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The Facts About Constipation and How to Treat It

by James M Stewart, MD

The gastrointestinal tract is designed to break apart food so that we absorb the nutrients we need while leaving behind the material in food we don’t need. To do this, our body secretes digestive enzymes from the pancreas and water from the body to liquefy the food we eat so that it can mix around in the intestines. Once the nutrients are absorbed, the remaining liquid with the non-absorbed food material enters the large intestine.

The role of the large intestine is to remove as much of the remaining liquid that was added to the food so that we don’t waste water. It is a very slow process and usually takes about 24 hours. Through very slow movements, the liquid waste is slowly turned into solid waste until enough has accumulated. At this point, most of us will feel the need to have a bowel movement and push the solid waste out of the body.

Constipation is when that process takes too long or there is something not functioning correctly with the muscles that coordinate bowel movements. When one meets with a physician, it is important to be very clear what one means by constipation because there are multiple symptoms that are called constipation. Constipation can mean that you have very infrequent bowel movements (less than 3 per week) or that it can very difficult to pass stool (straining while having a bowel movement). For the purposes of this article we will discuss infrequent bowel movements.

Most constipation in the United States is related to slow movement through the large intestine which results in infrequent bowel movements or hard bowel movements. There are many things that slow down the movement through the large intestine and most of them are harmless and do not impact one’s health but can affect one’s wellbeing. Pain medications containing opiates are one of the most common causes of drug-induced constipation. Stress, anxiety, and depression can also alter the function of the large intestine causing things to slow down. Certain diets, particularly those that are low in fiber, can cause temporary constipation. In some cases, the large intestine just doesn’t move as quickly as we would like.

Discussing symptoms with a physician can usually uncover some of the causes of constipation. Blood testing can sometimes help. Colonoscopy can sometimes be useful if there is any suspicion for narrowing in the intestines causing a blockage which can sometimes occur with colon cancer or large polyps.

Once the dangerous causes of constipation have been ruled out, treatment for constipation usually consists of increasing physical activity, dietary changes to increase fiber, using fiber supplements, and sometimes medications. Light to moderate exercise has been shown in multiple studies to help stimulate bowel function to have more regular bowel movements. Fiber supplements like psyllium husk (Metamucil) contains natural fibers which are non-digestible plant products. Other fibers include bran as well as semi-synthetic fibers such as Benefiber and Citracel.

Medications, or laxatives, can be divided into four categories.

• Osmotic laxatives, such as Miralax and lactulose, function much like fiber and help hold more water in the large intestines. These are extraordinarily safe medications because they do not alter any chemical receptors or nerves in the body but just change the osmotic gradient in the large intestine. These medications are not absorbed into the body and are eliminated with a bowel movement.

• Stimulant laxatives, such as Senna or bisacodyl, stimulate the large intestine to have a bowel movement. These medications are available over the counter and are safe for short-term and long-term use. Older versions of these medications were found to be unsafe and were removed from the market many decades ago, but the current medications are safe for long-term use.

• Secretory laxatives, such as Linzess, Amitiza, and Trulance, encourage the body to secrete more fluid into the small intestine to act as a “flush” and push the bowel movement out. These are available as a prescription and are very well tolerated and safe for long-term use.

• Opiate blockers, such as Relistor and Movantik, are only indicated for those using opiate containing pain medications. These medications will block the opiate effect in the intestines while still allowing the anti-pain effect of the opiates.

In summary, most constipation in the United States is caused by a variety of things that can slow down the large intestines. Discussing these symptoms with a gastrointestinal expert can help identify some of the causes of constipation and find ways to reverse them. Also, some constipation can be caused by serious conditions such as colon cancer so further testing may be required. Once the causes of have been identified, there are many safe and sensible therapies to treat constipation and improve one’s quality of life.

Patient Safety and Quality of Care

Granite Peaks GI is focused on delivering the highest quality of care for our patients and providing a safe, positive experience, whether our patients are having a procedure or being seen in our clinic for an office visit. Part of having a good experience means being an active member of your health care team.

Get More Out of Your Health Care Visit

One of the ways you can make your appointment productive and be sure to receive the information you need from your provider is to ask questions.

  1. 1. Bring someone with you – they’ll help remember answers to your questions
  2. 2. Know your family and personal health history, including dates of illnesses and surgeries
  3. 3. Either bring your medications with you, or bring a list that includes everything you take – prescription and over-the-counter products

Before your appointment, write down a few questions you have for your health care provider. Your provider will not go through 20 separate health concerns at one appointment, so focus on the questions you would like answered about symptoms, medication, treatment options, tests or procedures.

During your appointment, let the medical assistant or nurse know you would like to ask your medical provider some questions. When you’re with your provider, ask the questions you prepared starting with those most important to you. Then listen to the answers and take notes. If you don’t understand something, let your provider know. If you are having tests done, ask when you might expect results and how you will receive them – by phone, mail or online patient portal.

It is important for you to understand if you have been given a diagnosis and what treatment options are available to you. If medication is prescribed, be sure you understand what it will do. Before prescribing for you, your health care provider will check for interactions. This is why your provider having your complete list of medications is so important. If a procedure or surgery is recommended, be sure you understand the risks and other options for treatment and how it could affect your daily life.

After your appointment, follow your health care provider’s’ instructions. If you are to start a medication, ask the pharmacist questions about it if it’s a new medication to you. Read all of the side effects and possibilities for altering your state of health and your ability to continue daily functions. If you notice a problem or if you are having unexpected side effects, contact your doctor’s office. It is possible a different medication may be a better choice for you.

If you are going to call your physician after your visit, prepare for a phone call the same way you did for your appointment. Write down what you need to ask them because it is possible you will need to leave a message or contact them electronically. Let your medical provider know if you are having side effects or other difficulty with your medication or if your symptoms worsen. If you are waiting for test results, be sure you understand any results you are given. You are entitled to receive the full report of any tests results.

You play an important role in providing your doctors with accurate, complete information about your health history and your current condition. Your doctor uses this information to decide the safest, most effective treatment options to help you feel your best. Get involved, get informed and get healthy!

 

 

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