Constipation is defined as fewer than three stools a week, hard or lumpy stools, excessive straining when passing stools, and/or a sense of incomplete evacuation.

It can occur in people of any age, including children. It’s is more common in women than men, occurs in at least 15% of young and middle-aged adults, and in one-third of older adults. It’s responsible for three million doctor visits and 100,000 E.R. visits annually. Laxatives are among the top selling over-the-counter medications.

The most common causes of constipation are inadequate fiber intake, failure to hydrate adequately, and sedentary lifestyle. Cows’ milk and other dairy products are an important cause of constipation in children. Certain medications can contribute, including narcotics, calcium channel blockers, and calcium and iron supplements. Diseases such as irritable bowel syndrome and hypothyroidism (“low thyroid”) can cause constipation. Structural abnormalities including tumors in the rectum and colon can also be a cause, and it is particularly important to rule out obstructing tumors in new-onset constipation.

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Constipation can result in the following complications:

• Hemorrhoids — protruding veins around the anus than can cause pain and bleeding
• Fissures — painful tears in the lining of the anus
• Hernias, from increased abdominal pressure when straining on the toilet
• Heart attacks or strokes (especially hemorrhagic strokes caused by rupture of a blood vessel in the brain) related to sudden increase in blood pressure when straining to have a B.M.
• Impaction, where stool has to be removed from the rectum manually
• Rectal prolapse, where part of the rectum protrudes from the anus

Position matters when having a bowel movement. The rectum makes a sharp bend just before the anus, called the rectal-anal angle, which is good for preventing stool leakage but bad for having a bowel movement. The angle is more acute when people are sitting upright on the toilet, and is particularly problematic when lying down in a hospital bed using a bedpan. Squatting straightens out the angle, and in many parts of the world people still squat while having a B.M. In modern Western societies where everyone has a toilet, leaning forward helps straighten the rectal-anal angle.

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Following are other ways of preventing or managing constipation:

• Eat more fiber — found only in plants (animals have bones that hold them up, plants have fiber). During evolution, pre-humans and early humans ate at least 100 grams of fiber a day; now the average American eats much less than the recommended 30 grams a day. It takes a few to several days of eating fiber regularly before it starts to work.
• Hydrate adequately — drink enough water to keep the color of your urine clear to light yellow (note that B vitamins can cause dark yellow urine).
• Eating eight to 12 prunes a day is an effective and safe way to treat constipation. Plums, apricots, cherries and mangos either in dry or natural form also work.
• Regular aerobic exercise helps.
• The gastric-colic reflex refers to the urge to defecate when the stomach is full after eating a meal, so if you have a problem with constipation take advantage of this by having a B.M. after eating.
• Then of course there are laxatives, but don’t use them regularly because that can result in “laxative dependance.”

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market, and cooking classes. Call 970-379-5718 for appointment, or email gfeinsinger@comcast.net.