FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

FIBER, EXERCISE AND MORE WATER MAY HELP CHRONIC CONSTIPATION

Question: I have had trouble with constipation all of my life. I strain to pass hard stools, and I often have a feeling that I need to use the bathroom. Taking a fiber laxative every day helps, but it doesn't make me regular. Is there any cure for chronic constipation?

Answer: Constipation is a common complaint, and the studies of it reveal widely varying occurrence rates -- ranging from 3 to 30 percent of the United States population. It is hard to tell why these studies come up with such different estimates. It may be because of the way questions on particular surveys were worded, the manner of survey administration, or because of real variations within the different study populations. Taking an average of these studies, it seems a reasonable estimate would be that within the total U.S. citizenry, about 12.5 percent of adults under age 65 are suffering from this problem and 23 percent for those 65 or older.

For my purposes, I'll use the definition of chronic constipation as having two or fewer bowel movements per week, often straining to pass stool, having hard dry bowel movements, and frequently having the sensation of incomplete evacuation. Women report constipation about twice as often as men do in our country, although this isn't true in all countries and cultures. Non-whites in the United States report constipation about 1.3 times more frequently than do Caucasians. Interestingly, in studies done in Africa and India, the rates for non-whites and whites are essentially the same.

Constipation is actually a symptom, rather than a disease, and as such, it can have many causes. Most individuals who have had trouble with constipation have no easily identifiable abnormality of the colon or other parts of the digestive system. Rarely, individuals with chronic constipation do have an anatomic abnormality such as a narrowing of the rectal opening or weakness of the pelvic muscles that contributes to their problem. Medicines taken for common conditions such as high blood pressure, bladder control, depression, seizures and pain can cause constipation, but at the most these could only be contributing causes since you have had trouble "all you life."

Diet, and particularly the lack of fiber in the diet are often identified as causes of constipation. Certainly this can be true. Fiber from bran, apples and cabbage decreases the GI transit time. That is, the time it takes dinner to become waste. It is also important to consume adequate amounts of liquids to keep all that fiber soft instead of hard. In another indication of the value of fiber, research has confirmed that there is a difference in stool volumes between those who follow a vegetarian diet when compared to those who mostly eat a "meat and potatoes" one. However, a British study added some confusion to this picture. It found that there was no difference between the stool volumes of constipated and non-constipated individuals. (I'm glad I missed out on doing that study!)

Another commonly sited link to constipation is physical inactivity. Though "self-report" studies are consistent in showing a connection between activity level and bowel function, research using more rigorous methodology has not supported this assertion.

So, it is difficult to determine what is causing your constipation. Hormone imbalance, medicines, depression, diet, bowel movement habits and other factors can be involved. I'd suggest that you try the obvious simple things you've probably already done -- a high-fiber diet, plenty of water, at least 30 minutes of exercise every day, and going to the bathroom when the urge to defecate first occurs instead of holding it until a "more convenient" time. If these simple steps fail, then it is time to go see your doctor.

"Family Medicine" is a weekly column.

To submit questions, write to John C. Wolf, D.O., at Post Office Box 110, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.