So, you go to go and…nothing. Being constipated is frustrating, uncomfortable, and sometimes even downright painful. We asked Dr. Sameer Islam, MD, a Texas-based gastroenterologist who specializes in the diagnosis and treatment of diseases of the gastrointestinal tract, what's going on and why you always feel constipated. Here's what he told us (for more insight on the inner workings of your gastrointestinal system, check out Poop Tip Thursday and Let's Talk About Poop on his YouTube channel).
Before you get concerned about being constipated, consider this: Are you actually constipated? The 'technical' definition of being “regular” is having between three bowel movements per day to three bowel movements per week. That is such a wide range, and it can be different for so many people.
But what is more important about bowel movement frequency is how you feel. For example, if you are going to the restroom once a day but you don't feel like you are entirely emptying out or you are not happy with your bowel habits, you are constipated, in my opinion. On the flip side, if you only go once a week but you are comfortable and happy, then there is nothing wrong with that, and I would not treat this as a medical issue at all.
So if you are having trouble and you are always constipated, here’s what to know about why it happens and what to do about it.
What are the most common causes of constipation for ordinary, healthy people?
Diet, diet, diet. Our current diet in America is so low in fiber, vegetables, fruits, and essential nutrients, that it makes it hard for us to poop. All these factors contribute to constipation but are easy to fix.
A second reason for frequent constipation is that the rectal muscles could be too tight. For these individuals, they are literally anally retentive. Nothing will come out no matter how much you try and push. The only way to fix this is to fix the muscles of the rectum. For example, just like if I hurt my rotator cuff, I may need physical therapy; it's the same concept in the rectum—the only way to fix the rectum muscles is with physical therapy.
Are there common medications—either OTC or Rx—that make it worse?
Absolutely. Medications like blood pressure pills, pain medications (opiates in particular), depression, and anti-seizure medications can make constipation worse or can make people become constipated if they were not initially.
One of the most valuable things you can do is talk to your healthcare providers about adjusting or even stopping those pills. However, never do this unless you speak to someone first.
Do some people tend to be more constipated than others?
Some people and families are prone to constipation. It is common for an entire family to suffer from constipation. Whether it is genes, environment, or specific changes in the genetic structure, we do not currently know.
If you're on a high-protein diet and have constipation issues, what's the best way to prevent those problems?
Keto is notorious for making people constipated. Eating mainly fats and proteins with very few carbohydrates makes it more likely for your body to suffer from this. You have less fiber in your diet, so you don't have the usual “bulk” you need to keep your bowel movements regular.
To fix keto-constipation, the easiest thing would be adding more fiber, whether in foods or supplements. Adding more water will also help move your stool easier, as does regular movement and exercise. And if all the above does not work, over-the-counter medications can help out.
What matters more to staying regular and not being constipated all the time—eating fiber, drinking a lot of fluids, or staying active?
How about all the above? Constipation is not one cause for most people. All things like diet, fluids, activity, and medications play a role in making people constipation. But focusing on these things can really make things flow better.
Why does traveling sometimes leave you constipated?
Traveling will make you constipated because you are not in your everyday habits or eating the foods you regularly eat. For example, when I travel, I eat terribly. This destroys my gut, and it makes me constipated. Also, when I am on vacation, I have a terrible habit of not drinking a lot of water. Additionally, the physical act of traveling (driving or flying) makes people not use the restroom as often as they should.
Lastly, most people (including me) don't exercise when we travel or go on vacation. This can also slow down your bowels and make people constipated. All of this contributes to travel-constipation. But maintaining good habits, eating better, walking, and using the restroom when you need to will help out. Sometimes I recommend adding more fiber to your diet a few days before you leave to help prime the colon.
When should you see a doctor about it?
Here is when I recommend you see a doctor:
Your constipation is not better after trying all the above recommendations and over-the-counter options
You notice blood in your stool. No matter what you think is going on, blood is never normal.
If your constipation is associated with severe pain. That could mean something else is going on.
If you have a new change in bowel habits after the age of 45 years old.
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