Q. What is the definition of constipation?

The clinical definition of constipation is any two of the following symptoms for at least 12 weeks (not necessarily consecutive) in the previous year:

* Straining during bowel movements

* Lumpy or hard stool

* Sensation of obstruction or incomplete evacuation

* Fewer than three bowel movements per week.

Those reporting constipation most often are women and adults age 65 and over. Constipation is one of the most common gastrointestinal complaints in the United States.

Common causes of constipation include: insufficient intake of fiber and liquids, lack of exercise, medications, older age and abuse of laxatives.

The most common cause of constipation is a diet low in fiber and high in fats. The bulk and soft texture of fiber help prevent hard, dry stools that are difficult to pass. Fiber is the part of fruits, vegetables, and grains that the body cannot digest. Many of the refined and processed foods that we eat have natural fiber removed.

Many seniors eat a low-fiber diet that causes constipation. Some lose interest in eating and choose convenience foods low in fiber. Others have difficulties chewing or swallowing. This leads them to eat soft processed foods low in fiber.

Liquids add bulk to stools making bowel movements softer and easier to pass. People who are constipated should drink about eight 8-ounce glasses of liquids a day. Avoid drinks with caffeine and alcohol because they dehydrate.

Not enough exercise can lead to constipation, although doctors do not know why. If you want to move your bowels, move your body.

Some medications can cause constipation, including: pain medication (especially narcotics), antacids that contain aluminum and calcium, blood pressure medications (calcium channel blockers), antiparkinson drugs, antispasmodics, antidepressants, iron supplements, diuretics and anticonvulsants.

Aging may affect bowel regularity because a slower metabolism results in less intestinal activity and muscle tone.

Laxatives usually are not necessary to treat constipation and can be habit-forming. The colon begins to rely on laxatives to bring on bowel movements. Over time, laxatives can damage nerve cells in the colon and interfere with the colon’s natural ability to contract. For the same reason, regular use of enemas can also lead to a loss of normal bowel function.

Most people with constipation can be treated with changes in diet and exercise. A diet with 20 to 35 grams of fiber each day is recommended.

Other changes that can help include drinking enough liquids, engaging in daily exercise, and reserving enough time to have a bowel movement. In addition, the urge to have a bowel movement should not be ignored.

For those who have made diet and lifestyle changes and are still constipated, doctors may recommend laxatives or enemas for a limited time.

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