Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
There are many treatments for constipation, and the best approach relies on a clear understanding of the underlying cause. Some of the following are
examples of treatments for relief of constipation.
Dietary fiber (bulk-forming laxatives)
Lubricant laxatives
Emollient laxatives (stool softeners)
Hyperosmolar laxatives
Saline laxatives
Stimulant laxatives
lubiprostone (Amitiza
Enemas
Combination drugs
Colchicine
misoprostol (Cytotec)
Exercise
Biofeedback
Constipation facts
Constipation is defined medically as fewer than three
stools per week and severe constipation as less than one stool per week.
Constipation usually is caused by the slow movement of
stool through the colon.
There are many causes of constipation including
medications, poor bowel habits, low fiber diets, abuse of laxatives, hormonal
disorders, and diseases primarily of other parts of the body that also affect
the colon.
The two disorders limited to the colon that cause
constipation are colonic inertia and pelvic floor dysfunction.
Medical evaluation for the cause of constipation
should be done when constipation is of sudden onset, severe, worsening,
associated with other worrisome symptoms such as loss of weight, or is not
responding to simple, safe treatments.
Medical evaluation of constipation may include a
history, physical examination, blood tests, abdominal X-rays, barium enema,
colonic transit studies, defecography, ano-rectal motility studies, and
colonic motility studies.
The goal of therapy for constipation is one bowel
movement every two to three days without straining.
Treatment of constipation may include dietary fiber,
non-stimulant laxatives, stimulant laxatives, enemas, suppositories,
biofeedback training, and surgery.
Stimulant laxatives should be used as a last
resort because of the possibility that they may permanently damage the colon and worsen
constipation.
Most herbal laxatives contain stimulant-type laxatives and should be used, if at
all, as a last resort.
What is constipation?
Constipation means different things to different people. For many people, it
simply means infrequent stools. For others, however, constipation means hard
stools, difficulty passing stools (straining), or a sense of incomplete emptying
after a bowel movement. The cause of each of these "types" of constipation
probably is different, and the approach to each should be tailored to the
specific type of constipation.
Constipation also can alternate with diarrhea.
This pattern commonly occurs as part of the irritable bowel syndrome
(IBS). At the extreme end of the constipation spectrum is fecal impaction, a
condition in which stool hardens in the rectum and prevents the passage of any
stool.
The number of bowel movements generally decreases with age. Ninety-five percent of adults
have bowel movements between three and 21 times per week, and this would be
considered normal. The most common pattern is one bowel movement a day, but this
pattern is seen in less than 50% of people. Moreover, most people are irregular
and do not have bowel movements every day or the same number of bowel movements
each day.
Medically speaking, constipation usually is defined as fewer than three bowel movements per week.
Severe constipation is defined as less than one bowel movement per week.
There is no medical reason to have a bowel movement every day. Going without
a bowel movement for two or three days does not cause physical discomfort, only
mental distress for some people. Contrary to popular belief, there is
no evidence that "toxins" accumulate when bowel movements are infrequent or
that constipation leads to cancer.
It is important to distinguish acute (recent onset) constipation from chronic (long duration) constipation.
Acute
constipation requires urgent assessment because a serious medical illness
may be the underlying cause (for example, tumors of the colon). Constipation also
requires an immediate assessment if it is accompanied by worrisome symptoms
such as rectal bleeding, abdominal pain and cramps, nausea and
vomiting, and involuntary
loss of weight. In contrast, the evaluation of chronic
constipation may not be urgent, particularly if simple
measures bring relief.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Rectal bleeding (hematochezia) refers to the passage of bright red blood from the anus. Rectal bleeding may be moderate to severe and most bleeding comes from the colon, rectum, or anus. Common causes include anal fissures, hemorrhoids, diverticulitis, and more.
Hemorrhoid is an enlarged vein in the walls of the anus and sometimes around the
rectum, usually caused by untreated constipation, but occasionally associated
with chronic diarrhea. If untreated, hemorrhoids can
worsen, protruding from the anus. Also known as piles.
Diverticulitis is a condition in which diverticuli in the colon rupture. The rupture results in infection in the tissues that surround the colon. Diverticulitis symptoms include: abdominal pain, abdominal cramps, diarrhea, constipation, and bloating. Treatment methods include prescription medications, and in some cases, diverticulitis surgery.
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Gas or "intestinal gas" means different things to different people. Everyone has gas and eliminates it by belching or farting (passing it through the rectum).
Colon cancer is a malignancy that arises from the inner lining of the colon. Most, if not all, of these cancers develop from colonic polyps. Removal of these precancerous polyps can prevent colon cancer.
Multiple sclerosis (MS) is a disease which progressively injures the nerves of the brain and spinal cord, reflected by alterations of virtually every sensory or motor function in the body. The cause of MS is primarily unknown. There are different types of MS including relapsing-remitting MS, primary-progressive MS, and secondary-progressive MS. Symptoms of MS rang from mild to severe and examples include visual disturbances, muscle weakness, spasm, and fatigue. Decreased concentration, memory loss, and impaired judgment. Treatment for MS is generally with medications.
Anorexia is an eating disorder characterized by markedly reduced appetite or total aversion to food. Anorexia is a serious psychological disorder and is a condition that goes well beyond out-of-control dieting. With anorexia, the drive to become thinner is actually secondary to concerns about control and/or fears relating to one's body. There are psychological and behavioral symptoms as well as physical symptoms of anorexia including: depression, social withdrawal, fatigue, food obsession, heart and gastrointestinal complications, kidney function, flaky skin, brittle nails, and tooth loss (this list is not exhaustive).
An anal fissure is a small tear or cut in the skin lining of the anus. Pain and/or rectal bleeding during bowel movements are common symptoms of anal fissures. Treatment involves increasing liquid intake, using stool softeners and avoiding foods that may not be well-digested.
IBS (irritable bowel syndrome) is a common gastrointestinal disorder involving abnormal gut contractions (motility) characterized by abdominal pain,
bloating, mucous in stools, and irregular bowel habits with alternating diarrhea
and constipation, symptoms that tend to be chronic and to wax and wane over the
years. Treatment options include medication and lifestyle changes such as diet, exercise, and stress management to control symptoms. Also called spastic colitis, mucus colitis, nervous colon syndrome.
Multiple myeloma is a form of cancer that develops in plasma cells, the white blood cells that make antibodies. Symptoms include bone pain, weakness, extreme thirst, nausea, frequent urination, and broken bones. Treatment of multiple myeloma depends upon the staging and symptoms of the disease.
Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria (at least 100,000 bacteria per ml of fluid) are present in the small intestine and the types of bacteria in the small intestine resemble more the bacteria of the colon than the small intestine. There are many conditions associated with small intestinal bacterial overgrowth, to include: diabetes, scleroderma, Crohn's disease, and others. There is a striking similarity between the symptoms of irritable bowel syndrome and SIBO. It has been theorized that SIBO may be responsible for the symptoms of at least some patients with irritable bowel syndrome. Symptoms of SIBO include: excess gas, abdominal bloating, diarrhea, and abdominal pain.
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body, leading to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis, and the cause is unknown. Treatment of scleroderma is directed toward the individual features that are most troubling to the patient.
Huntington's disease is the result of degeneration of neurons in areas of the brain. Huntington's disease is an inherited disorder. Early symptoms include mood swings, apathy, depression, and anger uncharacteristic of the individual. Judgement, memory, and other cognitive functions may become impaired. Presymptomatic testing is available for individuals who have a family history of Huntington's disease. Treatment includes medication and therapy for symptoms.
Hyperparathyroidism is a disorder of the parathyroid glands. There are two types of hyperparathyroidism, primary and secondary. When the parathyroid glands produce too much hormone, hyperparathyroidism is the resulting condition. Most cases of hyperparathyroidism have no evident cause. Symptoms include fatigue, weakness, depression, loss of appetite, nausea, vomiting, constipation, or confusion. Increased calcium and phosphorous excretion may cause kidney stones. The main treatment of hyperparathyroidism is parathyroidectomy.
Laxatives for treatment of constipation include over-the-counter preparations such as bulk-forming laxatives, stool softeners, lubricant laxatives, stimulant laxatives, saline laxatives, enemas and suppositories. Some over-the-counter laxatives are not recommended for patients with specific diseases or conditions. Some laxatives may have negative adverse effects if taken over long periods of time.
Jet lag (desynchonosis) is a temporary disorder that results from travel across time zones. Symptoms include anxiety, constipation, headache, nausea, dehydration, diarrhea, confusion, sweating, irritability, and even memory loss.
Hypercalcemia is a condition in which calcium levels in the blood are elevated. Hypercalcemia is associated with other conditions such as hyperparathyroidism, lung cancer, breast cancer, kidney failure, and elevated levels of vitamin D. Symptoms of hypercalcemia include constipation, nausea, abdominal pain, kidney stones, to name a few. Treatment depends on the cause of hypercalcemia.
Menstruation (menstrual cycle) is also referred to as a "period." When a woman menstruates, the lining of the uterus is shed. This shedding of the uterine linking is the menstrual blood flow. The average menstrual cycle is 28 days. There can be problems with a woman's period, including heavy bleeding, pain, or skipped periods. Causes of these problems may be amenorrhea (lack fo a period), menstrual cramps (dysmenorrhea), or abnormal vaginal or uterine bleeding. There are a variety of situations in which a girl or woman should see a doctor about her menstrual cycle.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Patients with celiac disease are required to eat a gluten-free diet. Gluten is found in rye, barley, and wheat. Gluten damages the intestine in patients with celiac disease. Some mediations contain gluten, so careful monitoring of products consumed is imperative. Patients with celiac disease are also at risk for developing nutritional deficiencies. The information in this article contains both foods that contain gluten, and foods that do not contain gluten.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Abdominal adhesions (scar tissue) bands of scar tissue that form between abdominal organs and tissues. Symptoms of abdominal adhesions are pelvic or abdominal pain. Abdominal adhesions on the intestines can cause bowel obstruction, which is a medical emergency. Treatment for abdominal adhesions is generally surgery to cut the adhesions away from the internal tissues and organs. There is no way to prevent abdominal adhesions.
Hirschsprung's disease (Hirschsprung), is a disease of the nerve cells of of the large intestine. The primary symptom of Hirschsprung's disease is constipation. Hirschsprung's disease is diagnosed through barium enema, and treatment is surgery.
Urinary retention (inability to urinate) may be caused by nerve disease, spinal cord injury, prostate enlargement, infection, surgery, medication, bladder stone, constipation, cystocele, rectocele, or urethral stricture. Symptoms include discomfort and pain. Treatment depends upon the cause of urinary retention.
Polio is caused by the poliovirus and is spread through person-to-person contact. In non-paralytic polio, patients experience mild flu-like symptoms such as fatigue, fever, headache, sore throat, and vomiting. In paralytic polio, symptoms include difficulty swallowing and breathing, headache, mood swings, muscle pains and spasms, and paralysis. There is no cure for polio, so treatment focuses on alleviating the symptoms. In 1955, a polio vaccine was developed.
Flexible sigmoidoscopy is a procedure that allows your doctor to examine the rectum and the lower (sigmoid) colon. The flexible sigmoidoscope is a flexible tube 60 cm long and about the thickness of your little finger. It is inserted gently into the anus and advanced slowly into the rectum and the lower colon. It is an accurate and simple method of investigating the cause of rectal bleeding, change in bowel habit, and rectal symptoms such as pain and diarrhea. Flexible sigmoidoscopy also is a part of colon screening and surveillance for colon cancer.
What is the preparation for flexible sigmoidoscopy?
In order to obtain accurate results, the rectum and the lower colon must be completely clean of stool. Your doctor will give you detailed instructions on how to cleanse your colon. In general, this requires the use of one or two enemas prior to the procedure and may also call for a laxative and some dietar...