Although constipation is well understood by the medical practice community, there are various misconceptions that persist among the general public about constipation and its treatment, which are not evidence based. Misconceptions can add to the burden of discomfort and cost of this condition.
Is it dangerous for stool to remain in the colon for a long time period? Can this cause other diseases?
This belief dates from ancient times. Now, colon cleansing (colonics) is promoted by some to maintain “colon health.” However, there is no foundation in science for this theory.
Can changes in hormones cause constipation?
Some studies have associated hormonal changes with constipation. There is a lack of evidence for a primary cause and effect relationship between hormones and constipation. During pregnancy, when sex hormone changes are greater, they may play a role in slowing gut transit and increasing constipation.
Is constipation caused by low intake of fiber or fluid?
Fiber clearly increases stool bulk and frequency, and decreases transit time in healthy people, and may benefit individuals with relatively minor or occasional constipation. However, for chronic or more severe constipation no significant benefit has been demonstrated.
So far, research does not support increasing fluid intake to relieve constipation, but dehydration should be avoided.
Is the long-term use of stimulant laxatives for constipation unhealthy or unsafe?
In the only controlled study conducted to date, constipated patients treated with stimulant laxatives did not develop damage to their colons when compared to controls who did not receive laxatives. Hence, it is unlikely that stimulant laxatives are harmful when used at recommended doses. Nevertheless, the use of excessive laxatives over long periods has led to some serious metabolic consequences.
Are stimulant laxatives habit forming?
Although tolerance to laxatives has not been well studied in humans, animal data do not support development of tolerance. There are no data that suggests that laxatives are addictive or habit forming. Overall, the available data indicates that laxatives are safe and effective treatments for constipation. If patients with constipation find that their treatments are becoming less effective, then it is time to consult a doctor about alternatives.
How long can a person go without having a bowel movement before seeking medical attention? Could this ever become urgent and warrant a trip to the emergency room?
Constipation is a symptom, not a disease. The exact definition of constipation is problematic. Patients and doctors often define constipation differently. Doctors relate primarily to the frequency of bowel movements in a given time period (usually per week). Patients usually relate to the effort required (straining), to the consistency of the stool (hard), and to the feeling that they cannot entirely empty themselves.
Most people have their own ‘personal’ bowel habit. They may have a few bowel movements a day or a bowel movement every few days. Doctors usually define constipation as less than three bowel movements per week and may define severe constipation as waiting more than a week for a bowel movement.
Some people have less than a bowel movement a week and are not bothered by this at all, while others may find this physically uncomfortable or emotionally distressing. Just as there is no ‘magic’ number of bowel movements that an individual should have, there is also no magic number that defines when constipation is a medical problem requiring immediate evaluation or intervention.
An important question that should be addressed when deciding whether constipation should be evaluated or even justifies a trip to the emergency room is whether it is acute (of recent onset) or chronic (of long duration).
Cases of acute constipation are more worrisome and might indicate a significant underlying medical condition such as bowel obstruction. If constipation is associated with ‘alarm symptoms’ such as severe, worsening abdominal pain, extreme abdominal swelling, fever, nausea and vomiting, or if new-onset constipation occurs in an older person who is usually regular an immediate medical consultation should be obtained.
Most cases of constipation are chronic, having lasted for years, and are not associated with ‘alarm symptoms.’ It is usually related to a functional bowel disorder, such as irritable bowel syndrome (IBS).
However, there are other possible causes of chronic constipation including medication use, hormonal problems, pelvic floor disorders, neurological disorders like Parkinson’s disease, and other conditions. Thus, if any of these possibilities appears relevant, a non-urgent medical evaluation would be logical.
Adapted from IFFGD Publication: Common Questions about Constipation: Myths and Misconceptions by Kenneth G. Mandel, PhD, President, KGM Innovation Associates, Fairfield, OH, and an article published in Digestive Health Matters, Vol. 16, No. 4 by Ami D. Sperber, MD, Associate Professor of Medicine, Department of Gastroenterology, Soroka Medical Center; Faculty of the Health Sciences, Ben- Gurion University of the Negev, Beer- Sheva, Israel, and Roy Dekel, MD, The Gastroenterology Institute, The Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.