdominal pain (cramping), and a sense of incomplete emptying, then chances are that you are constipated. A patient may have a bowel movement daily, but it does not always mean that he/she is emptying their bowels sufficiently.

What causes constipation?

It is important to understand how the GI tract works, to understand the answer to this question. When we eat, food first it will travel to our stomach, where acid is released to help breakdown foods. After the food is broken down, it is pushed into the small intestine, where its principal job is to absorb the nutrients your body needs. When the food enters your colon, it is all liquid. As it passes through the colon, water and sodium are absorbed, and the stool slowly becomes formed. Constipation most commonly occurs when stool moves too slowly through the colon (slow transit), and therefore too much water is absorbed from the stool. It becomes hard, dry, and lacks the lubrication to help make its way through the colon.

Factors that can help contribute to this are:

  • Dehydration
  • Decreased activity
  • Changes in diet (low fiber)
  • Hormones
  • Some medications
  • Diseases of the colon such as cancers, colonic narrowing (strictures), anal tears, and colonic inflammation
  • Low calcium levels and low functioning thyroid
  • Diseases such as diabetes, Parkinson’s, and spinal cord lesions

To diagnose constipation, we would first need a thorough history and physical exam. If calcium and thyroid levels have not been checked, we check these as well. Many times we will order x-rays to assess for colon narrowing or obstruction. If your symptoms of constipation are new, then we may need to order more invasive tests, such as a colonoscopy, to rule out underlying lesions within the colon. These can be causing narrowing, and therefore stool retention. Depending on what your doctor suspects as the underlying cause, other tests may need to be performed.

The treatment of constipation varies based on the underlying etiology. For most cases of constipation due to slow transit, doctors will initially recommend a change in lifestyle, with increased water and fiber intake, as well as increasing exercise. The average American only consumes about 15 grams of fiber daily, when the actual recommended amount is 25-38 grams per day. Patients should also be consuming at least 6-8 glasses of water daily. When it is difficult to increase fiber intake through diet, doctors will recommend fiber supplements such as Metamucil, Benefiber, Citrucel, etc.

If after trying lifestyle modification, constipation does not improve, then doctors may recommend over the counter medications like stool softeners, polyethylene glycol, enemas, or stimulant laxatives. At times physicians may move to prescription medications to help control constipation.

When should I see a GI doctor?

  • Extremes of the above-mentioned symptoms
  • Have had constipation for more than three weeks and lifestyle modifications have not helped
  • Bowel movements are accompanied by pain
  • Stools have become consistently narrow
  • Started to see blood with bowel movements,

If you have been experiencing any of the above, then I would advise that you see a GI doctor as soon as possible.


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Dr. Apsara Prasad, gastroenterologist for Digestive Health Specialists
By: Dr. Apsara Prasad
Board-certified gastroenterologist at Digestive Health Specialists.
She works at our Kernersville and Winston-Salem locations. 
Learn more about her here:

Digestive Health Specialists, PA is here to help if you, or someone you know, would like more information, or if you are experiencing any digestive health symptoms and would like further evaluation. Feel free to give us a call at 336-768-6211 or fill the form below.

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