Constipation, fiber and toilet habits

Constipation seems so ordinary that many people do not talk about it, but it is one of the main causes of hemorrhoids and fissures. In this article you will read what counts as constipation, which habits help and when to see a doctor.

What is constipation?

You do not need to go every day. ASCRS says a bowel movement every 1 to 3 days and up to three times a day is within the normal range. Constipation can mean:

• Fewer than 3 bowel movements a week (NHS and the Rome criteria)
• Hard stools that need straining
• A feeling of incomplete emptying or blockage
• Needing a finger to help pass stool

ASCRS gives the Rome criteria as straining, hardness or a feeling of incompleteness in more than 25% of the time.

Causes

• Little fiber and fluid, little movement
• Ignoring the urge, a change of routine
• Some medicines: opioid pain relievers, some blood pressure medicines, antidepressants, antacids
• Illnesses such as diabetes and an underactive thyroid
• Functional disorders such as a pelvic floor disorder
• Less often, a structural or serious cause: a narrowing of the bowel, rectal prolapse and even cancer. The NHS says medical causes such as diverticular disease or bowel cancer are rare.

Fiber and water: how much?

ASCRS for constipation:

• 25 to 35 grams of fiber a day from whole grains, fruit and vegetables and, if needed, a fiber supplement. A supplement does not make up for a diet high in fat and red meat.
• 6 to 8 glasses of water (1.5 to 2 liters) a day
• About 30 minutes of brisk walking a day

The NHS also advises adding fiber gradually, drinking plenty of fluids and limiting alcohol. Improvement may take a few days to a few weeks.

Toilet habits

• Go at a regular time and place and give yourself time (NHS)
• Do not ignore the urge to go
• Rest your feet on a low stool so your knees are higher than your hips (NHS)
• ASCRS says squatting and abdominal pressure make passing stool easier
• Do not sit long on the toilet or strain; the NHS and NIDDK advise this for hemorrhoids

Laxatives

If habits do not work, talk to a pharmacist or doctor. ASCRS lists the types: stimulant laxatives (senna, bisacodyl), whose long-term use is not advised, osmotic laxatives (such as polyethylene glycol, which is considered safe and common), docusate (a softener), and suppositories and enemas (which may become a habit). The NHS says most laxatives work within 3 days and should be short-term. ASCRS warns not to take laxatives regularly without talking to a doctor, because a more serious illness may be hidden.

Constipation and anal problems

Hard stools and straining:

• Cause a fissure. ASCRS says a fissure usually comes from injury by a hard, dry stool.
• Raise abdominal pressure and can make hemorrhoids worse (ASCRS and the NHS).

Soft, bulky stool, in ASCRS’s words, is the best way to prevent anal problems.

When not to treat it yourself

ASCRS and the NHS say see a doctor if you have:

• Any blood in the stool
• Thinner stools (like a pencil or a ribbon)
• Constipation that is getting worse or does not improve with simple measures
• A sudden change in bowel habit
• Unexplained weight loss, constant tiredness or abdominal pain
• Constant bloating
• A prescribed medicine that causes constipation

Urgent: repeated vomiting or severe and constant abdominal pain, especially if gas and stool are not passing (ASCRS). See the guide “When should I call urgently?”.

The NHS says long-standing constipation can lead to stool becoming stuck in the rectum, and a sign of this is leakage of watery stool around it. Do not try to remove it yourself.

Tests that are sometimes needed

For severe or lasting constipation the doctor may ask for a colonoscopy (the first common test to see the bowel and remove polyps), a transit time study, or anorectal manometry and defecography (ASCRS). For a pelvic floor disorder, biofeedback is usually 4 to 6 sessions of an hour each and ASCRS considers it more effective than diet, exercise and laxatives. Surgery is rarely needed.

Summary

• You do not need to go once a day; fewer than 3 times a week, or hardness and straining, is what matters.
• 25 to 35 grams of fiber, 6 to 8 glasses of water and walking help.
• Not straining, not ignoring the urge and giving it time help the anus.
• Blood, thinner stools, weight loss or getting worse means a visit.

This article does not replace a doctor’s opinion; ask your doctor about your own situation.