Feeling bloated and blocked can happen during times of stress, frequent travel or when we aren’t eating well, skipping sleep or aren’t exercising enough. Constipation is common.
Whether constipation is occasional, or happens over an extended period of time – not just for a few days but for periods of weeks to months – there are ways to find relief.
Start with simple solutions
If you have mild, intermittent constipation, the first line of defense is water, exercise and fiber. Water keeps stool soft and regular vigorous exercise accelerates movement of stool through the colon. Even though people with constipation typically drink the same amount of water and eat as much fiber as those without constipation, more fiber from supplements such as psyllium or ispaghula husk can help. If you’re constipated, aim for a total daily fiber intake of 20-25 grams.
Shopping for relief
If simple changes fail, laxatives are the next step. When shopping for a laxative, name brand and store brand, also called generics, are effective. Here’s how they work and what to look for on the label:
- Osmotics work by drawing water from the body into the bowel. Water drawn to the bowel softens the stool and increases mass. The increasing mass stimulates bowels to contract more. On the label look for magnesium or polyethylene glycol.
- Stimulants work by stimulating the muscles to contract and move stool through the colon more quickly. Like osmotic laxatives, stimulants work well for symptoms such as infrequent or hard stools. On the label look for bisacodyl and senna.
- Stool softeners increase retention of water in the stool, making stool easier to pass. They generally don’t work for mild, occasional constipation. On the label look for docusate.
Laxatives are not the answer for everyone
If you’re looking for relief from constipation symptoms such as abdominal pain and bloating steer clear of stimulant laxatives. The most common side effect of stimulants is belly pain and cramping. Patients with severe kidney or heart disease (such as heart block, a type of arrhythmia) should avoid laxatives that contain magnesium.
When to see a doctor
Generally we tend to worry when anyone’s pattern is to go every day and suddenly changes to every other day. Change is something we pay attention to. Those with constipation often complain about hard, lumpy and difficult to pass stools, straining to make a bowel movement, never feeling empty after a bowel movement, abdominal pain and a feeling of belly fullness that can’t be relieved.
More serious symptoms are:
- Black stool,
- Unexplained weight loss (10 pounds over a period of six weeks)
More tests may be done to ensure there is no underlying, serious cause for the constipation. Tests could include thyroid function, a full body exam, or a colonoscopy. Anyone with a family history of colon cancer — a first degree relative or more than one second degree relatives with colon cancer, particularly if at a young age — inflammatory bowel disease (ulcerative colitis and Crohn’s disease) or celiac disease should be treated more carefully right away if they experience chronic constipation.
If your constipation is serious, you have options
Some prescription drugs are very effective at improving constipation, abdominal pain and bloating. Lubiprostone and linaclotide increase secretion of chloride and water. Patients with severe, chronic constipation may benefit from a combination of treatments including medications, physical therapy and biofeedback training, or surgery.
About 60 to 70 percent of patients with chronic constipation will get better by exercising more, taking more fiber or using laxatives. If those fail, seeing a doctor can help you get things moving again.
Take the next steps:
- Get advice from experts in the University of Michigan Bowel Control Program.
- Read frequently asked questions about constipation.
- Learn more about how a colonoscopy is performed.
- To schedule an appointment for a colonoscopy, contact us at 877-220-2920. No referral is needed, unless you belong to an HMO.
William D. Chey, M.D., is a gastroenterologist at the University of Michigan Health System with a special interest in improving doctor-patient communication. His current research includes H. pylori infection and opioid-induced constipation.
For more than 160 years, the University of Michigan Health System has been a national leader in advanced patient care, innovative research to improve human health and comprehensive education of physicians and medical scientists. The three U-M hospitals have been recognized numerous times for excellence in patient care, including a #1 ranking in Michigan and national rankings in many specialty areas by U.S. News & World Report.