The importance of developing healthy bowel habits

April 8, 2014 by Cynthia McMullen

VCU School of Pharmacy faculty, alumni and students have provided the Dr. Rx column for Richmond’s Fifty Plus magazine since December 2009. We now share those columns on the SOP website, as well, for those who might not have seen the most recent issue.

Serving as Dr. Rx for March 2014 was Sarah Barden, a third-year Pharm.D. student whose interests include interprofessional education, health policy and the care of older adults. She holds a B.S. in biology from Duke University.

Dear Dr. Rx: What causes constipation, and what can I do about it?

While constipation is not something we often feel comfortable talking about, it affects millions of people every day and deserves some attention.

Constipation is a condition in which getting rid of solid waste from the bowels is less frequent than normal and often quite painful due to dry, hardened stool. It can be caused by a variety of factors, including diet, hydration, medications and diseases.

For example, adults older than 65, especially women, are more likely to experience constipation. Constipation is common in patients with Parkinson’s disease and is a very common side effect of opioid pain medications, such as hydrocodone or oxycodone. If you frequently experience constipation, a trip to your physician may be necessary to determine if an underlying disease is causing the problem.

Now for some good news: Constipation often can be prevented or managed. Even in situations where constipation comes from a disease or an important medication, developing healthy bowel habits can improve digestive tract functioning and, therefore, avoid constipation. The best way to promote healthy bowels is to eat and drink the foods and nutrients your body needs to develop regular voiding patterns.

Fiber is an important part of that regimen. Dietary fiber, meaning fiber that comes from the foods you eat, not supplements, is the best type of fiber. For patients 51 and older, men should eat 30 grams of fiber per day and women should eat 21 grams.

The best sources of fiber are fresh fruits and vegetables, which are also part of a healthy diet. A word of caution about fiber: Too much actually can cause constipation, so you must find the right balance. If you do not currently have a fiber-rich diet, slowly increase the fiber in your diet until you reach the recommended daily amounts.

Exercise and water are two other critical components to a healthy digestive tract. Regular exercise that increases your heart rate increases the blood flow to your other organs, including your stomach and intestines. This helps with food digestion and movement through your system.

Drinking enough water and other fluids is important for the absorption of foods, including fiber, and helps keep things moving in your gut. You should drink at least two liters of noncaffeinated, nonalcoholic fluids each day. Water is best.

If dietary fiber, exercise and proper hydration are not enough to manage your constipation, some over-the-counter options are available.

Fiber supplements, such as Metamucil (psyllium fiber), can be safely used to add more fiber to your diet. Start with the recommended dose once a day and increase to three times a day only if needed. Colace (docusate sodium) is another option. It is a stool softener that can help reduce the strain associated with constipation. It does not make the bowels work differently, but it does make the stool easier to pass once it reaches the rectum. MiraLAX (polyethylene glycol 3350) works by drawing water into the stool to make it softer and help it move through the intestines more easily.

Other medications do exist, but they should be used under the guidance of a physician based on your individual circumstances.

Developing healthy bowel habits takes time. Increase your fiber intake slowly, give your body time to adjust to new exercise routines and increased water intake, and remember: Managing constipation takes patience and consistency.