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CONSTIPATION

Older people often claim that they are constipated. It is difficult to define what is “normal” when it comes to bowel habits. Perhaps you were brought up at a time when ideas about bowel movements led to some unhealthy practices, such as the use of cathartics (purges) and laxatives. Many people grew up with the idea that a frequent “cleaning out” was essential for health. The amounts of exercise and of fiber (roughage) in the diet also affect bowel habits.

If you have used laxatives regularly over many years, your bowels may no longer respond to them, and you may become more and more dependent on increasingly stronger laxatives. Perhaps you find that your bowel movement seems less likely to result in a feeling of relief. Some people spend a great deal of time during visits to the doctor describing their bowel problems, hoping to discover a magic formula for a good daily bowel movement and freedom from constipation. However, a bowel movement does not have to occur every day for you to be healthy. Some normal older people have a bowel movement only every two or three days. What is important is that when you do have a bowel movement, it is not excessively hard or difficult and does not cause discomfort.

It is important to distinguish between constipation as a result of a change in bowel habit and constipation that has existed for many years, or chronic constipation. The former may be an early sign of blockage of the intestine, sometimes from an inflammation or a tumor. If you have a change in bowel habits, you should consult your physician as soon as possible. If you suffer from long-standing and progressive constipation, you should be examined for an underactive thyroid gland (hypothyroidism). Sometimes local causes, such as hemorrhoids or fissures (sores in the anus), exaggerate a tendency toward constipation.

Your physician may find that your constipation is caused by poor bowel habits. He will advise you to try to discontinue the use of laxatives, which excessively stimulate the bowel, and replace them with safer substances, such as psyllium mucilloid or lactulose. You should make sure that your diet contains sufficient fiber in the form of bran, whole-wheat and other whole-grain breads and cereals, raw and cooked vegetables, and fruits, as well as an adequate intake of fluids. This gives the lower intestine enough bulk to stimulate a normal bowel movement. The ultimate goal is to have a bowel movement of sufficient frequency so that it is well formed, not excessively hard, and easy to expel. But it does not have to be a daily occurrence.

A change in behavior may also be helpful. Try to have a bowel movement following meals and try not to hurry. It is advisable to avoid enemas. However, while you wean yourself from laxatives, if a normal pattern does not become quickly established, an occasional enema is preferable to a strong laxative. Increasing your physical activity is also beneficial in breaking the constipation cycle.

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