Looking Beyond Fiber to Stay 'Regular'

Like many people, my parents believed that a "normal" digestive tract must cleanse itself of waste every day. They insisted that I was born constipated.

Skip to next paragraph Stuart Bradford

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Fortunately for my newest grandson, not everyone is so misinformed. For the first three months of his life, he averaged one bowel movement a week, if that. His pediatrician said not to worry unless he went longer than 10 days or had a very hard time of it when he finally tried to empty his colon.

I don't think there is another normal body function that concerns people as much as bowel movements that do not occur on a predictable daily basis. Millions of people go to great lengths, using diet, supplements and a wide variety of stimulants to "regularize" this digestive function. In the process, some people actually create an abnormality that did not previously exist.

What Is Constipation?

The number or frequency of bowel movements is not what defines constipation. What most gastroenterologists would consider normal ranges from 3 to 21 movements a week. But even if people typically go a week between bowel movements, this is not necessarily a concern if they have no trouble when they finally do go.

What is abnormal is the passage of hard stools, having to strain to have a bowel movement or experiencing a feeling of incomplete elimination after a bowel movement. Those with infrequent eliminations may feel bloated, crampy, uncomfortable or sluggish. In some people, like those with irritable bowel syndrome, constipation may alternate with diarrhea. People who experience pain during a bowel movement may have an anal fissure or hemorrhoids, both of which can result from chronic constipation.

Most important, anyone who experiences an unexplained change in their usual bowel habits - the onset of hard, infrequent stools after decades of daily, easy-to-pass movements, for example - should seek prompt medical attention.

Keep in mind that a number of circumstances can cause problems with constipation, among them pregnancy and childbirth; surgery; travel; a change in daily schedule that interferes with a person's usual bathroom time; taking a medication that affects bowel function, and an illness that disrupts normal eating habits.

A long list of factors, from daily diet and exercise habits to underlying diseases and old age, can cause chronic constipation. Normally, as liquid food waste moves through the colon, water is absorbed to form the stool, after which muscle contractions propel the stool toward the rectum. Failure to have enough fiber in the diet or to drink enough liquids (especially those without caffeine or alcohol, which are dehydrating) can result in hard stools that are difficult to pass.

Fiber is the indigestible part of plant foods. Soluble fiber absorbs water in the intestines, helping to soften the stool; insoluble fiber passes through the digestive tract virtually unchanged. Both types add bulk and texture to stools that make them easier to pass.

Lack of exercise is another common cause of constipation, as is repeatedly ignoring the urge to have a bowel movement. Both can result in poor muscle action in the colon.

Among the disorders associated with chronic constipation are strokes, multiple sclerosis, Parkinson's disease, spinal cord injuries, diabetes, underactive thyroid, excessive calcium in the blood, lupus and scleroderma. Other problems may directly involve the colon or rectum, including tumors, scar tissue, strictures and abnormalities in hormones, nerves or muscles that are involved in colonic function.

Many medications, too, can cause constipation. Among the most common offenders are pain medications (especially narcotics like codeine, morphine and oxycodone); certain antidepressants, although not the class known as selective serotonin reuptake inhibitors or S.S.R.I.'s; tranquilizers; antacids that contain aluminum or calcium; calcium-channel blockers to control blood pressure; diuretics; iron and calcium supplements; anti-Parkinson drugs; anticonvulsants and antispasmodics.

Coping Through Diet

I've had a lifelong problem maintaining regular bowel habits. In college, things got so bad - I suffered from bloating and cramps after days of no eliminations - that I visited the campus clinic, where an astute physician got me on track.

She advised me to eat a whole-grain cereal and plenty of fruits and vegetables every day; to drink lots of liquids, including a glass of water before bed and upon awakening, and to avoid white breads, nuts, cheese and chocolate. (White flour has been stripped of its bowel-stimulating fiber, and nuts, cheese and chocolate - along with white rice and bananas - tend to be constipating). She also recommended that I establish a time each day to use the bathroom.

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