This post was written by Reshi Kanuru, MD, PPG – Gastroenterology.
So often in life we suffer in silence because what concerns us seems to be too sensitive to talk about. Our bowel movements is one such example. Because of the subject matter, people want to be discrete and treat symptoms on their own or simply ignore them until it’s too late. While something like constipation may be a sensitive topic, not having regular bowel movements can cause severe pain, bleeding and other complications.
More importantly, constipation can be a sign of colorectal cancer, so it is imperative that you share your symptoms with a professional who can help. No matter how “private” a topic is, you should feel comfortable enough to consult with your healthcare providers and address the discomfort disrupting your life.
What is constipation?
Constipation is when someone has difficulty having regular bowel movements. Keep in mind that even if someone has regular bowel movements they can still be considered constipated if they are only able to pass small amounts with great difficulty and do not feel relief.
When it comes to frequency, it’s important to have a bowel movement every day to every other day, but the quality of the bowel movement is just as important. With each movement, you shouldn’t have to push too hard and, after the movement is over, you should feel relief. You shouldn’t feel like you have to go again.
Constipation can occur for many reasons. The most common causes of constipation are typically diet related. One of the biggest contributors to constipation is not drinking enough water. We need to remain hydrated to have effective bowel movements. It’s also important to make sure fiber is a part of your daily diet, as fiber can improve bowel movements.
Eating a healthy balanced diet that’s low in processed foods and contains only a moderate amount of meat can improve the symptoms of constipation. Diets high in salt can also contribute to the development of constipation and abdominal symptoms.
Lastly, stress plays a significant role in our bowel habits. Stressful situations alter our bowel habits significantly, so it is important you learn how to develop healthy coping mechanisms to combat stress.
Even though both diet and stress play a large role in our bowel movements, the most concerning cause of constipation is colorectal cancer. If you have frequent constipation, it’s very important that you discuss this with your healthcare provider. Your healthcare provider will be able to ask you questions to get a better understanding of whether you need a further workup, or simply need a medication to help improve the quality and frequency of your bowel movements.
Everyone has pelvic floor muscles. These muscles remain contracted when we are in public to prevent any accidents, but when we are trying to have a bowel movement, the pelvic floor muscles relax. Some people have constipation due to pelvic floor dysfunction, a condition where the pelvic muscles don’t relax when trying to have a bowel movement. It can feel like you’re pushing against a wall or as if the movement only has a small distance to pass but that distance is very difficult to pass.
Most people who have pelvic floor dysfunction are women who have had three or more children, labor complicated by tears due to the trauma of birth or tools had to be used to deliver the baby. Based on the symptoms of your constipation and your medical history, your healthcare provider might discuss further testing for pelvic floor dysfunction.
Another, commonly overlooked cause of constipation, is medications. Many times, our list of medications grows bigger than we would like. All medications have side effects, and when you put multiple medications together, cross reactions can occur. When being evaluated for constipation, your healthcare provider will consider assess all contributing factors, including your list of medications. In addition, medical diseases like low thyroid hormone, Crohn’s disease (an autoimmune disease of the bowel) and electrolyte imbalances can also contribute to constipation.
Constipation can lead to significant abdominal symptoms, including abdominal pain, bloating, nausea and, oddly, even diarrhea. There is a phenomenon called “overflow diarrhea”, where someone becomes so constipated that every few days they have diarrhea. Their bowel movements tend to swing from one extreme to another, so they are constipated for several days then they have diarrhea. This pattern continues to repeat.
In addition, when you’re constipated, it’s more difficult to pass a movement. With this difficulty, you strain more, and straining can lead to hemorrhoids due to the pressure we create with straining. The hemorrhoids can get so big they can bleed and cause severe pain and itching. Difficulty having bowel movements can also lead to anal fissures, small tears in the anal canal that typically result due to heavy straining. Having regular bowel movements can prevent many of these complications.
The most important step in evaluating constipation is to make sure colorectal cancer is not a likely cause. If it’s not, the next step is to focus on the diet. It’s important to remain hydrated and eat a well-balanced diet with fruits and vegetables. For those where diet is not playing a major role, then it’s important to evaluate any medications that you’re taking that could cause constipation.
Individuals who have pelvic floor dysfunction, where the pelvic muscles do not relax appropriately, can undergo a type of physical therapy called biofeedback therapy. Biofeedback therapy is when a trained physical therapist teaches you how to regain control of the pelvic floor muscles.
It’s common for people to express concern that they will become “addicted” to medications that are supposed to help them have bowel movements. These treatments are not addictive at all and should be thought of as an aid to help with bowel movements when the body cannot have them effectively on its own. It’s important that you speak with a medical professional before taking medications to assist with bowel movements, and if you notice any changes to your bowel movement behavior.
No matter what you’re going through, you should feel comfortable being honest and open with your healthcare providers so that they can help you resolve the symptoms causing discomfort. If you are dealing with constipation or other changes in your bowel habits talk with your primary care physician or seek a referral to a Parkview Gastroenterology for further assistance.