Constipation can emerge due to a number of factors, such as the medications you take (opioids, calcium channel blockers, iron supplements and others), being inactive, pregnancy, travel, diet, and health conditions that slow digestion (such as disorders and injuries that affect the brain and spinal cord, hypothyroidism and diabetes).

People who are constipated for long periods of time may also experience additional complications like hemorrhoids, anal fissures, rectal prolapse (rectum protrudes out of the anus) or fecal impaction (hardened stool stuck in the rectum).

Luckily, what helps constipation is as simple as paying closer attention to your nutrition intake. And remember, you should always talk to your doctor about any medical issues or concerns you have!

So what are some remedies for constipation?

You may need more fiber! Most Americans don’t get enough dietary fiber.

But what exactly is fiber? Fiber refers to the undigested parts of food, the NIDDK says. It helps make stool soft so it can move smoothly through your intestines.

There are two types of fiber — soluble and insoluble. Soluble fiber dissolves in water and is found in beans, fruit and oats. Insoluble fiber does not dissolve in water and is found in whole grains and veggies. Both kinds help prevent constipation, the NIDDK says. (Find more examples of fiber-rich foods here and here.)

Most Americans eat 16 grams of fiber a day, but should be getting 22-34 grams a day. But it’s not only the amount of fiber that matters, but also the rate at which you increase your fiber. Ramping it up full tilt can cause gas, bloating and cramps. Be sure to add fiber to your diet slowly so your body can adjust.

Also, make sure you are drinking plenty of fluids (water, fruit and veggie juices, clear soups) to help the fiber work better. And make sure you’re not eating foods that are making constipation worse.

What foods should you avoid if you’re constipated?

If you are constipated, foods with little to no fiber may be working against you, the NIDDK says. You may want to try avoiding cheese, chips, fast food, ice cream, meat, prepared frozen meals/snack foods, and processed foods like “TV dinners” or hot dogs, and see if your constipation improves.

Still facing digestive issues and feel like nothing works?

It’s time to test — don’t guess! Let’s get to the root of the issue with a GI (gastrointestinal) test. You also may want to consider a nutrition test to see if your body is getting and absorbing the nutrients it needs.

Enjoy Your Healthy Life!

Joy Stephenson-Laws is founding and managing partner of Stephenson, Acquisto and Colman (SAC), the healthcare industry’s premier litigation firm. In this role, Ms. Stephenson-Laws leads a diverse team of over 100 professionals that includes attorneys, doctors, nurses, technology and healthcare provider operations specialists. This interdisciplinary approach to representing clients such as Stanford University Hospital, UCLA Medical Center and UC Irvine Medical Center has resulted in SAC’s recovering over $1 billion for its clients while consistently receiving high marks for client satisfaction for such innovations as SACLINK, a proprietary, interactive, paperless document management system.

The pH (Proactive Health) professional health care team includes recognized experts from a variety of health care and related disciplines, including physicians, health care attorneys, nutritionists, nurses and certified fitness instructors. To learn more about the pH Health Care Team, click here. Check out their new book Minerals – The Forgotten Nutrient: Your Secret Weapon for Getting and Staying Healthy. 

Constipation can emerge due to a number of factors, such as the medications you take (opioids, calcium channel blockers, iron supplements and others), being inactive, pregnancy, travel, diet, and health conditions that slow digestion (such as disorders and injuries that affect the brain and spinal cord, hypothyroidism and diabetes).

People who are constipated for long periods of time may also experience additional complications like hemorrhoids, anal fissures, rectal prolapse (rectum protrudes out of the anus) or fecal impaction (hardened stool stuck in the rectum).

Luckily, what helps constipation is as simple as paying closer attention to your nutrition intake. And remember, you should always talk to your doctor about any medical issues or concerns you have!

So what are some remedies for constipation?

You may need more fiber! Most Americans don’t get enough dietary fiber.

But what exactly is fiber? Fiber refers to the undigested parts of food, the NIDDK says. It helps make stool soft so it can move smoothly through your intestines.

There are two types of fiber — soluble and insoluble. Soluble fiber dissolves in water and is found in beans, fruit and oats. Insoluble fiber does not dissolve in water and is found in whole grains and veggies. Both kinds help prevent constipation, the NIDDK says. (Find more examples of fiber-rich foods here and here.)

Most Americans eat 16 grams of fiber a day, but should be getting 22-34 grams a day. But it’s not only the amount of fiber that matters, but also the rate at which you increase your fiber. Ramping it up full tilt can cause gas, bloating and cramps. Be sure to add fiber to your diet slowly so your body can adjust.

Also, make sure you are drinking plenty of fluids (water, fruit and veggie juices, clear soups) to help the fiber work better. And make sure you’re not eating foods that are making constipation worse.

What foods should you avoid if you’re constipated?

If you are constipated, foods with little to no fiber may be working against you, the NIDDK says. You may want to try avoiding cheese, chips, fast food, ice cream, meat, prepared frozen meals/snack foods, and processed foods like “TV dinners” or hot dogs, and see if your constipation improves.

Still facing digestive issues and feel like nothing works?

It’s time to test — don’t guess! Let’s get to the root of the issue with a GI (gastrointestinal) test. You also may want to consider a nutrition test to see if your body is getting and absorbing the nutrients it needs. Read more about constipation here.

The pH professional health care team includes recognized experts from a variety of health care and related disciplines, including physicians, health care attorneys, nutritionists, nurses and certified fitness instructors. To learn more about the pH Health Care Team, click here.

Joy Stephenson-Laws is the founder of Proactive Health Labs (pH), a revolutionary health care company that provides tools needed to achieve optimal health. Her new book, Minerals – The Forgotten Nutrient: Your Secret Weapon for Getting and Staying Healthy [Proactive Health Labs, Inc., 2016] is available through Amazon or wherever books are sold. All proceeds from the book will be donated to The Bili Project Foundation, an organization devoted to reducing the incident and improve the outcome of Hepatobilary cancers, which are cancers of the liver, gallbladder, or bile ducts.  Connect with Proactive Health Labs on Facebook, LinkedIn, Instagram, Pinterest, Goodreads, and at www.phlabs.org.

No one remedy works for all patients, so there’s a great medical need to develop new therapies for IBS, says Andrew Mulberg, M.D., a gastroenterologist with the Food and Drug Administration (FDA). That’s why FDA is working to bring more treatments to the market.

“There’s a lot of new research about the role of carbohydrates, and specifically a nutrient called polyols, in triggering irritable bowel syndrome in some patients,” Mulberg says. “In addition, doctors, scientists and researchers are more closely examining the role of diet in IBS causes and treatments.”

What Is IBS?

IBS is a gastrointestinal disorder that affects the large intestine (colon) but doesn’t cause inflammation or permanent damage. Common symptoms of IBS include:

Diarrhea

Constipation

Abdominal pain, bloating or cramping

Gas

Mucus in the stool

The symptoms may come and go, and can change in the same patient. Sometimes the pain from IBS can be so severe that it’s disabling and patients can’t do routine things. In addition, severe diarrhea can lead to dehydration and an electrolyte imbalance.

Certain foods and drinks can trigger IBS symptoms in some patients. The most common are foods rich in carbohydrates, spicy or fatty foods, milk products, coffee, alcohol and caffeine.

There is no known cure. Studies estimate that as many as 20% of Americans suffer from IBS. Many people may not know they have this gastrointestinal disorder. They might have occasional diarrhea and constipation and think it’s caused by something they ate, or a virus, so they don’t see a doctor to get a proper diagnosis. When they do, doctors must first rule out that the symptoms aren’t caused by a disease or another condition.

“There are many conditions that have a female or male predominance, but we don’t understand why women have a higher prevalence of IBS,” says Mulberg, deputy director of FDA’s Division of Gastroenterology and Inborn Errors Products (DGIEP).

IBS is most common among people younger than 45, and patients usually first experience symptoms when they’re in their late 20s. People who have a family history of IBS are also more likely to develop the condition.

Depression, anxiety and other psychological problems are common in people with IBS, Mulberg says.

“Some people suffer from depression and IBS. The question is what’s primary or secondary – what came first?” he says. “Either way, antidepressants are not a cure for IBS.”

What You Can Do

Treatments for IBS vary from patient to patient and include changes in diet, nutrition and exercise. Some patients need stool softeners to treat constipation; others need antidiarrheal drugs to treat diarrhea.

“IBS is not like other chronic conditions, such as hypertension, which is constant. IBS is a variable condition. Even without treatment, the problem might go away in some patients. But the symptoms might return after a few months,” says Ruyi He, M.D., an internist and medical team leader with DGIEP.

No one medication works for all people suffering from IBS.

Most recently, FDA approved Linzess (linaclotide) to treat some adults who suffer from IBS with constipation and for chronic idiopathic constipation. Chronic idiopathic constipation is a diagnosis given to those who experience persistent constipation and do not respond to standard treatment. According to the National Institutes of Health, about 63 million people have chronic constipation.

In addition, FDA has approved Amitiza (lubiprostone) for IBS with constipation and one drug for IBS with diarrhea, Lotronex (alosetron).

“Drugs are a last option. Patients should try diet and lifestyle changes, especially exercise, before resorting to medication,” he says.

Courtesy of FDA Consumer Health Information. For more information on health and safety issues, visit the FDA’s Consumer Updates page; click here. 

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

The second week, the doctor moved on to O and A=Assessment or Analysis to continue to look for clues to the medical riddle. Last week, we let you know what some people had suggested as possible diagnoses. This week, the doctor will move on to P to reveal the actual diagnosis as well as outline treatment options and lifestyle recommendations. Then we’ll begin a new riddle for the following month!

The Doctor Reveals the Diagnosis

Congratulations to Mary S. who came the closest to the actual diagnosis for Sally’s chronic constipation when she said she thinks Sally just “holds it too long”! Thumbs up also to Carol M. who questioned whether Sally is drinking enough water. In view of Sally’s history of reduced physical activity/exercise, reluctance to use the toilet near the teachers’ room at the school, and her habit of postponing bowel movements, I diagnosed Sally with a problem that is popularly called “safe toilet syndrome”. This is a surprisingly common issue, especially, for women. The diagnosis does not have an ICD 9-CM code (soon to be ICD-10)
, by which I mean the International Classification of Diseases, Ninth Revision, Clinical Modification. That is the official system used in the United States to classify and assign codes to health conditions.
Even so, the actual label or precise diagnostic name is less important than the cause. Sally was quit literally afraid to use a toilet away from the safety of her own bathroom, especially if she felt others could hear her efforts to have a bowel movement.

Beyond that, she had experienced multiple lifestyle and functional changes that led to unhealthy modifications in her daily routine. Fortunately, though, she was not taking any offending over-the-counter supplements such as calcium carbonate, which is the form of calcium most likely to cause constipation, or multivitamins with iron, which is another cause of constipation. She was also not on any prescription medications that might cause constipation, such as calcium channel blockers to treat high blood pressure.

One of the main contributing factors to Sally’s constipation was her lack of exercise since she used to walk to and from school and now she drives, and she doesn’t play tennis or chase after her grandchild any longer.

Another factor was her diet, which had become unhealthy after she took the job at the school farther away from her home and felt rushed in the morning. Grabbing a power bar for breakfast instead of having a healthy meal definitely played into the condition.

The doctor told Sally she needed to eat about 15 to 20 grams of fiber a day to ensure adequate stool bulk. Good sources of insoluble fiber — which is best for bulk — are bran, vegetables, and fruits. Oat and grains are good sources of soluble fiber that also help with bulk and can lower cholesterol. Beyond that, over-the-counter fiber supplements with psyllium husks are great for people who need added bulk during the transition as the diet changes for the better. Metamucil is one popular brand. Osmotic laxatives such as sorbitol or stool softensers can be added if the extra time for the bathroom, increased fiber, fluids and exercise is not enough. As Carol M. suspected, Sally needed to increase her fluid consumption in order for the fiber to work best. Fluids are also good for softening stools.

Finally, Sally needed to set her alarm for an earlier time so that she can eat breakfast and restore her morning bowel movement routine at about the same time every day before she leaves for school. Early morning coffee also stimulates the colon, and that can help. A daily bowel movement is not essential, depending on the person, but establishing a great diet and healthy routine is paramount.

The doctor told Sally not to start taking laxatives, which can in fact cause the bowel to stretch excessively and lose muscle tone and cause constipation if they’re overused. Adding stool softeners, glycerin suppositories and/or An enema to get rid of the impacted stool might be needed) but this would rarely happen in with a person Sally’s age although it can be more common in the elderly for whom stool really is impacted). The doctor felt that if Sally followed all the recommendation, the problem would resolve itself without an enema.

Sally was strongly motivated to do just what the doctor ordered. A month later, she came back for a check up and reported that she never needed an enema and that the problem had been resolved.

“What a difference a few weeks can make!” she said. “I feel like my old self again. I’ve started getting up an hour earlier so I can have a good breakfast such as bran cereal with Greek yogurt and blueberries. I then use the bathroom before I get in the car to go to work. Also, even though we have playground monitors, I now go out with the kids during recess. I not only get some exercise and fresh air, but my students and I have really bonded over this activity.

“I still hate using the bathroom next to the teachers’ room. I guess I’m old-fashioned that way. But that’s not an issue now that I’ve adjusted my morning routine. Best of all, I’m playing tennis again and spending a lot of time with my granddaughter. My daughter is thrilled and so am I. Solving the constipation issue has made me feel years younger and really glad to be alive!”

Come back to ThirdAge.com next Thursday when we’ll introduce a new medical riddle!

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Pleas visit DrSavard.com.

The first week of this riddle, the patient reported her symptoms and the doctor proceeded with the examination. This was step #1, S, of the classic S-O-A-P notes as follows:
S=Symptoms or Chief Complaint
O=Objective Findings
A=Assessment or Analysis
P=Treatment Plan or Recommendations

The second week, the doctor moved on to O and A=Assessment or Analysis to continue to look for clues to the medical riddle. This week, we’ll let you know what some people have suggested as possible diagnoses. Next week, the doctor will move on to P to reveal the actual diagnosis as well as outline treatment options and lifestyle recommendations. Then we’ll begin a new riddle for the following month!

Some Guesses as to What the Diagnosis Will Be

“She might have Parkinson’s. If the treatment plan for a functional diagnosis doesn’t work, maybe she should be tested for PD. My brother has had Parkinson’s since he was in his mid-50s and he does have constipation issues.”
Lucille K.

“Maybe it’s Multiple Sclerosis. I have MS and I have problems with my bowels. The doctor could check for MS if the treatments you recommend don’t help.”
Judy B.

“I think she just holds it too long!”
Mary S.

“Maybe she’s depressed. Does she like her new school or was the change not a good one for her? Depression can cause all kinds of digestive problems. I’m sorry to say that I know this from experience.”
Marilyn T.

“Does she drink enough water? I’ll bet she doesn’t because she doesn’t want to have to go during the school day. That could be a big part of her problem.”
Carol M.

“She might have what’s called ‘rectocele’. I had that and it did cause constipation. It’s a bulge in the rectum that presses into the back of the vagina. My doctor told me it was due to thinning tissues, which can be age-related, and also to weak pelvic floor muscles. I had to start doing Kegel’s.”
Janet W.

What do you think the diagnosis will be?

To be continued . . .

Come back to ThirdAge.com next Thursday when the doctor will reveal the actual diagnosis and treatment plan.

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Pleas visit Dr.Savard.com