In these series of common gastroenterology symptoms, I want to help you to understand the causes of your symptoms and how to improve your symptoms. The first one I’ll start off with is constipation- a symptom that roughly 1/5 adults in the United States experience. While it’s true everyone has a different baseline number of bowel movements per week, anything less than 3 a week with hard, dry, lumpy stools accompanied by difficulty straining on the toilet would classify as you being constipated.
But why are you constipated? Physiologically there are two broad categories of constipation- slow transit constipation and dyssnergic defacation. While most patients fit into one or the other, many also have a combination of both as well. Let’s break down each one and how you can know which one you have and how best to improve your bowel habits.
Slow transit constipation is what we think of classically when we think of constipation- your colon is not propelling the stool forward as it should be leading to infrequent BMs and bloating. Below are the different classes of medicines that help.
- Bulk forming laxatives- Psyllium and calcium polycarbophil these help to bulk up your stools stimulating your colon to contract.
- Osmotic laxatives- Miralax, sorbitol, Milk of magnesia, Magnesium supplementation these are all poorly absorbed by the gut causing water retention and colonic contraction
- Stimulant laxatives- Bisacodyl, senna, picosulfate these actually directly stimulate the colon to contract instead of indirectly as above. Unfortunately as a result these can cause abdominal cramping as a side effect!
- Kiwis- Yes you read that right. In a randomized- control trials have shown eating two kiwis a ay not only increase bowel frequency but also stool consistency as well. This is due to the combination of fiber and other components in kiwi including actinidin which increases gastric and intestinal motility, polyphenols which help with gut microbiome and fermentation, and organic sugars that act as osmotics like as above.
- Prescription secreatagogues- if your constipation is refractory to the above then it’s time to talk to your proveder about secretatogues such as Linzess, Amitiyza, and Trulance that act to stimulate secretion in your colon. If still truly refractory it’s time to get considered to be tested for dyssnergic defacataion which you can read about in my Substack
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