Constipation and Impaction

Prevention

In many cases, you can prevent constipation by taking the following steps:

• Add more fiber to your diet - Set a dietary goal of 25 grams to 30 grams of fiber daily. Choose from a variety of high-fiber foods such as beans, broccoli, carrots, bran, whole grains and fresh fruits. To avoid bloating and gas, add these foods gradually over a period of several days.

• Drink adequate amounts of fluid - For most healthy adults, this is the equivalent of six to eight glasses of water daily.

• Begin a program of regular exercise - As little as 20 minutes of brisk walking daily can stimulate your bowels.

• Help train your digestive tract to have regular bowel movements - Schedule a 10-minute period to sit on the toilet at approximately the same time each day. The best time to do this is usually right after the morning meal.

• Do not postpone having a bowel movement until the time is more convenient - Respond to the urge immediately.

• Use an over-the-counter stool softener or fiber supplement - This may prevent occasional constipation. Always follow the dosage instructions exactly as written on the labels of these medications.

Treatment

If you have uncomfortable symptoms of constipation, it is reasonable to use a laxative treatment to help your bowel expel the stool. There are many laxatives available without a prescription, and they are safe for occasional use. Salt-based ("osmotic") laxatives contain magnesium. An example is milk of magnesia. This type of laxative helps to end constipation by drawing water through the bowel wall into the bowel. This loosens the stool. Stimulant laxatives, such as laxatives that contain senna, cascara or bisacodyl, are less gentle. Stimulant laxatives cause the colon muscles to contract more frequently or more aggresively.

Laxatives are available in forms that can be swallowed or inserted into the rectum as a suppository.

Enemas also can relieve constipation and are available at pharmacies without a prescription. An enema is a bag of liquid (usually a mixture of salt and water) attached to a plastic tube with a tapered tip. The enema fluid can be emptied into the rectum after the tip is inserted into the anus. The fluid is emptied when you lift the bag several inches and allow the fluid to move with gravity. An enema loosens stool in the rectum and triggers the rectal muscles to squeeze as a reaction to their being stretched.

If you have fecal impaction, your doctor may remove part of the fecal mass by hand, by using a lubricated, gloved finger inserted in the rectum. The rest of the mass usually can be removed with an enema, or by using water irrigation through a sigmoidoscope. Once the impacted stool is removed, your doctor will have you follow a high-fiber diet and may recommend a stool-softening medication or laxative to promote regular bowel movements.