What actually counts as constipation?
Doctors use a set of criteria known as the Rome criteria. It sounds formal, but behind the wording there is a common thought: it is not the frequency, but the quality of emptying that is important. The diagnosis of functional constipation is discussed if at least two of the listed signs are present during the last three months, and they appeared at least six months ago.
- Severe straining in more than a quarter of bowel movements
- Hard or lumpy stool in more than a quarter of cases
- Feeling of incomplete emptying in more than a quarter of cases
- Sensation of obstruction or blockage in the rectal area
- The need to help with your hands - to press on the stomach or perineum
- Less than three spontaneous bowel movements per week
- At the same time, loose stools practically never happen without laxatives.
A useful tool for self-observation is the Bristol Stool Shape Scale, where types are numbered from solid individual lumps to completely liquid. The guideline is simple: the first two types indicate constipation, the middle ones indicate normal, and the last two indicate diarrhea. This scale is much more informative than counting days, and it is this scale that allows you to notice an improvement before the frequency changes.
The Myth of Everyday Poo and Where It Comes From
The belief that you should have a bowel movement every day and always in the morning is surprisingly persistent and does a lot of harm. It gives rise to anxiety in completely healthy people and leads to many years of taking laxatives without any indication. Meanwhile, the rhythm of the intestines is individual, as is the duration of sleep: for some, six hours is enough, for others, nine are needed, and both are the norm.
- The norm is from three bowel movements per day to three per week, if this happens without straining and is comfortable
- The rhythm changes depending on diet, travel, stress and activity level - short deviations do not require treatment
- The idea of “self-poisoning of the body with fecal toxins” has no scientific confirmation
- The colon does not need to be flushed: colon hydrotherapy has no proven benefit and can cause harm
- Changing your habitual rhythm is more important than the rhythm itself: a persistent transition from daily bowel movements to once a week requires attention
Constipation when traveling deserves special mention - the condition is so common that it has its own name in everyday life. Change of time zones, unusual food, lack of water on the road and reluctance to use someone else's toilet come together, and the intestines stop for several days. This is not a disease and not a reason for treatment: usually everything returns to normal within a few days after returning to the usual routine.
Why it occurs: reasons that are rarely thought about
Most chronic constipation is functional - that is, the intestines are structurally healthy, but the rhythm of its work is disrupted. But before dwelling on this conclusion, it is worth going through the reasons that are easy to eliminate. This is especially true for medications: very often constipation turns out to be a side effect, and a person treats the consequence for years without connecting it with the prescribed drug.
- Medicines: iron supplements, opioid painkillers, some antidepressants, aluminum antacids, certain blood pressure medications, diuretics
- Decreased thyroid function - hypothyroidism, in which constipation is often one of the first symptoms
- Diabetes mellitus with damage to the intestinal nerves
- Low potassium levels and high calcium levels in the blood
- Inactivity, bed rest, prolonged sitting work
- Lack of fluid and very small amounts of food during strict diets
- Pregnancy and postpartum period - the influence of hormones and mechanical pressure
- Diseases of the rectum: fissure and hemorrhoids, in which a person deliberately postpones bowel movement due to pain
- Impaired coordination of the pelvic floor muscles, when when straining the muscles do not relax, but contract
The last point deserves special attention, because with it the usual treatment does not work at all. A person conscientiously eats fiber, drinks water, takes laxatives, but there is no result, because the problem is not in the movement of the contents, but in the act of emptying itself: the pelvic floor muscles contract instead of relaxing. This condition is recognized by special research and is treated not with pills, but with muscle training with feedback, and quite successfully.
Fiber and water: how to use it correctly
The advice to “eat more fiber” is fair, but it’s incomplete, and it’s the incompleteness that makes it harmful. Dietary fiber works by absorbing water and increasing the volume of intestinal contents. If there is little water in the body, they, on the contrary, make the mass denser, and constipation worsens. This is the most common reason why a person says “bran didn’t help me, it only got worse.”
- The guideline is about 25–30 g of dietary fiber per day, but you need to increase it gradually, over 2–4 weeks, and not in one day
- A prerequisite is a sufficient amount of fluid, approximately 1.5–2 liters per day in the absence of restrictions on the heart and kidneys
- Soluble fibers - psyllium, oatmeal, legumes, apples, citrus fruits - soften stool and are more easily tolerated
- Insoluble fibers - wheat bran, vegetable peels - increase volume and stimulate movement, but are more likely to cause bloating.
- Prunes work not only due to fiber, but also due to the sorbitol they contain, which attracts water.
- Kiwis, figs and pears have been shown to be simple and well-tolerated options in studies
- A sharp increase in bran without water is the most common cause of deterioration
There is a situation in which increasing fiber does not help and is even contraindicated: slow transit through the intestines and suspicion of an obstruction in the lumen. If an increase in fiber volume leads to increasing bloating, distension and pain, this is not a reason to double the dose, but a reason to stop and consult a doctor. There is no universal “more fiber is better” here.
Laxatives: what you can do for a long time and what you can’t
Laxatives differ not in strength, but in mechanism, and this determines whether they can be taken for a long time. The most common mistake is to start straight with stimulants like senna, because they act quickly and are available without a prescription, when it makes more sense to start with other groups.
- Объёмные средства, включая псиллиум: работают как пищевые волокна, требуют достаточного питья, подходят для длительного применения при лёгких формах.
- Осмотические средства — макрогол, лактулоза: притягивают воду в просвет кишки и размягчают содержимое. Считаются основой длительной терапии, привыкания не вызывают. Лактулоза при этом чаще даёт вздутие и газообразование.
- Размягчающие и масляные средства применяют ограниченно и обычно коротко.
- Стимулирующие — сенна, бисакодил, натрия пикосульфат: усиливают сокращения кишки, действуют быстро. Уместны эпизодически или коротким курсом, а не как ежедневная привычка.
- Свечи и микроклизмы работают локально и помогают, когда проблема именно в последнем этапе опорожнения.
- Рецептурные препараты нового поколения назначает врач при неэффективности перечисленного.
The most typical long-term story is associated with senna and other stimulants. A person begins to take the drug occasionally, then daily, and after a while he notices that the previous dose does not work and has to be increased. A dependence on the procedure is formed and the belief is that without the pill the intestines will not work at all. That is why stimulants are not intended for multi-month daily use, and if you cannot do without them, this in itself is a reason for examination, and not for increasing the dose.
Mode, position and when you need a colonoscopy
There are simple things that work better than they seem because they use natural physiology. The strongest wave of intestinal contractions occurs after waking up and after eating - this is the gastrocolic reflex. If you regularly hit this window, the rhythm is restored in a significant proportion of people without any medications.
- Set aside quiet time in the toilet 15-30 minutes after breakfast, at the same time every day
- Never suppress the urge: systematic procrastination is one of the main causes of chronic constipation.
- Do not spend twenty minutes in the toilet with your phone: prolonged straining contributes to hemorrhoids and fissures
- Use a low footrest so that your knees are higher than your hips: this position straightens the angle of the rectum
- Do not hold your breath when straining too hard, but exhale through slightly pursed lips
- Walking for at least 20-30 minutes every day—body movement directly stimulates bowel movements
Workup for typical functional constipation in a young person without warning signs is usually limited to physical examination, complete blood count, and thyroid testing. Colonoscopy becomes necessary in other situations: the appearance of constipation for the first time after 50 years, blood in the stool, weight loss, anemia, night pain, palpable formation, persistent change in the shape of the stool, and colon cancer in close relatives. Routine screening colonoscopy makes sense even without complaints - it allows you to find and remove polyps before they become dangerous.
