Fiber Alone May Not Resolve Constipation
Medications, other disorders can be at the root of the problem

(HealthDay News) -- People who suffer from constipation understand misery.

And that misery intensifies when eating more fiber and exercising still provide no relief.

But something else might be causing the problem, one expert says, urging doctors to look beyond diet for an explanation.

"The idea that many patients have, and unfortunately their physicians -- [that] if we just keep pushing fiber until the grass grows out of their behind they'll have been treated successfully -- that's not really true," Dr. Arnold Wald, a professor of medicine in the gastroenterology and hepatology section at the University of Wisconsin , told HealthDay .

Fiber is easy to recommend because it's simple to take and it's cheap, Wald said, but it doesn't work for everyone.

According to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases, a person is considered constipated if he or she has three or fewer bowel movements in a week. With constipation, the stool is hard and dry and sometimes painful to pass. People often feel "draggy" and full.

People become constipated when the colon absorbs too much water or when muscle contractions in the colon become too slow. People who don't get enough exercise and fiber in their diet are susceptible.

About 80 percent of people suffer from constipation at some point, and brief bouts of constipation are normal, according to the American Society of Colon and Rectal Surgeons. But when it keeps recurring, people probably need to see a doctor.

Anyone who experiences at least two bouts of constipation for at least three months (not necessarily consecutively) over a period of six months is considered chronically constipated, said Dr. Satish S.C. Rao, a professor of internal medicine and director of neurogastroenterology and gastrointestinal motility at the University of Iowa .

But constipation can also be a side effect of other health problems, Rao said.

Medications, including painkillers and antidepressants, can cause it. Neurological disorders such as Parkinson's disease, metabolic and endocrine conditions, including diabetes, and systemic disorders such as Lupus also can cause problems by slowing the movement of stool, according to the digestive diseases institute.

Constipation also can result from colonic nerve or muscle dysfunction. In some people, Rao explained, "the problem is that the individual has the inability to coordinate the pelvic floor muscles and anorectal muscles to evacuate stool."

Another cause of constipation can be irritable bowel syndrome. And other people have what's called "slow-transit constipation," which means it takes longer to pass stool.

Biofeedback, a technique that teaches people to use the mind to control the body, proved successful in treating people with nerve or muscle dysfunction in a study Rao conducted. Compared with people given fake biofeedback sessions and others treated in the standard way -- with diet, exercise and laxatives -- those who used biofeedback came out "far, far superior" to the other two groups, Rao told HealthDay . The results were published in the journal Clinical Gastroenterology and Hepatology .

Bouts of constipation can vary in frequency and severity, and only when it becomes "a real problem" will people need to seek referrals for specialty tests and treatment, Wald said.

In fact, he added, most people find relief on the shelves of their local pharmacy, where they'll find stimulant laxatives or polyethylene glycol, an over-the-counter stool softener. Natural stimulants, such as raisins and prunes, also help many people, Wald said.

And there's always fiber, which is found in many vegetables, fruits and grains. Just be sure to add fiber a little at a time, so the body gets used to it slowly.

"Diet doesn't work in every scenario," Rao said, "but for occasional constipation, that is the group that I think diet will be effective for."

On the Web

To learn more about constipation, visit the American Gastroenterological Association online.

SOURCES: HealthDay News ; Arnold Wald, M.D., professor of medicine, Section of Gastroenterology and Hepatology, University of Wisconsin, Madison, Wis.; Satish S.C. Rao, M.D., Ph.D., professor of internal medicine and director of neurogastroenterology and gastrointestinal motility, University of Iowa, Iowa City, Iowa; National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md.; March 2007, Clinical Gastroenterology and Hepatology
Author: Anne Thompson
Publication Date: Sept. 30, 2008
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