Digestive Health Digestive Health Basics

Clearing Up Confusion About Constipation

Overall, people who are in good health tend not to discuss their bowel habits. Yet, constipation is a common phenomenon: It's estimated that Americans make 2 million trips to the doctor each year for constipation problems, and spend millions at the drugstore on remedies.

Sometimes people mistakenly believe that they're constipated because they think they need to have a certain number of bowel movements per week, even though the "normal" number varies from person to person. True constipation occurs when food in the large intestine, or colon, moves too slowly, or because the colon has absorbed too much water, making the stool hard and dry and difficult to pass.

If untreated, constipation can lead to problems associated with straining, like hemorrhoids, anal tears and prolapse (in which some of the intestinal lining is pushed out of anus). In rare cases, constipation can also lead to a buildup of stool that can cause incontinence or even an obstruction in the colon.

Constipation's Causes
One of the reasons constipation is so common is that it has a wide range of potential causes, from diet to disease. Sometimes the problem derives from not having enough fiber or fluid in the diet. Insoluble fiber, which is found in fruits, vegetables and whole grains, pulls water into the intestines, helping to soften the stool. A lack of physical activity also appears to contribute to constipation, though it's not understood how exactly exercise improves bowel habits.

These lifestyle factors are often partially to blame for the prevalence of constipation among people older than 65. "In older people, you tend to see constipation from medications, poor food or water intake, or poor muscle tone," says Dr. Jamie Barkin, chief of gastroenterology at Mt. Sinai Medical Center in Miami Beach, Florida. "Usually, they just have a feeling of incomplete evacuation or a feeling sometimes of bloating, but don't have pain with their constipation."

Still, younger people have trouble with regularity as well. If they also have bloating and abdominal pain, some of them—particularly if they're women—may have irritable bowel syndrome (IBS). According to Dr. Lin Chang, an associate professor of medicine in the division of digestive diseases at the University of California, Los Angeles, people with IBS may find relief with stool softeners or with a drug that affects serotonin, a nervous system chemical that helps regulate digestive function. The higher rate of IBS among women is one reason they are particularly prone to constipation and diarrhea; the hormonal changes that come with the menstrual cycle and pregnancy are another.

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