Constipation is often dismissed as a minor problem, but experts say it can have a significant impact on patients' quality of life and their well-being.
On a typical day in her clinic, gastroenterologist sees about 20 patients, more than half of whom are constipated. “It’s incredibly common,” says Prather, a professor in the Division of Gastroenterology & Hepatology at Saint Louis University, where she directs the Gastrointestinal Motility Center.
Indeed, about 42 million Americans are persistently stopped up, making constipation one of the most common gastrointestinal problems in the United States, according to the .
But misinformation about is as ubiquitous as the condition itself. Here’s what you need to know to win the battle of the bowel once and for all.
Myth No. 1: We all agree on what "constipation" means.
Say “constipation” to a doc, and he or she likely hears a complaint about absent or infrequent bowel movements. After all, one medical definition of constipation is fewer than three trips to the toilet each week.
But to patients, the word can mean all sorts of below-the-belt bothers, including straining to go, having hard stools and . “[Patients just want to have normal, complete bowel movements where they … go in, they do their business, they get out,” Prather says. “The number of bowel movements – with a few exceptions – just isn’t that important.”
Details matter when talking to your doctor (spare them for your friends and family), since there are different causes and . “The better you understand the patient’s symptoms and what they’ve tried before, the better you can identify what, if anything, you need to do,” Prather says.
For example, while most people assume their intestinal issues are the result of a slow-moving colon, that type of backup only affects about 10 to 20 percent of constipated patients at an academic center, Prather says. More common is "dyssynergic defecation," or constipation caused by uncoordinated pelvic floor muscles, and even more common is constipation related to .
Myth No. 2: It’s inevitable as you age.
Constipation is more common among older adults, but that doesn’t mean you’re doomed to bowel backlog as you age. “Healthy aging is not associated with an increased risk of constipation,” Prather says. “It has more to do with your underlying medical conditions and the medications that you take.”
That's why it's important for patients with no clear causes of constipation to undergo a general medical evaluation. "You want to make sure there isn't some sort of medical condition that's contributing to it," Prather says. For example, , people with and people with are more prone to constipation. Anti-inflammatory and antihypertensive medications, as well as narcotics, can also come with a side of stoppage, Prather says. Sometimes, changing the medication or treating the underlying condition may be best for the bowel, she adds.
Myth No. 3: It’s caused by too little fiber.
No doubt where most Americans fall short. The Academy of Nutrition and Dietetics recommends consuming 20 to 38 grams per day, depending on your age and gender, but most of us get closer to get about 15 grams. Still, studies show no difference in fiber intake among people who are constipated and those who aren’t, Prather says.
“Fiber is an important part of a healthy diet, but it’s probably not simply a cause of constipation,” adds Jeffrey Lackner, a professor of medicine at the University of Buffalo who studies new treatments for gastrointestinal disease.
Myth No. 4: Yogurt will cure.
may get more credit than it deserves for its ability to clear the colon. While probiotics in yogurt can help promote , “you need to have live cultures and you need to get at least 2 servings of yogurt a day” for it to help with constipation, Prather says. She usually recommends patients take a daily instead of doubling up on yogurt.
Myth No. 5: To treat it, drink more water.
When it comes to water intake as a way to flush out the bowels, the hype may be overblown. While is all well and good, unless you’re , guzzling down gallons of H20 probably won’t encourage a No. 2 – “It’s just going to make you have to urinate more,” Prather says.
With her patients, she evaluates their – helping them find ways to add more fruits, vegetables and whole grains – but lifestyle changes aren't always the end-all and be-all.
“If you can get better on that on that alone, fantastic,” Prather says. “But you don’t want to beat yourself up about the fact that ‘I’m eating a healthy diet, I’m drinking my fluids, but yet I’m still having constipation’ – thinking that you’re not doing something right.”
Myth No. 6: Move your body, move your bowels.
Prather also encourages her patients to get at least 30 minutes of moderate most days of the week, but she's careful not to overemphasize its effect on constipation. “The data really are not that strong that increasing exercise improves bowel movements,” she says. Instead, she tells them: “[Exercise] is good for you, you need to this, you should be doing this anyway. I can’t promise you that that your bowel movements are going to get better with that.”
Myth No. 7: It’s not a big deal.
It’s easy for both clinicians and patients to dismiss constipation since it describes the absence of something rather than the presence of it, says Lackner, who directs the University of Buffalo’s Behavioral Medicine Clinic. But in reality, the condition “really does have a significant impact on people’s quality of life, their well-being, their functioning and their digestive health,” he says.
For instance, people with constipation – and particularly those with irritable bowel syndrome whose symptoms may alternate between constipation and – have trouble adhering to schedules, traveling and even leaving the house because they don’t know when the urge to go will hit.
They’re often sluggish, their clothes don’t fit and they even have trouble in personal relationships, Prather adds. “The quality of life impact is absolutely significant,” she says.
Myth No. 8: Lifestyle changes and laxatives are the only treatments.
The good news is that there are effective treatments. Outside of diet and medication changes, people can often alleviate constipation by taking osmotic laxatives such as Miralax or Milk of Magnesia, which draw more water into the stool. If those don’t work, Prather may suggest a stimulant laxative, but only temporarily since patients can develop tolerances to them. In more unusual cases, patients may undergo surgery that shrinks the size of the colon by removing most of it and then attaching the small intestine to the rectum.
For patients whose constipation is due to problems with the pelvic floor, can help them retrain how to relax and contract those muscles more effectively. The treatment works 70 percent of the time and, among those who benefit, at least half get off all medications, according to Prather. “It is life-changing,” she says.
The bottom – no pun intended – line? If you’re plugged up, speak up.
“Just because you’re encouraging patients to make certain lifestyle modifications doesn’t mean that it’s not a legitimate problem – that’s one of the biggest challenges,” Lackner says. “And as long as people continue to think that, people have a hard time getting the help they need and deserve.”