Constipation

Some Basics...

• Normal bowel movement (BM) frequency varies from 3 times a day to 3 times a week.
• Trouble or pain passing a BM or infrequent BMs may mean a person has constipation.
• Passage of a large BM is not constipation. The amount of food a person eats determines the BM size. The more a person eats, the larger the BM.
• The passage of small, dry, rabbit-pellet-like stools is not constipation. This is from a lack of fluids.
• Healthy living and eating habits can help prevent and treat constipation.

Causes

• Not enough fiber in diet: this makes BMs hard and more difficult to pass. Fiber will help hold more water in the stools. Good sources of fiber are fresh fruits and vegetables, beans, and bran. A person can also take fiber supplements (like Metamucil).
• Not enough liquids: this causes stools to be dry and harder to pass. Adults should drink 6-8 glasses of water a day.
• Lack of exercise: this decreases bowel function. Exercise helps keeps the bowels regular. People who have to stay in bed are more likely to be constipated. They may get fecal impaction.
• Holding in BMs: some people ignore their body's signals for having a BM. This can lead to problems with constipation.
• Recent travel: travel can cause constipation. It gets in the way of normal diet and BM cycle.
• Taking narcotic (opiate) medicines. Narcotic pain medicine can cause constipation. All persons taking narcotic pain pills, especially the elderly, should also be taking a laxative like docusate (Colace).

Prevention

• Eat a high fiber diet. Drink plenty of liquids.
• Exercise regularly (even a daily 15 minute walk!).
• Get into a rhythm. Try to have a bowel movement (BM) at the same time each day. Don't ignore the body's signals to have a BM.
• Avoid enemas and laxatives.

When to Call for Constipation

Care Advice

Constipation

1. What You Should Know:
   • Trouble passing a stool, hard stools, and infrequent stools are signs of constipation.
   • Healthy living habits can help treat and prevent constipation. Healthy habits include eating a diet high in fiber and regular exercise.
   • You can treat mild constipation at home.
   • Here is some care advice that should help.
2. General Constipation Instructions:
   • Eat a high fiber diet.
   • Drink enough liquids.
   • Exercise regularly (even a daily 15 minute walk!).
   • Get into a rhythm. Try to have a BM at the same time each day.
   • Don't ignore your body's signals to have a BM.
   • Avoid enemas and stimulant laxatives.
3. Eat a High Fiber Diet:
   • Slowly increase the amount of fiber in your diet. This will help soften your BMs. Fiber works by holding more water in your stools.
   • Eat more fresh fruit and vegetables. They are great sources of natural fiber. This includes peas, prunes, citrus, apples, beans, and corn.
   • Eat more foods made from whole grains. Foods made from whole grains also have fiber. Examples are bran flakes, bran muffins, graham crackers, oatmeal, brown rice, and whole wheat bread. Popcorn is also a source of fiber.
4. Liquids:
   • Drinking enough liquids is important to keep your stools soft.
   • Drink 6-8 glasses of water a day. Caution: certain medical problems require fluid restriction.
   • Prune juice is a natural laxative.
   • Avoid alcohol.
5. Exercise:
   • Staying active is always a healthy choice.
   • Regular exercise decreases constipation.
   • Even a daily walk for 15 minutes helps.
6. Get Into a Rhythm:
   • Try to have a BM at the same time each day. The best time is about 30-60 minutes after breakfast or other meal.
   • Don't ignore your body's signals to have a BM.
7. Call Your Doctor If:
   • Constipation lasts more than 2 weeks after using Care Advice
   • Abdominal swelling, vomiting or fever occur
   • Constant or increasing abdominal pain
   • You think you need to be seen
   • You get worse

Rectal Pain

1. What You Should Know:
   • The skin around the rectal area has a rich nerve supply. Pain in this area can be intense.
   • Hemorrhoids (piles), anal fissures (skin cracks), and hard stools are the top causes of rectal pain.
   • You can treat pain from hemorrhoids, anal fissure, or hard stool at home.
   • Here is some care advice that should help.
2. Warm Sitz Baths Twice a Day:
   • Sit in warm bath water for 20 minutes 2 times each day. This helps clean and heal the rectal area.
   • If you want, you can add ¼ cup (80 grams) of table salt or baking soda to each tub of water. Stir the water until it dissolves.
   • This is also called a Sitz bath.
3. Hydrocortisone Ointment Twice a Day for Hemorrhoid Pain:
   • You can use 1% hydrocortisone ointment (Anusol HC) to decrease hemorrhoid pain and irritation.
   • Hydrocortisone is available over-the-counter at the drug store.
4. Rectal Pain and Can't Pass Stool (blocked up feeling):
   • Sitz Bath: Take a 20-minute bath in warm water. It often helps relax the anal sphincter and release the stool.
   • Glycerin Suppository: If the Sitz bath does not work, try 1 or 2 glycerin rectal suppositories.
   • Enema: An enema should be used rarely and only after other measures have not worked.
   • The rectal pain should be completely gone after using this Care Advice. If the pain does not go away, you will need to be seen.
5. Call Your Doctor If:
   • Rectal pain not better after using Care Advice
   • Abdominal swelling, vomiting or fever occur
   • Constant or increasing abdominal pain
   • You think you need to be seen
   • You get worse

Over-the-Counter (OTC) Medicines for Constipation

1. Step-By-Step: A step-by-step approach to using OTC medicines for constipation is best.
2. Step 1 - Fiber laxatives, every day:
   • You can take a fiber laxative instead of eating more fiber. An example of a fiber laxative is psyllium (Metamucil). Fiber can help soften your stools. Fiber works by holding more water in your stools. Be patient. Sometimes this takes a couple weeks before it starts to work.
3. Step 2 - Use an osmotic laxatives, if needed:
   • You can take polyethylene glycol (PEG, Miralax) or milk of magnesia.
   • This type of medicine helps pull water into your intestines. This softens the stools.
4. Step 3 - Add a stimulant laxative:
   • If the constipation does not get better with the Care Advice in Steps 1 and 2, add a stimulant laxative.
   • Use either bisacodyl (Dulcolax) or a glycerin suppository.
5. Call Your Doctor If:
   • You have more questions
   • You think you need to be seen
   • You get worse

And remember, contact your doctor if you develop any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.