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Constipation: Causes and Prevention Tips

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As many as one in five people experiences chronic constipation, a condition that’s even more common in women as they get older. It’s something that can easily creep up on you if you’re not paying attention, with many factors, from diet to other health conditions, contributing to the problem. 

Linda Lee, M.D., director of the Johns Hopkins Integrative Medicine and Digestive Center, talks about constipation symptoms, causes and prevention, including when women should seek help from a doctor.

Defining Constipation

Most people think constipation means not having frequent enough bowel movements. In reality, constipation is more complicated and more subtle than that, with a range of symptoms that you may not always recognize.

“People think if they are having a bowel movement every day, they can’t be constipated,” says Lee. She points out that the medical definition of constipation actually requires a person to have just one of many symptoms that include: 

  • Fewer than three bowel movements per week
  • Straining to start or complete a bowel movement
  • Stool consistency that looks like rocks and pebbles
  • A feeling of incomplete emptying

Lee says that because of this range of symptoms, many people don’t know when they’re constipated. Depending on the severity, constipation can cause problems like abdominal pain and gas. Excessive straining during bowel movements may also cause hemorrhoids (swollen anal veins), anal fissures (tears) and rectal prolapse, where part of the rectum sticks out through the anus. 

Causes of Constipation

Constipation has a wide range of causes and risk factors ranging from poor diet to disorders that are more serious. In terms of how our bodies operate, the causes of constipation fall into three categories: 

  • Slow transit: When stool doesn’t move through your digestive tract quickly enough, you can become constipated. Risk factors for slow transit include a low-fiber diet, dehydration and taking certain drugs, such as narcotic pain medication or antidepressants. Intestinal obstruction is another potential cause, which may arise from a bowel blockage, narrow areas in the intestines called strictures or even cancer.
  • Nerve signaling problems: Neurological (nerve) problems can impact the movement of stool in the digestive tract. Constipation can be an issue for people with conditions such as Parkinson’s disease and multiple sclerosis. 
  • Pelvic floor dysfunction: Pelvic muscle weakness and other muscle function problems are a major contributor to constipation. “It turns out the muscles in our pelvic floor have to work in a very particular way in order for stool to move through the rectum,” says Lee.  

How to Prevent Constipation

The good news is that if you have mild constipation, simple lifestyle changes can help manage the condition. Prevention tips include:

  • Increasing your fiber intake: Fiber-rich foods, such as fruits, vegetables and whole grains, all help improve gut function. If you have bowel sensitivity, you’ll want to avoid high-fructose fruits, such as apples, pears and watermelon, which can cause gas. 
  • Getting more exercise: Regular exercise can help keep stool moving through the colon. 
  • Drinking more water: Aim for eight glasses daily, and avoid caffeine, as it can be dehydrating. 
  • Go when you feel like it: When you feel the urge to go, don’t wait. 

When to See a Doctor About Constipation

If increasing fiber intake, exercise and hydration don’t solve the problem, your constipation may be characterized as chronic. Depending on the cause of chronic constipation, you may need physical therapy or even low-dose laxatives to treat the problem.

“If you have chronic constipation, it’s important to meet with a professional who can help guide you to the right kind of therapy,” Lee says. “This is especially true if you have any warning signs, like weight loss, bleeding or pain, or if your stool becomes pencil-thin and stays that way.”

All things considered, Lee says you should see a doctor if constipation is something that’s interfering with your daily life. At Johns Hopkins, the Women’s Digestive Health Program focuses on issues such as this.

“It feels terrible, and if it’s happening a lot, then you probably need to be seen,” she says.

 

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