Constipation
Millions of adults in the US suffer from constipation. Left untreated, constipation can lead to a number of health problems.
Constipation Overview
Constipation affects millions of people worldwide, and most people do not discuss their symptoms with healthcare providers. This is not good, as untreated constipation can become a chronic condition, significantly impacting quality of life and causing discomfort and frustration. Only 1 in 5 patients who see a healthcare provider about their constipation feel satisfied about the management of their symptoms.
At Easy Belly, we take the time to understand the unique challenges that each constipated patient faces, and through shared-decision making, work with the patient to create a comprehensive, patient-centered, long-term constipation management plan.
In this article, we will provide an overview of constipation, outlining common symptoms and reviewing common treatment options to relieve symptoms. For a more personalized treatment plan, signup for a one-on-one counseling session.
Types of Constipation
The onset of constipation can be broken down into two types of disorders.
Primary Disorder
The constipation is being caused by problems involving the bowel and or anus.
Secondary Disorder
The constipation is being provoked by something outside of the body, such as a medication.
Constipation Symptoms
There are many ways to define constipation. Constipation is commonly characterized by infrequent or difficult to pass bowel movements. Other signs of constipation can include straining to pass the stool, experiencing a sensation of incomplete stool evacuation, passing hard stools, or needing to use laxatives to have bowel movements. Constipation can become a chronic condition with many different treatment options that range from behavioral and or nutritional changes to over the counter and or prescription medications. Constipation symptoms can be significantly improved by seeking care that focuses on creating a holistic, patient-centered approach for long-term treatment and management.
Difficulty Passing Stools
One of the primary signs of constipation is struggling to have a bowel movement. This can manifest in various forms such as:
Experiencing straining or spending excessive time in the bathroom.
Passing hard, dry stools. Constipated individuals often notice that their stools are lumpy or hard.
Experiencing a sense of incomplete evacuation of the stool. After a bowel movement, a constipated person may feel that there is still stool to pass.
Infrequent Bowel Movements
While weekly bowel movement frequency naturally varies, having fewer than three bowel movements per week can be concerning. Patients with less than three bowel movements per week meet one of two diagnostic criteria for a medical diagnosis of functional constipation.
Abdominal Discomfort
Constipation can cause abdominal bloating, pain, and or discomfort. You may feel a sense of fullness or heaviness in your abdomen that changes based on your bowel frequency, the caliber of your stool (the stool shape, size, firmness) or when passing the stool.
Constipation Treatment Options
Dietary modifications
Make sure you’re eating enough fiber each day:
Fiber is something that is consumed and is not absorbed (remains in the bowel lumen). Fiber is believed to improve constipation by increasing the amount of water in the bowel, creating softer stool and bowel distention that promotes bowel contraction. Consuming an adequate amount of fiber-rich foods like fruits, vegetables, and whole grains can improve bowel movements. The daily recommended fiber intake for children and adults ranges from 25 to 35 grams per day, but the average person is estimated to consume less than half of this daily recommendation.
Exercise
Though not well studied, increasing daily activity is recommended to improve constipation. It is thought that exercise may result in reduced water absorption from the colon, resulting in softer stools and stimulating bowel contraction. Exercise does not have to involve intense movements. Even just walking for 10 minutes daily could improve your bowel movements.
Yoga Flows
Data supports the use of yoga moves to help the bowels move. A few studies even suggest that a yoga flow can clear the bowels as effectively as a colonoscopy bowel prep! Flow intensities range from involving physical movements, to holding poses, to vibration changes through sound, and or breath work. Research to date has evaluated the use of yoga flows to improve bowel movements in a range of people, studying young kids as well as elderly adults. One study suggests that incorporating a yoga flow into your morning routine can improve bowel movements and reduce the need for constipation medications.
In order to learn more about these research supported yoga moves, we have an awesome post coming your way that will go over in detail how to do these specific, researched moves. Be sure to drop your email at the end of this page to receive a notice of its release!
Over-the-Counter Therapies
Standard of care treatment approaches to constipation involve first dietary and behavioral changes, such as increased consumption of fiber rich foods and incorporating daily movement into your day. If this is not enough, trying over the counter fiber supplement and/or laxatives is typically the next recommended step.
Fiber Supplements
Adding a fiber supplement to your diet, such as Metamucil, can help you achieve your daily fiber intake requirement and add bulk to your stools to ease stool passage. Increasing fiber consumption slowly is important; if you increase fiber supplementation too quickly, you may experience common fiber side effects such as bloating and or abdominal distention, cramping abdominal pain, and/or flatulence.
If you do experience this, you are recommended to reduce your fiber dose to the highest amount tolerated. After two to three weeks at this dose, you can retry increasing your fiber supplementation slowly to meet your nutrition and bowel needs.
Osmotic laxatives
Osmotic laxatives, such as MiraLAX, attract water into the colon, causing colon distention that stimulates bowel contraction and results in softer stools. You can try taking a capful of miralax (17grams) daily mixed in a cup of water. Try taking this every day for a couple of weeks. If you continue to experience constipation, then try taking miralax (17 grams) mixed in a cup of water twice a day.
Stimulant laxatives
Stimulant laxatives, like Senna, can improve bowel movements through acting on nerves in the smooth muscle lining your bowels to stimulate bowel contractions. Stimulant use can be challenging, as many patients report needing to decrease the stimulant dose or stop use of the stimulant altogether due to side effects of abdominal cramping and diarrhea. Limited data even suggests that when regularly used, Senna may cause problems, including but not limited to melanosis coli (change in the color of your colon), inflammation of the liver, and possibly bowel tolerance (more senna is needed to produce the same effect). Because of the limited data at this time, Senna is recommended to be used as a short-term treatment (regular use of 4 weeks or less) or on an as-needed basis. Try to avoid this medication if you have a history of liver disease!
Magnesium-containing agents
Magnesium-containing agents, such as Magnesium Oxide, work by retaining water in the bowel, bulking and softening stool, theoretically distending the colon and promoting bowel contractions. Current data supports a 4 week course of 400-500 mg daily, though you could likely increase the dose or safely extend longer if it’s working. This should be avoided if you have a history of renal disease and/or are pregnant.
Prescription Medications:
When dietary changes and over-the-counter options prove insufficient, prescription medications are often necessary either alone or in combination with the other relief approaches.
Pending your preference, prescription medications can be considered earlier versus later in the treatment plan. By maintaining strong, open communication with our patients, and by providing our patients education, we use shared-decision making platforms to create patient centered plans that over time help patients achieve successful improvement of their constipation.
The following are some easy and immediate things you can do to relieve constipation.
Constipation Relief Checklist
Easy and immediate things you can do to relieve constipation.
Increase your fiber intake
Try to consume 30 grams of fiber a day. You can review our high-fiber database to learn about foods high in fiber and low in calories.
High-fiber food database
Try a fiber supplement
Try taking a ¼ teaspoon of Metamucil daily.
Increase by a ¼ teaspoon every 3 days. You can increase to a max dose of 2 teaspoons twice a day.
If you experience bloating or discomfort, decrease your Metamucil and try taking a laxative.
Try A Laxative or Magnesium-Containing Agent
Further options to stimulate bowel contraction include Osmotic Laxatives (MiraLAX), Stimulant Laxatives (Senna), or Magnesium-Containing Agents (Magnesium Oxide).
How to know your constipation treatment is working?
Oftentimes, success in treating constipation is defined as increasing the number of daily or weekly bowel movements. However, this is a limited view of success that can cloud the true milestones of a successful constipation relief program. In terms of frequency, success may be defined as an increase of at least one complete spontaneous bowel movement per week over a patient’s baseline. A complete spontaneous bowel movement may be defined as having a full evacuation of the bowels without straining. Other factors to evaluate the success of a program may include how a therapy reduced abdominal pain and any positive changes in stool form.
Overall, it is important to create a treatment plan with your healthcare provider that is tailored to your individual needs and preferences. As such, your constipation treatment goals may not involve having daily bowel movements. At Easy Belly, we focus on taking the time to fully understand your history, symptoms, and treatment goals so that we can create a personalized treatment plan to work towards getting you feeling better.
Remember, this approach is for people with Constipation without alarm symptoms and is intended to help you as you await seeing your GI provider. If you have any of the following alarm symptoms, please let your doctor know so that they can expedite having you seen. Alarm symptoms most often include but are not limited to blood in stool, abdominal pain or diarrhea that awakens you out of sleep, unintentional weight loss. This also includes if you have a family history of inflammatory bowel disease (IBD) or colon cancer in first-degree relatives (Mom, Dad, Siblings) age 60 or younger, or irritable bowel syndrome diagnosed after age 40.
Telemedicine Consultation
At Easy Belly, we place a strong emphasis on long-term patient-centered care.
Our goal is to help you understand your condition, explore your options, and decide on a treatment plan that best suits your needs and lifestyle.
