It is estimated that 50 percent of the healthy people have bowel problems. One of the most common complaints is constipation.

Constipation is hard to define. To some it means stool is too hard. To others it means stool is difficult to expel. Some have sense of fullness after defecation, some need to strain at stool frequently.

How often one should have a bowel movement?

Most people have between 3 movements per day and 3 movements per week. Some people consider that fewer than three movements a week without discomfort or dissatisfaction is normal.

Each day, one to two liters of semiliquid material passes from small intestine (ileum) to large intestine (colon). The material is composed of undigested food residue and intestinal secretions. There is nothing much left of nutritional value at this stage.

The liquid material is absorbed in the colon to convert the residue to solid feces. This advances to the rectum by the propulsive action of the colon, stimulated by the bulk of the stool.

The weight of stool in Western countries varies from 35 g. to 225 g. Water makes up 60 to 80 percent of the stool content.

What causes constipation?

Medications like narcotics and water pill can cause constipation. Dehydration, underfunctioning thyroid gland, increase in calcium level, spinal diseases, spastic bowel, bowel tumor, and narrowing due to various reasons may result in constipation.

Most cases of chronic constipation are due to habitual neglect of desire to go to the washroom because of sense of social impropriety, strange surroundings, poor toilet facilities, or illnesses which results in prolonged confinement to bed.

Constipation is a frequent problem in children under 6 years. The cause is not always clear. Most often, constipation is short-lived and of little consequence. In a British study, 5 percent of the children had constipation lasting for more than six months.

What’s wrong with constipation?

Constipation can create bloating and abdominal pain. Straining results in fissures and hemorrhoids. Increased pressure in the colon can result in pouches (diverticulosis).

Constipation is thought to increase the incidence of colon polyps and cancer. Since 1970, many studies have reported reduced risk of polyps and cancer with increased intake of fiber. But a recent study of 90,000 females followed for more than 16 years failed to confirm this.

Do we need to investigate cases of constipation?

Yes. If there is a recent history of change in bowel habit. If constipation is associated with rectal bleeding. If there is loss of weight, anemia, or suggestion of bowel blockage.

How can we manage constipation?

If investigations reveal no abnormalities, then careful education relieves lot of anxiety and discomfort. Do not ignore urge to defecate. Establish a routine at a given time each day. Physical exercise and increase in fluid intake helps.

Increase fiber intake with fruits, green vegetables, and cereal grains. Bulk laxatives, such as hemicellulose, psyllium extract, and all bran provides additional bulk.

Older individuals with poor muscle tone, minimal physical activity and other medical problems need more than bulk in the colon. Stool softeners, enemas and stimulant laxatives are required until a regular pattern is established.

So, next time you are constipated, make sure you get some relief with fluid and fiber. That is better than having an enema!

An after thought advisory: do not read this column before a sumptuous meal. It may result in nausea, vomiting and constipation!

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