The King’s Constipation, Part 2

The first thing to understand is that constipation is a symptom, not a disease in itself.  Many different, underlying diseases or conditions can lead to constipation and it’s important to know the cause to get the most appropriate treatment. To understand what causes constipation, it helps to know how the large intestine works. The large intestine removes most of the water from stool and changes it to a solid waste. The large intestine then moves the stool through the rectum and anus as a bowel movement. Constipation occurs when stool passes through the large intestine too slowly. When stool stays in the large intestine too long, the intestine removes too much water, and the stool becomes hard and dry.

How do you know if you’re constipated? Doctors and patients can and often do differ in what they mean by particular terms. Below are the so-called “Rome criteria” for constipation. You have to have two or more of these symptoms for at least three months:

Straining at defecation at least 25% of the time
Hard stools at least 25% of the time (see the Bristol Stool Chart)
Incomplete emptying of the bowels at least 25% of the time
Two or fewer bowel movements per week

An important point to remember is that constipation affects almost everyone at one time or another.  In most cases, following these simple steps will help prevent constipation:

Eat a variety of foods, especially vegetables, fruits and whole grains
Drink plenty of liquids
Exercise regularly
Visit the restroom as soon as you feel the urge to have a bowel movement
Fiber pills and powders available at your local drug store may help

Most people with mild constipation do not need laxatives. However, your doctor may recommend a laxative for a limited time if you have constipation that does not improve.

One important point we haven’t mentioned yet is that some medicines can cause constipation. Topping this list are prescription painkillers (narcotic analgesics) such as demerol, a drug to which Elvis was addicted.

Getting back to Holly McKay’s story on Dr. Nick’s account of Elvis’ problems, it states at one point that Mr. Presley was considering a colostomy as a treatment. This doesn’t really make any sense to us because such surgery is typically used to treat serious bowel obstructions (such as can be caused by a tumor). In such cases, the colon can actually become so inflated that it bursts like a balloon leading to a life-threatening infection called periotonitis.

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Mark Boguski, M.D., Ph.D. is on the faculty of Harvard Medical School and is a member of the Society for Participatory Medicine, "a movement in which networked patients shift from being mere passengers to responsible drivers of their health" and in which professional health care providers encourage "empowered patients" and value them as full partners in managing their health and wellness.

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