THE DOCTOR IS IN
OP / ED BY DR. ADIL MANZOOR
Constipation is generally characterized by having less than three bowel movements in one week. We’ve all had days where our bowel movements are really irregular and trips to the restroom are futile. However, this isn’t technically constipation, as the threshold is less than three bowel movements in a week.
If you have ever been constipated, you will most definitely agree that it is extremely unpleasant. Now, imagine being constipated not for days, but for weeks or even months. That’s what chronic constipation is. As you can imagine, it is as bad as it sounds. Fortunately, though, they are ways to treat and prevent this type of constipation.
Let’s start with the treatment options for the condition. While many patients have subscribed to the tag that there is “a pill for every ill”, doctors are far more cautious in administering drugs. In fact, many doctors exhaust all non-drug ways to treat a condition before prescribing pills.
The default treatment strategy is lifestyle modification. If you have this condition, you should revamp your diet. Start to eat more fiber foods, which are foods with little nutritional value but can help stimulate the flow of the bowels. Many fruits and whole grains fall into this category. Another part of diet is water, and this is often overlooked in society today. Water is also key to mitigating the symptoms of chronic constipation.
Exercise is another important lifestyle modification for treating chronic constipation. And before you ask, this is not just another bait to get you working out. Studies actually show that exercise can improve circulation as well as bowel movement. Get approval from your doctor before you hit the gym, though.
If these lifestyle modifications fail, the next default option is medication use. There are different types of drugs with different mechanisms of action that can help in relieving chronic constipation. I don’t want to drag you into the pharmacology of these drugs, but the ultimate aim is usually to stimulate the bowel or soften the bowel to allow easy excretion.
Examples of drugs that doctors administer to patients of chronic constipation include Misoprostol, Probenecid, and Botox. Doctors may also suggest docusate sodium and bisacodyl.
A note of warning regarding medications is the use of painkillers for chronic constipation. I cannot deny the temptation to use painkillers to combat the pain that may accompany chronic constipation. While most people use NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), like ibuprofen, some individuals resort to using narcotic painkillers for pain relief. These narcotic painkillers include oxycodone and codeine. However, these painkillers can actually cause and worsen chronic constipation. Therefore, ensure you speak to your healthcare provider before getting on painkillers.
While I have singled painkillers, there are several other medication groups that can cause chronic constipation. This includes some antidepressants, anti-allergy drugs, psychiatric medications, and antacids. The list is far too extensive for me to start listing potential culprits. While these drugs can cause constipation, they will not necessarily cause it. Nonetheless, speak with your doctor the moment you notice signs of constipation after starting any medication.
Aside from the orthodox medications you are used to, there are other agents that can help stimulate bowel movement when taken. The umbrella term for these agents is laxatives. As with medications, there are different mechanisms of action of laxatives. Many of these laxatives may present as supplements, herbs, and the like. Be careful when taking these laxatives as they may present with several adverse events.
If all medications and lifestyle modifications do not work, doctors may consider surgery. No one wants to hear this, but it often is the solution to stubborn chronic constipation. The type of surgery depends, of course, on the cause of chronic constipation. If it happens to be that a segment of the colon is not functioning as it should, it may have to be removed entirely.
Let’s move on to the prevention of chronic constipation in the first place. Again, diet comes to the forefront. Ensure your meal is rich in fiber, and generally steer clear of low-fiber diets, like processed foods. You should also ensure you drink a lot of water, as well as be physically active. For children, you may need to be stricter in enforcing their eating and drinking patterns.
If you follow the right lifestyle practices and are careful with medication use, you should not have to worry about chronic constipation, Nonetheless, do not hesitate to contact your doctor when you notice your constipation is lasting longer than normal.
This article was written by Dr. Adil Manzoor DO, a Board-Certified Internist & Board Certified in Pediatrics, who works as a Hospitalist, and Emergency Room Physician. He is also the current President of Garden State Street Medicine, a non-profit organization whose sole purpose is to provide free preventive and acute urgent care services for the homeless. He is also the co-founder of his own unique medical practice Mobile Medicine NJ.
References
- https://www.webmd.com/digestive-disorders/chronic-constipation-treatment
- https://my.clevelandclinic.org/health/diseases/4059-constipation
- https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253#:~:text=Include%20plenty%20of%20high%2Dfiber,try%20to%20get%20regular%20exercise.
- https://www.mayoclinic.org/diseases-conditions/constipation/diagnosis-treatment/drc-20354259
