Columnists

Are you experiencing uncomfortable plumbing problems? Here might be why

I’m running through my list of suggested topics from readers, and this one goes out to a reader from Sheridan. It’s a common problem, but one of those topics that doesn’t usually come up in casual conversation – constipation.

There are three common times in a person’s life when constipation can become a problem. The first is during early childhood, the second when a person has decreased activity for some reason, and the last is during the elder years. Each one has different causes.

First, I have to deliver yet another lesson in basic anatomy and physiology. When we eat, food travels through the following structures: mouth, esophagus, stomach, small intestine and finally, the large intestine. This journey is facilitated by peristalsis, a physiologic process where involuntary muscles in the wall of the digestive tract contract to move food from north to south.

While constipation can involve trouble anywhere along the way, the vast majority of problems occur in the colon. One of the main jobs of the colon is to reclaim water from the stool (undigested food that remains). If the stool is slowed down in its transit through the colon, more water is absorbed, making the stool firmer and more difficult to evacuate.

Young children can develop problems with constipation when they put off going to the bathroom for various reasons. When this happens, they can develop a condition called encopresis and they can retain incredible amounts of stool in their colons. 

Eventually the colon dilates to the point where the muscles are not able to push the stool out and the child may lose the urge to have a bowel movement. These children may pass very large bowel movements and may have a great deal of pain when doing so. They also may have accidents, passing semi-solid or liquid stool that has leaked around the blockage. Painful movements lead to the child not wanting to have a bowel movement and the cycle repeats itself. It’s important to treat this condition as early as possible using medications and behavioral modification.

Another common cause of constipation is a period of inactivity, especially after surgery. This is especially true following abdominal surgery, particularly if it involved manipulating the intestines. When a surgeon handles the intestines it tends to interrupt normal peristalsis for a period of time. Taking pain medication post-operatively is also a common cause of constipation, especially in older patients. It’s important to minimize the use of narcotics and to prevent post-operative constipation using a regimen started immediately after surgery.

Older persons are also more likely to be inactive, so they tend to suffer from bouts of constipation. Often these folks are on medications that can exacerbate the normal age-related slowing of intestinal motility. Some common drugs that can cause this slowing include Benadryl®, Tylenol PM®, Zantac®, some antidepressants, and anticholinergic medications used to treat bladder spasms and incontinence.

As usual, prevention is the best medicine. All people should consume adequate fiber as well as plenty of fruits and vegetables. Google “high fiber diet” for recommendations. Children need to be taught the habit of sitting on the toilet at least twice a day for ten minutes or so. They should not be rushed and they should have good support for their feet. Along those lines, a shout out to two of my patients for telling me about the Squatty Potty ®. This is a simple device that elevates the feet, allowing one to be in a more anatomic position to make it easier to have a bowel movement (www.squattypotty.com).

Those who are having surgery or who are laid up for another reason should make sure they are consuming plenty of liquids and they should take a stool softener like docusate or osmotic agent like Miralax® on a regular basis starting at the beginning of their illness, before constipation becomes an issue. The elderly should consume fluids and also remain as active as possible. We joke a lot about prunes, but they really do work.

Young children who have difficulty with bowel movements should be evaluated by their physician. The earlier this problem is treated, the easier it is to correct. For adults who are suffering from constipation who do NOT have abdominal pain, laxatives such as Dulcolax® are generally safe and effective for short-term use. If results are not obtained in a few days or you develop pain you should consult your medical provider.