Getting the low-down on regularity
If you look at the ads on TV and in magazines, and you might conclude our nation is preoccupied with, um, “regularity.”
There are laxatives to help you go if you can’t, and a plethora of products containing fiber or probiotics that promise to help you maintain healthy bowel habits.
The problem is, regularity is difficult to define, according to Falmouth gastroenterologist Joseph Cobb, MD.
“There is a notion that I have to have one formed bowel movement a day,” he said. “There is a variation in normalcy from five a day to one every four days. Almost everyone fits within that curve.”
Doctors become concerned when there is a sudden change in someone’s usual pattern, he said.
Dr. Cobb said he rarely sees young patients complaining of constipation, but older patients, especially those who are sedentary and on multiple medications, often seek help with this problem. Opioids and medicines for hypertension can contribute to constipation, and so can vitamin and mineral supplements that contain high amounts of iron.
When patients come to him seeking relief, Dr. Cobb said he first checks to see if they are eating enough fruits and vegetables. These foods contain soluble and insoluble fiber, along with valuable nutrients. Insoluble fiber adds bulk to stool, allowing food to proceed more quickly though the digestive track. It is found in vegetables, wheat bran and whole grains.
Soluble fiber absorbs water and becomes gel-like, slowing digestion, which may lower the risk of heart disease. It is found in oat fiber, barley, nuts, seeds, peas, lentils, beans and some fruits and vegetables. Beyond fiber, some fruits contain natural laxatives. That old favorite, prunes, contains two: sorbitol and dihydrophenylisatin.
Dr. Cobb next checks whether a patient is drinking enough water each day. Fiber needs water to move it along and water helps keep stool soft and easier to pass. Alcohol and caffeine can contribute to dehydration, so these drinks should be avoided or consumed in limited quantities. Coffee can stimulate the digestive tract, but it increases urination, taking away water needed to keep stool moist.
Exercise not only aids your heart, your skeletal muscles and your mood, it influences digestion. Aerobic exercise gets the body and the intestines moving. Experts recommend against working out immediately after a large meal, as exercise temporarily causes to blood to be diverted away from the digestive tract and to the muscles and heart.
For most patients complaining of constipation, Dr. Cobb said he starts by prescribing a mild laxative, such as Metamucil, which uses soluble fiber to soften stool. Next he suggests stool softener pills.
If these steps prove ineffective, a stronger laxative, such as Miralax, is recommended.
“It contains a smaller dose of the same medicine used for colonoscopy prep,” he said, and works by bringing water into the intestines.
People with certain medical conditions that result in “floppy, non-squeezing colons,” can be helped by using biofeedback to retrain their internal and external sphincters, Dr. Cobb said.
And what about probiotics as digestive aids, which are touted heavily in yogurt and food supplement ads chiefly targeted at women?
“Probiotics probably don’t have a role in constipation; probiotics have a role in bloating,” Dr. Cobb said. “I would never tell someone not to take probiotics.”
Probiotics are substances and microorganisms that promote the growth of healthy gut bacteria. Dr. Cobb said there haven’t been enough double-blind studies done to establish if they help prevent constipation.
“There’s real theoretical benefit to it,” he said. “If they’re going to eat yogurt, yeah, that’s a double benefit because there’s calcium and probiotics. I definitely encourage my female patients to do that.”