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What constitutes constipation and what are the best treatments?

By Judy Foreman
June 15, 2009
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Q. What constitutes constipation and what are the best treatments?

A. Ubiquitous as it is, there are many misconceptions about constipation and what to do about it.

Many people think having a bowel movement more or less frequently than once a day is not normal. In truth, roughly three times a day to roughly three times a week is all normal. In fact, consistency of the stool is more important than frequency. Smooth, soft and sausage-shaped is the ideal, according to the seven-point scale that doctors use. (If you're curious, Google "Bristol Stool Scale.") Straining can also be part of constipation.

Constipation is often caused by medications, says Dr. Robert Burakoff, clinical chief of the division of gastroenterology at Brigham and Women's Hospital. These include calcium channel blockers used for heart disease and hypertension, narcotic pain relievers, and older antidepressants such as Elavil. Age contributes, too, because intestinal muscles don't work as well as we grow older. Pelvic floor problems in women can contribute to constipation, as can excessive iron in the diet or supplements.

Fiber is a good first step in treatment, both fiber that comes naturally in fruits and vegetables and over-the-counter drugs like Metamucil containing psyllium, says Dr. Braden Kuo, a gastroenterologist at the Digestive Healthcare Center at Massachusetts General Hospital. But too much fiber can cause bloating and gas, so don't overdo it. Other over-the-counter fiber medications such as Citrucel and Benefiber may cause less bloating.

If fiber doesn't help enough, try over-the-counter laxatives such as MiraLAX, Dulcolax, Correctol, or an occasional dose of milk of magnesia (too much of the latter is bad for the kidneys). Senna products can also work, but they stain the inside of your colon, though doctors now think this is not dangerous. Don't use any of these medications chronically, though, because you can get diarrhea and cramping, and if you use laxatives too often, you may make it harder for your colon to contract naturally.

If all these treatments fail, you can try the prescription drug Amitiza. Most people with constipation don't need to see a doctor. But you should if constipation is chronic and there's no obvious reason for it, to make sure there is no bowel obstruction.

E-mail health questions to foreman@globe.com.

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