When the bowels won’t moveBy Rafael Castillo M.D.
Philippine Daily Inquirer
Doctors treating heart patients usually watch out for constipation in their patients because we’ve seen quite a number of patients suddenly succumbing to a heart attack or a fatal irregularity of heartbeat or arrhythmia after straining hard to force their stools out. No matter how much patients are instructed not to “force the issue” when they’re constipated, they find it so frustrating and can’t help but make an effort to strain and give it the necessary push. Unfortunately, such effort can trigger some harmful reflexes that can lead to a heart attack for those with blocked arteries.
The frequency of bowel movement varies from one person to another. Some move their bowels twice or thrice daily, usually after meals, while some people only move every other day or every third day. There are some who can stay a whole week without moving their bowels. After three days without a bowel movement, the stool or feces become a hard and solid ball, making it more difficult to pass. Some can even have signs and symptoms of intestinal obstruction, and not a few have been operated because of these impacted stools presenting as obstructed bowels.
If one experiences any of the following for at least three months, he/she is said to be suffering from constipation:
• Hardened stools and straining hard to move bowels more than 25 percent of the time;
• Incomplete evacuation of the stools more than 25 percent of the time; and
• Less than three bowel movements in a week.
Some common causes
Some of the more common causes of constipation are inadequate water intake, lack of fiber in the diet, sedentary living or lack of exercise, depression, pregnancy and some medicines (strong analgesics, antidepressants, iron preparations, antacids containing calcium or aluminum).
Frequent and prolonged use of laxatives or stool softeners can weaken the intestinal muscles and cause recurrent constipation. Personally I avoid laxatives in heart patients and prescribe magnesium supplements which have a beneficial effect on the heart, as well as a stool softening effect. Trimag is a local brand available as an over-the-counter food supplement in Mercury and other drug stores. It may be taken one to two capsules daily.
People under stress may have either frequent bowel movements or constipation. Those with painful hemorrhoids could subsequently develop constipation because they unwittingly resist their urge to have a bowel movement.
Even if one does not have a heart problem, suffering from constipation can be figuratively and literally a difficult burden to carry. Aencille Santos, our junior writer for H&L (Health & Lifestyle) magazine, interviewed Dr. Jaime Ignacio, head of the section of gastroenterology at the Veterans Memorial Hospital for some pointers on how to avoid constipation.
1 Most cases of constipation are easily treatable by the proper combination of healthy diet, fiber supplements and laxatives, Dr. Ignacio advises.
2 A high-fiber diet remains the mainstay of treatment. A plant-based diet— fruits, vegetables, nuts, legumes and whole grains—provides all the fiber one needs for bowel health. Fiber is the part of plant foods that are not digested by the intestines, so it helps add bulk and softness to the stool. It comes in two forms—soluble and insoluble.
3 Soluble fiber absorbs fluid and takes with it fatty acids from the intestines forming a gel-like substance that keeps stools soft. On the other hand, insoluble fiber is not soluble in water and further adds to the bulk of the stools. For practical purposes though, one need not try to find out how much soluble and insoluble fiber a plant food contains. Eating three to five servings each of fruits and vegetables daily would be a sufficient advice to remember.
4 For those who are not fond of eating fruits and vegetables, fiber supplements may help. But while fiber supplementation is effective to prevent constipation and treat acute forms of constipation, Dr. Ignacio does not advise it for longstanding constipation, since it may even cause gaseousness and bloating without improving the bowel movement. For such cases, a judicious use of laxatives may help.
5 Testing for colon cancer with X-ray, imaging or colonoscopy is recommended for those with longstanding constipation, especially if there’s blood in the stools, unexplained anemia, weight loss of more than 10 pounds, abdominal or rectal mass felt by the doctor on rectal examination. If the individual has a strong family history of colon or rectal cancer, one should have a high index of suspicion and rule out this problem.
6 Colonoscopy requires the insertion via the anus of a slender hose-like fiber-optic tube with a camera at the tip to visualize the inside of the colon. This is usually done with the patient sedated. In some modern tertiary hospitals in the country with a state-of-the-art CT scan machine, a virtual colonoscopy can be done. The important thing is that both can rule out tumors as the cause of the constipation.
Summing up, Dr. Ignacio advises that the first line of treatment for chronic constipation is a lifestyle change—regular exercise to stimulate colon movement and a diet which should be rich in fiber and free from heavy meats. The second step includes fiber supplements. If these don’t work, laxatives may be tried.
For the rare cases of difficult-to-treat constipation when the bowels simply won’t budge despite all known medical treatments and the patient can’t stand anymore the bothersome symptoms of constipation, surgery may be considered. The surgical procedure done is called colectomy, wherein a part of the large intestines is removed. Dr. Ignacio stresses that this should be done in extreme cases only. “I haven’t encountered such a case yet in the country,” he says.