The adult colon, also called the large intestine, is about 5 feet long. Its job is to absorb water and salts from partially digested food that enters from the small intestine and then send waste out of the body. Sometimes, because of congenital abnormalities or problems that develop with age, it doesn’t do that last part so well.
If you have a congenital abnormality, you have already gotten medical advice on voiding your colon, so this article is directed to the people who occasionally get into constipation problems.
This is not to say that constipation is a minor problem. It may be caused by an anatomic problem, an obstruction such as a tumor, that can be corrected only by surgery. Anatomic problems can block the passage of food through the digestive system. Some problems can become life-threatening. Symptoms of anatomic problems include abdominal pain, abdominal distension, vomiting, and diarrhea or constipation. Should constipation persist for more than a few days, or if there is significant pain associated with it, you would be well advised to see a doctor about it.
The Symptoms of Constipation
Constipation is defined as having less than three bowel movements per week. Stools are typically hard, dry, small in size, and difficult to eliminate, making bowel movements painful. With it comes intestinal bloating and discomfort. It is a symptom, usually of a poor diet combined with an aging digestive system, not a disease. It’s one of the most common gastrointestinal complaints, most common in women and adults ages 65 and older. It’s also associated with pregnancy and the post-partum period.
Constipation is clinically diagnosed when a patient has any two of the following symptoms for at least 12 weeks (not necessarily consecutive) in the last 12 months:
- Straining during bowel movements
- Lumpy or hard stool
- Sensation of incomplete evacuation
- Sensation of anorectal blockage/obstruction
- Fewer than three bowel movements per week.
What Causes Constipation?
If you ignore the urge to have a bowel movement, you will eventually stop feeling the need to have one, which can lead to constipation. Some people delay having a bowel movement because they do not want to use toilets outside the home. Others ignore the urge because of emotional stress or because they are too busy. Children may postpone having a bowel movement because of stressful toilet training or because they do not want to interrupt their play.
Constipation occurs during pregnancy because of hormonal changes or because the uterus compresses the intestine. Aging may also affect bowel regularity, because a slower metabolism results in less intestinal activity and muscle tone. In addition, people often become constipated when traveling, because their normal diet and daily routine are disrupted.
Diseases that cause constipation include multiple sclerosis, Parkinson’s disease, stroke, spinal cord injuries, diabetes, uremia, lupus, scleroderma, intestinal obstruction, scar tissue (adhesions), diverticulosis, tumors, colorectal stricture, cancer, and pelvic floor dysfunction.
How to Cleanse Your Colon
The most common way of self-treating constipation is with over–the–counter (OTC) laxatives. By far the most common procedure, around $725 million is spent on laxative products each year in the U.S. alone! Although laxatives may provide relief, users must increase the dose over time because the body grows reliant on laxatives in order to have a bowel movement. As a result, laxatives may become habit-forming.
Most people who are mildly constipated don’t need laxatives. However, when diet and lifestyle changes have not worked, a doctor may recommend laxatives or enemas for a limited time to retrain a chronically sluggish bowel. Laxatives taken by mouth are available in liquid, tablet, gum powder, and granule forms.
Laxatives work in one of several ways:
- Bulk-forming laxatives are fiber supplements that absorb water in the intestine and make the stool softer. Brand names include Metamucil and Citrucel. These agents must be taken with water or they can cause obstruction.
- Stimulants like Dulcolax and Senokot cause rhythmic muscle contractions in the intestines. The FDA has proposed a ban on the possibly carcinogen, phenolphthalein, which is an ingredient in some stimulant laxatives. Most laxative makers have replaced, or plan to replace, phenolphthalein with a safer ingredient.
- Osmotics like Sorbitol cause fluids to flow in a special way through the colon, resulting in bowel distention. They are not recommended for diabetics.
- Stool softeners, for example, Colace, moisten the stool and prevent dehydration. Prolonged use may result in an electrolyte imbalance.
- Lubricants grease the stool and typically stimulate a bowel movement within 8 hours.
- Saline laxatives act like a sponge to draw water into the colon for easier passage of stool. Brand names include Milk of Magnesia and Haley’s M-O. Saline laxatives are used to treat acute constipation if there is no indication of bowel obstruction.
- Chloride channel activators such as Amitiza increase intestinal fluid and motility and can be safely used for up to 6 to 12 months.
- Serotonin agonists help the muscles in the intestines work correctly when a slow-moving digestive system is caused by low levels of serotonin, a neurotransmitter found in the digestive tract.
Other non-laxative, useful therapies include:
- Put more fiber in your diet. Fiber—both soluble and insoluble—is the part of fruits, vegetables, and grains that the body cannot digest. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Insoluble fiber, like that found in bran and psyllium, passes through the intestines almost unchanged. A diet high in fats, such as cheese, eggs, and meats, is counter-productive. Fiber is even more important among the elderly, yet the elderly tend to temp constipation through the consumption of low-fiber, easy-to-prepare processed cheap meals.
- Drinking more. Although increased fluid intake does not necessarily help relieve constipation, it does help some people. Liquids add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass. People who have problems with constipation should try to drink liquids every day.
- Avoiding alcohol and caffeinated beverages, such as coffee and cola drinks, which will worsen one’s symptoms through dehydration.
- Getting more physical activity. Low activity is an especially common cause of constipation, although doctors do not know precisely why. It’s thought to be one of the reasons constipation is common in older people.
- If the constipation has come on with the beginning of a course of medications, notify the prescribing doctor to get her advice on what to do. Watch out for medications that can cause constipation, including:
- Pain medications (especially narcotics)
- Antacids that contain aluminum and calcium
- Blood pressure medications (calcium channel blockers)
- Antiparkinson drugs
- Iron supplements
- Milk and dairy products have a tendency to bind some people up. Stop consuming them, at least for a while.
In cases where the bowel becomes impacted, an enema may be recommended in conjunction with a dose of mineral oil to soften the stool. A doctor may then insert one or two fingers into the anus to break up and remove part of the hardened stool.
One more treatment for intestinal blockage (and, according to its advocates, about 3,000 other diseases) is called high colonic irrigation. It consists of sticking a modified hose nozzle into the patient’s rectum, then alternately pumping in water and pumping it out. The treatment is looked upon by most physicians with serious disdain, seeing it as “an expensive enema.”