Constipation: When Is It Time to Tell Your Doctor?

Everyone Poops. It’s a children’s cartoon book by Taro Gomi — ideal for toddlers in the midst of potty training. Beyond that, it’s an important bodily-function that’s seldom discussed among adults — even in the doctor’s office. Even when the patient is worried about not pooping, also known as constipation.

Some eight million visits to healthcare providers each year are the result of constipation, according to a new review of studies in the Journal of American Medical Association (JAMA), even as the study’s author concedes that a majority of people concerned about constipation do not report it to their doctor.

Rozan Razzouk, M.D., a family medicine physician with Baptist Health Primary Care in South Miami, routinely asks her patients about their bowel health. “They say it’s OK,” Dr. Razzouk says. “They don’t talk about it very often, to be honest. Sometimes, [constipation] is really bothering them, but they don’t want to admit it.”

Defining Constipation

Some people may be surprised to learn the definition of constipation. Hint: BMs aren’t a daily requirement for good health. “Patients don’t have to have a bowel movement every day, but that’s what they believe,” Dr. Razzouk says.

Rather, constipation is defined as fewer than three bowel movements per week, or a hard, small stool (even if the bowels move daily). Straining to produce a bowel movement or the inability to empty the bowels during a movement are other signs of constipation.

Sometimes, constipation goes along with another medical problem, including Parkinson’s disease or multiple sclerosis, and endocrine conditions, such as diabetes and thyroid disorders. Constipation may also be a sign of a physical obstruction or tumor in the bowel, so it’s always important to check with your doctor.

Some people, including longtime medical writer Jane Brody, the New York Times Personal Health columnist, suffer from chronic constipation, for which lifestyle changes and over-the-counter medications can be very effective. Ms. Brody shared her nearly lifelong experience with constipation, which she described in a recent column as “an all-too-common problem.”

Tips for Preventing Constipation

Constipation also can be a side effect of certain medications, including antidepressants, narcotic painkillers and antihistamines.

Dr. Razzouk offers these tips to prevent and treat occasional constipation.

• Drink plenty of water. A lack of proper hydration can contribute to constipation and lead to a hard stool.
• Add fiber to your diet through food, such as whole grain breads and cereals, legumes such as lentils and beans, and fruits and vegetables. It’s no myth that fiber-rich prunes often do the trick.
• Remember to exercise. A sedentary lifestyle often is a key factor in constipation.
• When the urge strikes, don’t ignore it. Whenever possible, head to the bathroom as soon as your body gives you the signal. Over time, the signal may become weaker if it’s not heeded regularly.
• Talk to your healthcare provider before starting any herbal or “natural” supplements to prevent or treat constipation. These products are not regulated or tested by the Food & Drug Administration so you can’t be sure they are safe and effective.
• Stool softeners often help stimulate a bowel movement without the side effects (bloating, gas and cramps) that some laxatives can produce. When you do need a laxative, those without psyllium produce less intestinal gas.

Talk to your doctor if you have a sudden change in bowel habits, Dr. Razzouk emphasizes. Certain symptoms occurring along with constipation — including weight loss, blood in the stool (known as melena) or a family history of colon cancer — are “red flags” that need to be checked out. “If you have a regular bowel movement all your life and suddenly you start to be constipated,” Dr. Razzouk says, “you need to bring that information to your healthcare provider.”