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Constipation

Constipation You Shall Not Pass - You shall not pass | Meme Generator

A Movement you can get Behind!

WARNING:  We're going to be talking about poop so if you're not interested in it, skip ahead to #2 - there's a joke there but I'm classy enough to toilet it go.

My recently retired colleagues tell me that one constant through medical practice over the years has been constipation concerns.  It's tough to define what constipation means because a "normal" bowel routine is usually considered to be anything between 1 BM ever 3 days to 3 BM's every day.  It's more about what's typical for your body.

Your small and large intestine (colon) have small muscles that move matter along from top to bottom.  The small intestine absorbs most of the nutrients from what you eat and the large intestine absorbs most of the water.  Constipation happens when either a) the muscles stop moving as well or b) the stuff they're moving gets too hard to move or c) there is a blockage in the tube.

What can stop the muscles from moving?  An old adage is "motion makes motion" - when you are moving around more, it helps things move along.  When you start sitting more often, usually during travel, things get stopped up (common with air travel due to pressure changes too and diet changes on vacation).  There are some medical conditions that can cause this to happen as well (called an ileus usually) and also medications (opioids are the biggest cause of this, as outlined very well in the movie Trainspotting, but other medications can do this as well).  Getting up and getting moving is very helpful for this but sometimes this is a good time for something like Senna or Dulcolax (bisacodyl) as both of those are bowel stimulants that make the muscles move.
Fiber and water are important for stool bulking which makes things easier to move along and avoid rabbit pellets.  Too much fiber can cause bloating though so it's important to go up on your fiber intake slowly rather than very quickly.  I once had a proctologist (which is a term you don't hear much anymore) tell me that Citrucel (methylcellulose) is the least likely fiber supplement to cause bloating so all things being equal, I recommend that and have a fiber titration regimen I recommend as well for people as it is a good treatment for hemorrhoids, irritable bowel syndrome and constipation.  I can send this to you if you are interested.  As for water, I once heard a gastroenterologist say don't go overboard as we probably only need a cup or two of water a day for the GI tract.

Blockages are a bigger issue.  The most common way this happens is with a big area of constipation that just stops moving.  Usually this happens towards the end of the tract and can be addressed with a good enema.  Much less common would be blockage in the colon from a cancer or from outside the colon from a big mass pushing in on it.  The short answer is new, progressive and unexplained constipation in someone over 45 or 50 is something we generally get more concerned about.

A final "plug" so to speak - Docusate, commonly in Colace or Ex-Lax, has been widely used for many years.  It's also no better than placebo but it's firmly entrenched in people's minds due to years of great advertising and recommendations from family/friends.  My old chief of medicine in his more curmudgeonly years railed wildly against its use for constipation.  It is, however, a good treatment for earwax blockages, when used in liquid drops in the ear.  More information about the lack of benefit with docusate here

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