Q: I have chronic constipation, which is probably from the medication I have to take for severe arthritis and a fractured spine. Regular use of over-the-counter laxatives results in nausea. Prescription laxatives haven't helped. High-fiber diet and activity aren't enough to prevent it. What can I do?
A: Bowel habits differ, and it is not necessary to have a bowel movement every day. However, lack of a bowel movement beyond a 72-hour period or straining generally indicates a problem. Constipation is often a side effect of many medications, especially narcotics. Increasing fiber and fluids is always a good first step. Make sure you are getting at least 14 grams of fiber for every 1,000 calories or are eating a minimum of 25 grams of fiber per day. It isn't difficult to consume 25 grams of fiber with a little effort. For example, you might have a cereal with at least five grams of fiber per serving at breakfast with a serving of fruit; a sandwich on whole wheat bread with a pear for lunch and a cup of broccoli with a baked potato as part of your dinner, ending with a snack of a handful of nuts. Beans and peas, high-fiber cereals, fruits, vegetables and nuts all add fiber to the diet. When increasing fiber in the diet, it is also important to drink adequate amounts of fluid, or large amounts of fiber can have the opposite effect causing more constipation. Try for at least 64 ounces of fluid a day and make sure that most of these fluids are decaffeinated.
Inactivity and poor bowel habits (ignoring the signal to have a bowel movement) can also contribute to constipation. Get regular exercise, if possible, and be sensitive to your body's signals.
Sometimes changing the bacterial environment of the gastrointestinal tract can help relieve constipation. Although the evidence is not definitive, many people have found that using a probiotic (bacteria that is beneficial to the body) aids in establishing an intestinal environment that promotes regularity. Probiotics can be purchased separately as a supplement or in yogurt and some milk drinks. There are a number of these products on the market. Look for those containing live cultures of bifidus. To be effective, products must contain at least a certain number of organisms. Ask your pharmacist for a product recommendation.
Finally, there are times when lifestyle management is not sufficient. In this case, your health care provider may suggest you follow a bowel regimen including non-stimulating laxatives with suppositories and enemas. Adequate follow-up and evaluation are important because persistent use of stimulating laxatives can lead to dependency and mineral imbalances in the body.