If you don’t have these symptoms but you rely on extra fiber (such as Metamucil), a stool softener, a laxative, or some other method to prevent these symptoms, then you also have constipation. Constipation is one of the primary symptoms defined as IBS – irritable bowel syndrome.
Constipation is a symptom of slow transit time, not unlike rush-hour traffic. When the colon is backed up, the small intestine is also backed up. And when the intestines are backed up, the stomach can be delayed in emptying itself of food matter. This is why some people with constipation also experience heartburn and reflux.
Constipation of course affects digestion and therefore can contribute to the malabsorption of nutrients, which can lead to a wide spectrum of health problems. It can also delay the removal of waste from the body, and not just from the colon. The liver is responsible for removing a majority of toxins (including pollutants, hormones, drugs, heavy metals, and even cholesterol) from the blood stream. Much of this waste is then dumped into the gastrointestinal tract for final disposal. If the intestinal tube is slowed in its transit time, then these toxins are not removed in a timely manner and may even be reabsorbed. This is akin to setting the garbage out at the curb but not having it picked up for several weeks. It’s not good for the neighborhood, so to speak.
Constipation may also be painful. As fecal material passes through the intestine, water is absorbed out of it. The longer it remains inside the tube, the drier and harder to pass it will be, causing painful stretching of the colon as well as the anus.
There are essentially two different kinds of constipation. In the first type, the lower intestine cramps and spasms, like a charley-horse, and stops the fecal material dead in its tracks. If you could invite a masseuse into your lower intestine, that might help, and abdominal massage often does improve movement. But most people rely on other methods to relax the muscles, such as laxatives or stress reduction. Usually by the time it all gets moving again, the fecal material is hard and dry and painful to pass, causing a good deal of straining.
In the other kind of constipation, the lower intestine gets lazy and relaxes too much. This often happens when you rely on laxatives for too long. The digestive system comes to depend on the laxatives and your muscles lose their tone, becoming sluggish and unable to move fecal material along in the normal manner. This is typical of chronic constipation. Fortunately you can regain muscle tone over time, once the cause of the constipation has been found.
There are a number of conditions that can cause constipation, aside from over-use of laxatives. Immune system triggers can cause the intestines to slow down. The immune system is highly concentrated in the digestive tract. Food allergies and infections can both trigger the immune system in this way. Much more rarely a deficit in fiber is the issue. Most people get plenty of fiber to enable normal bowel function, absent any immune system triggers. Some people need to adjust their diet to include more fiber, but occasionally, the fiber supplement itself can cause immune system problems that result in constipation. Treatment must be tailored to the patient.
Generic treatments, such as adding fiber, or general dietary recommendations may help very mild cases, but usually do not help those with chronic constipation or IBS.
Dr. Wangen is the founder and medical director of the IBS Treatment Center, the award winning author of two books, and a nationally recognized speaker on digestive disorders. He has been on ABC, NBC, and Fox as well as public radio, and was named one of Seattle’s Top Doctors by Seattle Magazine.