Coping with Chronic Constipation – The Washington Post


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It is normal to have an occasional bout of constipation. As uncomfortable as it may be, it usually resolves within a few days. But the problem may be chronic – and require action – if you have had two or more of the following symptoms for at least three months:

  • You have less than three bowel movements per week.
  • You should strain for at least a quarter of all your bowel movements.
  • The stools are often hard or lumpy.
  • Sometimes you feel like your bowels haven’t completely emptied.

For relief, people with chronic constipation can turn to laxatives.

“Many older people assume that constipation is just another unavoidable part of aging, but it can be avoided through lifestyle. [strategies and] sometimes medication,” says Christian Stevoff, a gastroenterologist at Northwestern Medicine in Chicago.

Know the causes of chronic constipation

Chronic constipation may be more common in older people, affecting around 26% of women and 16% of men over 65, and 34% of women and 26% of men over 85, according to a 2021 study .

“As we age, our gut and our nervous system also age, and one of the consequences of that is the nerves and muscles (which move waste) degenerate so that they don’t work as well as they used to,” explains Satish. Rao, chief of gastroenterology at Augusta University in Georgia.

But other factors, including a lack of fiber and too little physical activity, can also contribute. Medications such as opioids and some antidepressants, blood pressure medications and drugs for Parkinson’s disease are all potential culprits, Stevoff says.

Some over-the-counter (OTC) pain relievers, such as ibuprofen and naproxen, are also associated with constipation, and supplements containing calcium or iron “can bind you,” says William Chey, a gastroenterologist at the University of Michigan in Ann Arbor.

Hypothyroidism or neurological problems such as multiple sclerosis can also lead to constipation, as can pelvic floor disorders — which affect the ability to coordinate muscles to pass stool, says NYU Langone gastroenterologist David Poppers. Health in New York.

Try these lifestyle steps

Lifestyle strategies can be quite effective if you stick with them, but they can take several weeks to start working. If you need immediate relief — for example, you haven’t passed a bowel movement in several days — you might consider using an over-the-counter osmotic laxative with polyethylene glycol (PEG), Stevoff says. (For some, stimulant laxatives, such as senna and bisacodyl, may have more serious side effects than PEG medications.)

Always tell your doctor if you haven’t had a bowel movement for several days. For the long term, try these strategies:

  • Increase your fiber. It helps bulk up the stool, making it easier to pass. Research suggests that eating five or six prunes a day is as good for chronic constipation as some laxatives, Rao says. Or try eating two kiwis a day; Chey’s research reveals that it relieves constipation in about half of people, without some of the side effects of prunes, such as abdominal pain, bloating and gas.
  • Increase your fiber intake. Try this over a period of a few days to a few weeks to allow your body to get used to it, Chey says. If you’re struggling to get enough fiber from food, consider taking an over-the-counter fiber supplement. The best evidence is for those that contain psyllium, Poppers says.
  • Drink enough fluids. Aim to drink about eight 8-ounce cups of fluid each day. A cup of coffee can also be helpful as it is a mild gastrointestinal stimulant. Many seniors are perpetually dehydrated, which can make constipation worse, Chey says.
  • Pay attention to the timing. Your bowels tend to be most active about half an hour after a meal, so make sure you have access to a toilet at that time. It’s fine to spend about five to 10 minutes in the bathroom, but if nothing happens during that time, try later in the day, Poppers says.
  • Adopt the correct posture. You want to keep your knees above your hips, which relaxes the pelvic floor muscles that wrap around the back of your rectum, says Carrie Pagliano of the American Physical Therapy Association. “That way it allows the BMs to go straight out,” she says. One option is to sit on the toilet with your feet on a small footstool, like the Squatty Potty. And don’t force it.
  • Exercise. A 2017 study found that women with chronic constipation who walked on a treadmill for 60 minutes three times a week for 12 weeks reported improvement compared to a control group.

If you need long-term help

If you’ve tried lifestyle changes for three to four weeks and still have chronic constipation, see your doctor, Stevoff says. A doctor can do blood work to rule out medical conditions, review your medications and supplements, and, if needed, perform tests such as a colonoscopy to check for an obstruction or blockage. If your chronic constipation is caused or made worse by pelvic floor problems, your doctor may recommend pelvic floor physical therapy, where you’ll learn techniques such as abdominal massage that can help get things moving.

When there’s no clear cause, Rao says prescription drugs could be an option — temporarily or in some cases long-term.

When the problem gets serious

If your constipation isn’t resolved for too long, it can lead to fecal impaction, where a piece of dry, hard stool gets stuck in the rectum.

In addition to constipation, this can bring abdominal pain and a feeling of satiety which affects appetite. Fecal impaction can also lead to diarrhea, due to watery stools from higher up in the gastrointestinal tract circulating around stuck-on stools, Rao says.

A doctor can diagnose fecal impaction with a digital rectal exam and X-rays. They may try to remove the impaction manually or give a warm water enema to remove it. If it doesn’t respond to these measurements, or if your doctor sees signs of a perforated colon, you may need emergency surgery.

After the stool is removed, your doctor will recommend a laxative or other measures to prevent a recurrence, such as increasing fiber intake and staying active. You’ll also want to talk to your doctor about medications that might be contributing.

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