Raymond Wayne Whitted MD, MPH
…dedicated to healthy lifestyles and safe, state-of-the-art, innovative surgery for women of all ages
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R. Wayne Whitted MD, MPH
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Constipation: Keeping Your Bowels Moving
What is constipation?
Constipation is when you have trouble having bowel movements. Your stools may be very
hard, making them so difficult to pass that you have to strain. Or you may feel like you still need
to have a bowel movement even after you've had one.
How often should I have a bowel movement?
Not everyone has bowel movements once a day. Don't believe ads that say you must have a
daily bowel movement to be "regular." A normal range is generally 3 times a day to 3 times a
week. You may be getting constipated if you begin to have bowel movements much less often
than you usually do.
What causes constipation?
As the food you eat passes through your digestive tract, your body
takes nutrients and water from the food. This process creates a
stool, which is moved through your intestines with muscle contrac-
tions (squeezing motions).
A number of things can affect this process. These include not drink-
ing enough fluids, not being active enough, not eating enough fiber,
taking certain drugs, not going to the bathroom when you have the
urge to have a bowel movement and regularly using laxatives. Any
of these things can cause the stools to move more slowly through
your intestines, leading to constipation.
How is constipation treated?
The main thing in treating constipation is to be sure you're eating
enough fiber and drinking enough fluids. This helps your stools
move through your intestines by increasing the bulk of your stools
and making your stools softer. Increasing how much you exercise
will also help.
Talk to your family doctor if you notice any blood in your stools, if
constipation is new and unusual for you, if you're constipated for 3
weeks or more, or if you're in pain.
What should I eat?
Eat plenty of fiber (see the box below). Two to 4 servings of fruits and 3 to 5 servings of vege-
tables a day is ideal. Add extra fiber to your diet by eating cereals that contain bran or by add-
ing bran as a topping on your fruit or cereal.
If you are adding fiber to your diet, start slowly and gradually increase the amount. This will
help reduce gas and bloating. Make sure to drink plenty of water too.
Tips on prevent-
ing constipation
 Don't resist the
urge to have a
bowel movement.
 Set aside time
to have a bowel
movement. A good
time may be after
breakfast or any
other meal.
 Eat more fiber.
 Drink plenty of
fluids--at least 8
glasses a day. Flu-
ids can include wa-
ter, juices, soup,
tea and other
Don't take laxa-
tives too often.
 Exercise or
move around more.
Foods rich in fiber
 Unprocessed wheat bran
 Unrefined breakfast cereals
 Whole wheat and rye flours
 Grainy breads, such as whole wheat, rye or pumpernickel
 Fresh fruits
 Dried fruits, such as prunes, apricots and figs
 Vegetables
 Legumes, such as chickpeas, baked beans and lima beans
Should I use laxatives?
Laxatives should usually be avoided. They aren't meant for long-term use. An exception to this is bulk-forming laxatives.
Bulk-forming laxatives work naturally to add bulk and water to your stools so that they can pass more easily through your
intestines. Bulk-forming laxatives can be used every day. They include oat bran, psyllium (one brand: Metamucil), poly-
carbophil (one brand: FiberCon) and methylcellulose (one brand: Citrucel).
How are bulk-forming laxatives used?
You must use bulk-forming laxatives daily for them to work. Follow the directions on the label. Start slowly and drink
plenty of fluids. Gradually increase how much you use every 3 to 5 days (as you get used to it) until you get the effect you
You can help bulk-forming laxatives taste better by mixing them with fruit juice.
Do bulk-forming laxatives have side effects?
You may notice some bloating, gas or cramping at first, especially if you start taking too much or increase the amount
you're using too quickly. These symptoms should go away in a few weeks or less.
Are mineral oil and castor oil good laxatives?
These laxatives should generally be used only when your doctor recommends them, such as if you've just had surgery
and shouldn't strain to have a bowel movement.
While both mineral oil and castor oil have their place as laxatives, they shouldn't be used regularly. If mineral oil is used
regularly, it can cause deficiencies of vitamins A, D, E and K. Castor oil can lead to serious problems if it's used regularly.
Should I try enemas?
Enemas aren't usually needed. Many people use enemas too much. It's better to let your body work more naturally.
What if I've been using enemas or laxatives for a long time?
You may have to retrain your body to go without laxatives or enemas if you've been using them for a long time. This
means eating plenty of fiber and using a bulk-forming laxative, drinking plenty of water, exercising and learning to give
yourself time to have a bowel movement.
If you've used laxatives and enemas for a long time, your family doctor may suggest that you wean yourself off of them
slowly to give your system a chance to return to normal. Be patient--it may take many months for your bowels to get back
to normal if you've been using laxatives or enemas regularly. Talk with your family doctor about any concerns you have.