Constipation

What Causes Constipation?

More than 20% of Americans experience constipation at some point, and it is especially common in the elderly and in women. The hard, dry stool and constant straining from constipation increases the risk of enlarged hemorrhoids. You should have an easy to pass, moist stool at least every two to three days and limit your time bearing down on the commode to less than two minutes to decrease your risk of enlarged hemorrhoids.

In most cases of constipation, there is no obvious cause. Consuming a large amount of dairy products or having a low fiber diet without enough fluids can cause constipation. Pregnancy can also cause constipation. So increasing your fiber and water intake is recommended during pregnancy. Constipation can become worse during the menstrual period as well. Constipations may also be caused by low potassium, high calcium, low thyroid, or diabetes mellitus. Certain neurological conditions such as Parkinson's disease, spinal cord lesions, stroke, multiple sclerosis, Hirschsprung's disease, or autonomic neuropathy can lead to constipation as well.

Taking antacids that contain calcium (Tums) or aluminum (Amphojel), calcium supplements, anticholinergics, antidepressants, cholestyramine, catapres, sinemet, narcotic pain medicines (codeine, oxycodone, hydrocodone), diuretics, NSAID's, psychotropics, sympathomimetics, anticonvulsants (Dilantin or Tegretol), iron supplements, or calcium channel blockers (Cardizem or Procardia) may all lead to constipation.

Diagnosing Constipation

Chronic constipation may lead to anal/rectal bleeding, abdominal pain, nausea, cramps, and even anal/rectal fissures. If you are suffering from constipation, and want to avoid further complications it is important to go to a doctor. A rectal exam, sigmoidoscopy, or colonoscopy should be done. For chronic constipation that does not respond to dietary changes the workup may include a physical exam, history, blood work, rectal exam, colonoscopy, barium enema, rectal manometry and transit time or motility studies.

Treating Constipation

No specific product is perfect since each person's body is different. Trial and error is the best bet. Usually, it takes 1-2 weeks to experience the full benefit of the additive. Foods that are rich in fiber, grains, beans, fruits, and vegetables will help. Look for products with four or more grams of fiber. You should also try fiber and water. Prunes have proven helpful in most cases. 

Be careful of overusing laxative stimulants such as mineral oil, Ex-lax, Senokot, Correctol, Dulculax, etc. that may lead to dependency. The abuse of these stimulants can lead to the weakening of the intestinal muscles and worsen your constipation. Safe laxatives to soften stool are Colace or Miralax. Miralax may cause less bloating and gas. It pulls water into the intestines. Take 17 grams per day. Adjust dose or frequency downward if stools are too loose. Stool softeners may be taken with fiber. Docusate sodium (Colace or Surfak) 100mg may be taken one to three per evening to help the morning motion. Do not  take mineral oil with Colace as it may increase the absorption leading to inflammation of lymph nodes or liver. Flaxseed and Flaxseed oil have been helpful but may reduce the absorption of some medications such as Digitalis. Lactulose or Linzess may occasionally be prescribed for constipation that does not respond to other measures. Do not use laxatives on a regular basis without having your colon evaluated by a physician.

If you are suffering from constipation, drink up to 6 glasses of water with 5 grams of fiber per glass for the first 5 days. You can add an additional 5 grams of fiber every 5 days until you've reached 15-25 grams of fiber per day. Fiber may cause gas or bloating that can be decreased by slowly adding fiber over time to allow your intestines to get used to the slower transit time and increased bacterial load that fiber causes. Fiber softens stool, lowers cholesterol, decreases the risk of heart disease and diverticulosis, and may also decrease the risk of colon cancer.

For dry stool you may apply Vaseline inside the rectum with your finger to try and aid the passage of stool and prevent a fissure. Enemas should not be used on a regular basis as they may injure the rectum.   A consultation with an internist or gastroenterologist may be helpful.

Chronic constipation is likely to exacerbate hemorrhoids and can anal/rectal fissures. If you are having constipation that aggravates your hemorrhoids please seek help from an expert.