Managing Constipation: The Basics

The National Institute of Diabetes and Digestive and Kidney Disease defines constipation as three or fewer bowel movements per week or hard, dry, or small bowel movements that are painful or difficult to pass1. Constipation remains one of the most prominent of gastrointestinal (GI) issues and affects roughly 42 million people in the United States1. Populations that are at risk for developing constipation are women (especially during pregnancy or after birth), older adults, non-caucasians, people with a history of surgery, or people who take medications to treat depression or pain.

Given the vast number of people who are troubled with constipation, it is important that constipation is managed properly. The GI system is impacted by so many different things that make managing it difficult. Dietary intake, stress, activity level, and medications among other things can all significantly impact the GI system and therefore play a role in managing constipation. Since these basic elements of everyday living affect your bowel habits they are a great place to start if you develop constipation. Before trying over-the-counter medications or seeing your primary provider, consider trying the following things to help manage your constipation.

  • Increase your fiber intake2: Fiber is a basic dietary element that is commonly found in fruit and whole grain bread. Fiber adds weight to the stool as it passes through the intestinal tract, which helps it move quicker. You can consult with your doctor regarding how much fiber to intake each day.
  • Exercise most days of the week2: Physical activity stimulates the muscles in the intestines to be more active. Try to participate in some sort of physical activity most days of the week at a minimum. Often times something as simple as a walk can help depending on your lifestyle.
  • Drink enough water3: According to Vandana Sheth, a registered dietitian nutritionist and spokesperson for the Academy Of Nutrition and Dietetics, if you eat too much fiber but don’t drink enough water, that can cause you to become more constipated. Drinking adequate amounts of water helps to soften the stool and lubricate the stool as it passes through the intestines. As a general rule of thumb, Sheth recommends you drink half your weight in ounces of water. So if you weigh 120 pounds, you should consume about 60 ounces of water daily.
  • Cope with stress3: Stress has been shown to cause a significant number of health issues, constipation being one of them. Stress reduction techniques can go a long way in reducing stress and alleviating the side effects of stress. Examples of stress reduction techniques could include meditation, deep breathing, exercise, or participating in a fun activity that is enjoyable.

Another way to help alleviate constipation is to avoid factors that cause constipation. Sheth notes that it is a good idea to cut back on alcohol and energy drinks as they are a diuretic (diuretics make you pass more urine) and can cause constipation. Coffee can help to stimulate a bowel movement but also can cause constipation if too much is consumed3. Many medications can cause constipation as well. Classic constipation inducing medications include narcotics (opioids) and antidepressant medications. These medications are notorious for slowing the gut down and causing people to get backed up.

Pain and Constipation

Pain issues are commonly associated with constipation. With a more intrusive look, it is easy to see why. Pain is common after some procedures, surgery, or injury. Often constipation inducing medications are given to help alleviate the pain. When pain is experienced, generally it impacts all basic elements of everyday living. When we experience pain and are recovering from something we generally are less active, have less of an appetite, drink less water and might be more stressed. These factors increase the risk of constipation.

Over The Counter Medications

If these steps do not alleviate constipation and help to accomplish four or more full bowel movements a day, then it could be time to consider trying some over the counter medication. Whenever starting a medication it is wise to inform your doctor, especially if you plan to stay on it long term.

For basic management of constipation, it would be good to start off with a stool softener. These medications do exactly what they are called, they soften the stool and help the stool pass more easily. Adding a bulking agent like Metamucil or Citrucel can be a potential idea as well to start with. If these efforts don’t help to facilitate a regular bowel movement consistently, then you might want to consider taking a medication like Miralax daily. These medications are generally safe to take on a long-term basis.

Managing bowel habit is a balancing act. In an attempt to resolve constipation you could then develop diarrhea. It is wise to start with the lowest recommended dose of a particular medication and increase it according to the medication label or based off of your doctor’s recommendations.

Time To Be Seen

If all of these measures fail to help control your constipation then you should be seen by your primary care provider. If they feel they cannot help, they can refer you to a gastroenterologist. If you don’t do these basic measures outlined in this article they will likely be recommended as a first step for management by your physician. By utilizing these steps you can hopefully alleviate your constipation symptoms and if not, then you can be confident a doctor’s visit is necessitated.


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