Dear Dr. Toshi,
I'm often constipated. Can you tell us about constipation and some home remedies I can try?
You may have chronic constipation if you have two or more of these characteristics for more than three months: if you have less than three bowel movements (BMs) a week, if you have hard or pebble-like stools, if you have to strain when you have bowel movements, if you feel like there's a blockage in your rectum that prevents BMs, if you feel like you can't completely empty the stool from your rectum, if you need help to empty your rectum such as using your hands to press on your abdomen or using a finger to get some stool out of your rectum. It's estimated that about 15% of people have chronic constipation. Chronic constipation is more common in older people, especially people over 65 years. Among older people, about one out of every four men and one out of every three women have constipation.
Constipation can be caused by many different things such as dehydration, a diet that's low in fiber, lack of exercise, neurologic disorders (e.g., Parkinson disease, multiple sclerosis, and stroke), metabolic disorders (e.g., diabetes and hypothyroidism), obstruction in the GI (gastrointestinal) tract, pelvic muscle problems, psychiatric disorders, medications (e.g., opioid pain medications like oxycodone, hydrocodone, and tramadol), and other diseases such as irritable bowel syndrome.
Chronic constipation can cause other problems such as hemorrhoids (swollen veins in or near the anus), rectal prolapse (which is when part of the rectum protrudes out from the anus), fecal impaction (stool that gets stuck and blocks the anus), and anal fissures (tears in the skin of the anus).
So, it's very important to do prevent constipation by staying well-hydrated by drinking water, eating a high-fiber diet (e.g., foods like vegetables, beans, fruits are high in fiber), exercising, and not ignoring the urge to have a BM.
There are different types of laxatives you can buy without a prescription to make it easier to have BMs, but it's very important to remember that overusing them can cause more problems, so please discuss the use of laxatives with your doctor or provider. You may not actually need them if you do the things I listed above.
Some examples of laxatives are: fiber supplements (e.g., Citrucel), stimulants (e.g., Dulcolax and Senokot), osmotic agents (e.g., Milk of Magnesia, lactulose, magnesium citrate, and MiraLAX), lubricants (e.g., mineral oil), stool softeners (e.g., docusate sodium such as Colace), and enemas and suppositories. Stimulants cause your intestines to contract. Osmotic agents increase the fluid from the intestine to make the stool softer and help stimulate BMs. Stool softeners make the stool moister by drawing water into the intestines.
The most important first steps to prevent constipation are hydration, exercise, and eating a diet that's rich in fiber!
Dr. Toshiko ("Toshi") Luckow, MD, is a Family Physician at the West River Health Services Hospital and Clinics.