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Constipation's Many Causes and Cures

Poor diet, medication and nerve-and-muscular dysfunction can create problems

FRIDAY, Aug. 31 (HealthDay News) -- If you've tried loading up on fruits, vegetables and whole grains and still can't get relief from constipation, maybe you need more than a boost of fiber.

"The idea that many patients have, and unfortunately their physicians, 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," said Dr. Arnold Wald, a professor of medicine in the section on gastroenterology and hepatology at the University of Wisconsin.

Doctors recommend consuming fiber, because it's easy to take and cheap, he explained, but it doesn't work for every patient. That's because constipation is a symptom that can have many different causes.

About 80 percent of people suffer from constipation at some point in their lives, according to the American Society of Colon & Rectal Surgeons. Brief bouts of constipation are normal. But when symptoms persist, people may need to consult a physician.

Anyone who experiences at least two symptoms 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 in Iowa City.

The symptoms are excessive straining, hard stools, a feeling of incomplete evacuation, a sensation of blockage in the anorectal region, use of digital maneuvers to facilitate a bowel movement, and a stool frequency of less than three bowel movements a week, he said.

People become constipated when the colon absorbs too much water or if muscle contractions in the colon become too slow or sluggish, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Diets that are low in fiber and a lack of exercise are believed to be common causes of constipation.

But constipation can also be a side effect of other health problems, Rao explained. Many medications, including painkillers and antidepressants, can cause constipation, for example. And, the NIDDK noted, certain 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 through the colon, rectum or anus.

For some people, constipation is the direct or "primary" result of colonic nerve or muscle dysfunction. This group of people includes patients with "dissynergy defecation," a problem that has only been recognized in the last 15 years, Rao said.

"The problem is that the individual has the inability to coordinate the pelvic floor muscles and anorectal muscles to evacuate stool, so many of them have a sense of stooling, but they can't pass, or they only pass small amounts, or incompletely and so on," he said.

Rao and his colleagues recently examined a technique for teaching these patients to improve bowel function. The study, published in the journal Clinical Gastroenterology and Hepatology, compared the use of biofeedback therapy with either sham biofeedback sessions or standard treatments consisting of diet, exercise and laxatives. The biofeedback group came out "far, far superior" to the other two groups, he reported.

Dr. Henry P. Parkman, a professor of medicine and director of the GI Motility Laboratory at Temple University School of Medicine in Philadelphia, said he uses biofeedback -- a form of complementary medicine in which the patient uses the mind to control the body -- quite a bit in his own practice. "It has a response rate of 50 to 75 percent," he said.

Another type of "primary" constipation, called "slow-transit constipation," takes patients longer to pass stool. There's also irritable bowel syndrome (IBS) with constipation, which causes abdominal pain or discomfort.

Until recently, Zelnorm, a drug made by Novartis Pharmaceuticals, had been approved for treating both groups of patients. But on March 30, the company pulled it from the market after new data indicated an increased risk of heart attack, stroke and death. Gastroenterologists say the move leaves a gap in treatment options, particularly for treating women with IBS with constipation.

Like anything else, 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 may find relief on the shelves of their local pharmacy or grocery store. They can try stimulant laxatives or polyethylene glycol, an over-the-counter stool softener. There are also natural stimulants like raisins and prunes.

And there's always fiber.

"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."

More information

For more on constipation, visit the American Gastroenterological Association.

SOURCES: Arnold Wald, M.D., professor of medicine, section of gastroenterology and hepatology, University of Wisconsin, Madison; Satish S.C. Rao, M.D., Ph.D., professor of internal medicine and director, neurogastroenterology and gastrointestinal motility, University of Iowa, Iowa City; Henry P. Parkman, M.D., professor of medicine and director, GI Motility Laboratory, Temple University School of Medicine, Philadelphia; American Society of Colon and Rectal Surgeons, Arlington Heights, Ill.; National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md.; March 2007, Clinical Gastroenterology and Hepatology

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