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Q: I am a healthy person, but I have a problem with having proper bowel movements even though I eat a healthy diet.  What can I do?

Dr. Donnica:
I am assuming you mean you have trouble with constipation, which is a very common challenge for women. In constipation, bowel movements either occur less often than expected, or the stool is hard, dry, and difficult to pass. Normal frequency for bowel movements varies considerably, but ranges from 3 times per day to 3 times per week. Constipation is usually related to diet, lifestyle, or medications. While you may have a healthy diet, it may be low in fiber. You need about 25 to 30 grams of fiber daily to be "regular." Most Americans get less than half that amount.  Foods high in fiber that promote bowel regularity include most fruits and veggies, although bananas may be binding.  Raisins and prunes on the other hand, can really help.

Usually when discussing constipation we focus on what you eat, but what you drink-and how much-may be even more important.  Be sure to drink an adequate amount of water or other beverages such as fruit juice (6 to 8 glasses per day). Exercise is important to most aspects of our health, and bowel regularity is no exception; this is the reason a vigorous daily walk is called a "constitutional." Poor toilet habits can also contribute to constipation, such as ignoring the urge to defecate because of travel, convenience, or competing demands (a big problem for moms with small children, for example). Go when you gotta go!

Constipation may also occur as a side effect of many different prescription and nonprescription medications, including iron supplements and vitamins that contain iron; calcium supplements; antacids that contain aluminum; antidepressants and tranquilizers; narcotic pain killers; general anesthesia; diuretics; and certain prescription drugs used to treat hypertension (especially verapamil), seizure disorders, or Parkinson's disease. Overuse of laxatives can also be a problem. Your body comes to rely on these medicines, eventually causing constipation rather than relieving it.

Less often, constipation may be a symptom of some underlying illness or condition that either affects the digestive tract alone or involves larger portions of the body. Examples of this include irritable bowel syndrome, intestinal obstruction, diverticulitis, colorectal cancer, hypothyroidism, hypercalcemia, systemic sclerosis, multiple sclerosis, Parkinson's disease and spinal cord injury.

Constipation is a very common problem that affects at least 80 percent of people at some time in their lives. Currently in the United States, treatment for constipation accounts for over 2.5 million visits to doctors' offices each year, with at least $800 million spent annually for laxatives. Although adults of all ages may suffer from constipation, the risk for this problem increases dramatically after age 65 in both men and women.

Symptoms of constipation include:

  • Fewer than three bowel movements per week
  • Small, hard, dry stools that are difficult or painful to pass
  • The need to strain excessively to have a bowel movement
  • A feeling that your rectum is not empty after a bowel movement
  • Frequent use of enemas, laxatives or suppositories

If you have constipation together with rectal bleeding, abdominal pain or abdominal distention, tell your doctor immediately. He or she may wish to see you for further evaluation, including a brief physical exam and digital rectal examination.

Created: 8/15/2002  -  Donnica Moore, M.D.

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