Chronic Constipation: Effective Solutions and Concerns

Q: Chronic Constipation: Effective Solutions and Concerns

Hello： Regarding your current constipation situation, if dietary adjustments are not effective, you may consider using medication as an adjunct. <br>While laxatives can potentially lead to dependency, short-term use should be acceptable. <br>It is recommended to take a laxative f

Constipation issues?

Hello, doctor.
I would like to ask about my constipation issue.
I have been struggling with constipation since I was a child (I had enemas when I was very young).
After entering college, I started taking enzymes to maintain regular bowel movements, going to the bathroom about 2 to 3 times a week, but sometimes I still experience more severe constipation.
Recently, the situation has changed compared to before.
When I had severe constipation in the past, I would drink some rose jujube juice, and after that, my bowel movements would return to normal.
However, in the past two weeks, even after taking enzymes, I have had no urge to go.
I bought black jujube juice, and the first time I drank it, I felt a little movement in my stomach, but I still didn’t have a bowel movement; instead, I passed hard pellet-like stools.
I then went to see a doctor who prescribed magnesium oxide and other digestive medications, as well as a laxative.
In the past, the laxative would always work effectively with just one pill, but this time I still only produced hard, pellet-like stools.
For the past few days, I have struggled to pass any stool at all, and I have had no urge to go, feeling no sensations in my abdomen except for gas.
However, the doctor said during the ultrasound that there was a lot of stool present.
Last week, I consumed less water, although I did drink coffee, but this week I have been drinking a lot of water.
In the past two to three weeks, I have actually been eating healthier meals compared to before, and I have been eating vegetables, but my overall food intake has not been large.
I have wondered if I am not consuming enough fats and have tried drinking a little olive oil, but it hasn’t helped.
Because I have had constipation since childhood, I become very anxious if I haven’t had a bowel movement for three days...
I would like to ask the doctor if I should continue taking magnesium oxide and the laxative until I can pass a normal stool, considering I have no abdominal pain or discomfort.
I am concerned about the potential dependency on senna leaves.
Thank you!

Ms. Zhang, 30~39 year old female. Ask Date: 2023/11/21

Dr. Lin Zhebin reply Family Medicine

Hello: Regarding your current constipation situation, if dietary adjustments are not effective, you may consider using medication as an adjunct.
While laxatives can potentially lead to dependency, short-term use should be acceptable.
It is recommended to take a laxative for the next few days; if one tablet is not effective, you can increase the dosage to two tablets.
Once your bowel movements improve, you can try to discontinue the medication.
Additionally, besides dietary control, if you have the time, try to exercise more, as it can also help with bowel movements.

Reply Date: 2023/11/21

More Info

Chronic constipation is a common gastrointestinal issue that can significantly impact an individual's quality of life. Your experience with constipation, especially since childhood, highlights the complexity of this condition and the various factors that can contribute to it. Let's delve into the potential causes, effective solutions, and concerns related to chronic constipation.

Understanding Chronic Constipation
Chronic constipation is defined as having fewer than three bowel movements per week, along with symptoms such as straining during bowel movements, hard or lumpy stools, and a feeling of incomplete evacuation. It can be caused by a variety of factors, including dietary habits, lifestyle choices, medications, and underlying medical conditions.

In your case, it appears that you have been managing your constipation with enzyme supplements and natural remedies like rose jujube juice. However, the recent changes in your bowel habits, despite increased fluid intake and a healthier diet, suggest that your body may be experiencing a shift in how it processes food and waste.

Factors Contributing to Your Constipation
1. Dietary Fiber: While you mentioned eating more vegetables, it's essential to ensure that your diet is rich in both soluble and insoluble fiber. Soluble fiber (found in oats, beans, and fruits) helps to soften stools, while insoluble fiber (found in whole grains and vegetables) adds bulk to the stool, promoting regularity.

2. Hydration: Adequate fluid intake is crucial for preventing constipation. You noted that your water intake has varied, which can significantly affect bowel movements. Aim for at least 8-10 cups of water daily, and consider incorporating hydrating foods like fruits and vegetables.

3. Physical Activity: Regular exercise can stimulate bowel function. If your activity level has decreased, this could contribute to your constipation. Aim for at least 30 minutes of moderate exercise most days of the week.

4. Medications: The medications you are taking, such as magnesium oxide and laxatives, can have varying effects on bowel movements. While magnesium can help draw water into the intestines, over-reliance on laxatives can lead to dependency, making it harder for your body to have regular bowel movements without them.

5. Psychological Factors: Anxiety about bowel movements, especially if you have a history of constipation, can create a cycle of fear and avoidance that exacerbates the problem. Stress management techniques, such as mindfulness or cognitive-behavioral strategies, may be beneficial.

Effective Solutions
1. Gradual Dietary Changes: Instead of relying solely on supplements, focus on a balanced diet rich in fiber. Gradually increase your fiber intake to avoid gas and bloating, and ensure you are drinking plenty of water.

2. Regular Bowel Habits: Establish a routine for bowel movements. Try to set aside time each day, preferably after meals, to sit on the toilet, even if you don't feel the urge. This can help train your body to recognize when it’s time to go.

3. Medication Review: Discuss with your healthcare provider the possibility of adjusting your medications. If you are concerned about dependency on laxatives, your doctor may suggest alternative treatments or a tapering plan.

4. Probiotics: Consider incorporating probiotics into your diet, either through supplements or fermented foods like yogurt and kefir. Probiotics can help balance gut bacteria and improve bowel function.

5. Consult a Specialist: If your symptoms persist despite these changes, it may be beneficial to consult a gastroenterologist. They can perform further evaluations to rule out any underlying conditions, such as irritable bowel syndrome (IBS) or structural issues.

Conclusion
In summary, while it’s understandable to feel anxious about your bowel habits, especially given your history of constipation, there are several strategies you can implement to help manage your symptoms. It’s important to approach this condition holistically, considering dietary, lifestyle, and psychological factors. Continue to communicate with your healthcare provider about your symptoms and treatment options, and remember that improvement may take time. With patience and the right approach, you can work towards achieving more regular bowel movements and alleviating your anxiety surrounding this issue.

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