Plumbing Problems: How to Keep Your Bowels Running Smoothly
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 usual times in a person’s life when constipation can become a problem. The first is during early childhood, the second when a person becomes sedentary, 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 undigested food remaining in the feces. If food is slowed down in its transit through the colon, more water is absorbed, making the feces 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. They can retain very large amounts of stool in their colons 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, usually following surgery. This is especially true following abdominal surgery, particularly if it involved manipulating the intestines. Handling the intestines 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 bowel regimen started as soon as possible following surgery.
Older persons are also more likely to be inactive, so they tend to suffer from bouts of constipation. They are also commonly dehydrated due to not drinking enough fluids. These folks are frequently on medications that can exacerbate the normal age-related slowing of intestinal motility. Common drugs that can result in 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, plenty of fruits and vegetables, and enough fluids to keep the urine clear to pale yellow. 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 prior 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 (squattypotty.com).
Those planning to have surgery, or who are laid up for another reason, should make sure they are consuming plenty of liquids and taking a stool softener like docusate or an osmotic agent like MiraLAX immediately following surgery or at the beginning of their illness. The elderly should consume fluids and also remain as active as possible. We joke a lot about prunes, but they are very effective.
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 couple of days or you develop pain you should consult your medical provider.
Dr. John Roberts is a retired member of the Franciscan Physician Network specializing in Family Medicine.