Treatment for Constipation Explained

Constipation is very common especially among older people.

Constipation
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To feel constipated for short periods of time is to be human. All people have felt constipated at some point. Constipation has a distinct ability to throw people off-kilter. To make matters worse, many physicians fail to recognize or empathize with just how terrible a feeling constipation is. Consequently, many people with constipation treat themselves with over-the-counter laxatives, and chronic use of laxatives can get pretty dangerous.

Before we begin, let's stress two points. First, there's no right or normal number of bowel movements. Some people may have two bowel movements a day, and other people may have three bowel movements a week. Depending on the person, either of these scenarios can be normal. Second, constipation is technically a symptom and not a disease in and of itself. In other words, the treatment of constipation is a symptomatic treatment which doesn't cure this condition.

What Is Constipation?

If somebody were to mention constipation, few people would wonder what constipation is. We all know what constipation is. Nevertheless, definitions of constipation in the medical and nursing literature have been variable and inconsistent.

Here are some ways in which constipation is defined:

  • fewer than two bowel movements a week
  • straining during bowel movements
  • hard stools
  • feeling as if your bowels haven't completely evacuated
  • feeling blocked

Please understand that you don't need to have all of the above symptoms to be constipated. In fact, if you have two or more of these symptoms present a quarter of the time—amounting to at least 12 weeks a year—you meet Rome II criteria for constipation.

How Common Is Constipation?

Constipation is really common.

An estimated 26 percent of all women and 16 percent of all men report having recurrent constipation. Furthermore, among adults older than 65, 34 percent of women and 30 percent of men report having having constipation.

Why Do (Older) People Get Constipated?

People experience constipation for many reasons. Many of the reasons that people experience constipation are age related.

First as we age, more collagen is deposited in the colon. This increased deposition of collagen decreases the elasticity of the bowel and decreases motility of the bowel. By means of analogy, it's easier to squeeze pudding out of a plastic bag than it is to squeeze pudding out of a garden house. (And I'm not saying that anybody's bowel gets as rigid as a garden hose, but I'm sure you get my drift .... )

Second as we age, the number of nerves in the myenteric plexus decreases, which may impair gut motility. The myenteric plexus can be likened to your gut's brain. More specifically, the myenteric plexus is a complex framework of motor, sensory and autonomic nerves that controls gut motility or movement.

Third as we age, the tone of the internal sphincter decreases, which makes evacuation of feces more difficult.

Things That Make Constipation Worse

In addition to physiological changes, constipation can be exacerbated by other things including the following:

  • anticholinergic drugs (think tricyclic antidepressants and antipsychotics)
  • taking more than 5 medications at once
  • opiates (think painkillers Norco or Vicodin)
  • iron supplements
  • calcium channel antagonists (think verapamil)
  • calcium supplements
  • diets lacking in fiber or low in calories
  • NSAIDs (think aspirin or ibuprofen)
  • dementia
  • diabetes
  • dehydration
  • hypothryoidism
  • dialysis
  • tumor
  • lack of privacy or poor access to toilets

Obviously, some of these risk factors can be controlled for. For example, if you think that some of your medications are contributing to your constipation, bring this concern to the attention of your physician.

Treatment for Constipation

The FDA estimates that over-the-counter laxatives are the second most abused drugs behind over-the-counter analgesics or pain relievers. Overuse of laxatives can lead to a vicious cycle of dependence as well as nutritional deficiencies, electrolyte (body salt) imbalances and osteomalacia, or softening of the bones.

To be sure, physicians and other healthcare practitioners also rely too heavily on prescription of laxatives as a quick fix, particularly among people living in institutional settings like nursing homes.

Please keep in mind, however, that laxatives are useful in treating constipation. But instead of mindless prescription and consumption, laxatives, such as psyllium, sorbitol and senna, are best taken judiciously and as part of an integrative regimen targeting the treatment of constipation. This treatment regimen should be supervised by knowledgeable and sympathetic physician who values the impact that constipation has on your life.

Besides laxatives, here are some other ways that constipation can be treated:

  • increasing your fiber intake to at least 10 grams a day
  • increasing your consumption of fluids to between 1.5 and 2 liters a day
  • engaging in regular physical activity (walking at least 30 minutes a day)
  • ensuring bathroom comfort and privacy
  • receiving abdominal massage or enemas

On a final note, regular and satisfying bowel movements are important. Please don't mindlessly take laxatives to "treat" constipation. Symptomatic treatment of constipation is an important part of your health care and requires the compassion and attention of your physician. If you feel that your physician isn't sympathetic to your concerns about constipation, it's a good idea to find a physician who does care about helping relieve your constipation.

Sources

Article titled "Constipation and Laxative Abuse" by RR Babb published in The Western Journal of Medicine in 1975.

Harari D. Chapter 93. Constipation. In: Halter JB, Ouslander JG, Tinetti ME, Studenski S, High KP, Asthana S. eds. Hazzard's Geriatric Medicine and Gerontology, 6e. New York, NY: McGraw-Hill; 2009. Accessed January 18, 2016.

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