26: Constipation: Lifestyle Changes and Medicines for Treatment

 In this episode of Your Checkup, we're diving into a topic that's got everyone… stuck! Constipation may not be glamorous, but it's a real pain in the gut for millions of Americans. We’ll break down the common causes, from ignoring your body’s natural cues to skimping on fiber, and share simple lifestyle changes that can get things moving again. From morning coffee tricks to the fiber showdown, we’ll also cover the basics of laxatives—fiber boosters, stool softeners, and the “pushers” you should save for emergencies. Tune in for the scoop on smooth moves and when it's time to check in with your doc! 

Takeaways

• Constipation is a common digestive complaint in the U.S.
• Symptoms of constipation can vary from person to person.
• Dietary factors, such as low fiber intake, can lead to constipation.
• Ignoring bowel urges can contribute to constipation over time.
• Increased fiber and water intake are key to preventing constipation.
• Certain medications can cause constipation as a side effect.
• Lifestyle changes, such as stress management, can help alleviate constipation.
• Home remedies and over-the-counter medications can effectively treat constipation.
• It's important to recognize warning signs that may require medical attention.
• Open discussions about bowel health should be encouraged.

Keywords

constipation, digestive health, fiber, bowel movement, home remedies, medications, health education, patient care, podcast, health tips

Chapters

• 0:06 Chit Chat
• 4:24 The Stuff You Came For

Transcript

Speaker 1 (00:04)
Hi, welcome back to your checkup. We are the Patient Education Podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky a family medicine resident in the Philadelphia area.

Speaker 2 (00:18)
and I'm Nicole Aruffo I'm a nurse.

Speaker 1 (00:20)
And we are so excited and grateful that you were able to join us today for this episode. What are you drinking over there, Nikki?

Speaker 2 (00:28)
I'm drinking this drink we got at Trader Joe's earlier. It's new. It's like a sparkling rose tea something. It's fine.

Speaker 1 (00:39)
But what's it placed in?

Speaker 2 (00:42)
a wine glass. Here, do you want to try it? It's heavy on the tea. I like the ginger one better. I don't know that I will buy that again, but it's fine.

Speaker 1 (00:44)
It's as it looks elegant.

definitely heavy on the T here. wow. Yeah.

Speaker 2 (00:55)
Mm-hmm.

Yay. Get that on the back end, right?

Speaker 1 (00:59)
Yeah, definitely lots of tea on the back end here. So thank you for bearing with us while we didn't have an episode last week. We took a holiday. think we like it had been a couple of months since we took a week. Yeah, so.

Speaker 2 (01:09)
Not since 4th of July, I'm pretty sure. And

we appreciate our loyal listeners, but some of them don't have respect for our fall break.

Speaker 1 (01:18)
Well, one particular person of interest, but we noticed that some of you were able to go back and find some of our old episodes and listen to those in the meantime. So that was awesome. Kudos to you for continuing learning about health for yourself, a loved one or. And otherwise, there's been lots of exciting stuff happening. I'll go first. I can't believe the Mets are doing what they're doing. I know we're based in Philadelphia here with this podcast, but my God, literally. my God, these.

Speaker 2 (01:32)
a neighbor.

Speaker 1 (01:46)
These guys are doing things that I never thought that they would be able to. Yeah, there's a lot of.

Speaker 2 (01:49)
There's still four more games, so

don't speak it too highly into existence because you might cry later.

Speaker 1 (01:55)
No, it's so true because like, mean, we're recording this and like by the time that this will be out, there will be a whole other game played and we'll be looking towards game three of the NLDS, which will take place in New York. It's just so exciting. October baseball. It feels like they shouldn't be here, but they are. And God bless Pete Alonzo. Yeah. You have any thoughts about the Mets?

Speaker 2 (02:16)
No, no thoughts about the Mets. Or baseball really. I think baseball is one of the most boring sports one can watch.

Speaker 1 (02:27)
Hmm, maybe in.

Speaker 2 (02:29)
It's just

like slow. It's a slow game.

Speaker 1 (02:32)
It's very intense, though. Well, the thing about baseball is that like you can't run away from your opponent. You have to face them. You can't dribble out the ball. You can't take a knee at the end of the game. So everything is heightened as you go along. You have to face your opponent. And that's the charm of it, especially in October, which for the Mets, this doesn't happen all the time. In fact, once every.

Speaker 2 (02:34)
Yeah.

I was gonna say it's probably gonna be another 10 years.

Speaker 1 (02:58)
Probably. So I'm going to relish this every bit that I can because I'm just and the fact that I even have a little bit of a platform to talk about how excited I am about them. And Candelita, the pop star. I got to be honest, I wasn't all in on that whole aspect of it. But now in the last 24 hours, we've listened to the song eight times. Yeah. And grimace. I mean,

Speaker 2 (03:23)
OMG

Speaker 1 (03:27)
Well, we're going to lose all of our Philadelphia listeners at this point if I keep going with this.

Speaker 2 (03:31)
We've been busy. We've been booked and busy. We had to schedule a rot day.

Speaker 1 (03:38)
We dead. We had to schedule a right day.

Speaker 2 (03:41)
which is today.

Well, we've done some productive things. But the bulk of today is us sitting on the couch watching Love is Blind. Yep.

Speaker 1 (03:47)
Totally.

that's fun thing. First six episodes came out and that's exciting. It's been fun. I mean, I think they're based in Washington, D.C. this year and it gets a little bit closer to Philadelphia to make it more relatable. Some of these people are freaks.

Speaker 2 (04:08)
do

based around here next time.

Speaker 1 (04:12)
What are we gonna talk about today, Nick?

Speaker 2 (04:13)
We're talking about one of your favorite topics, constipation.

Speaker 1 (04:17)
Actually, it's one of your favorite topics since you yourself are a survivor.

Speaker 2 (04:21)
Not really. I wouldn't say.

Speaker 1 (04:25)
No? mean, you treat it almost every night.

Speaker 2 (04:29)
Well, you know, we're getting ahead of it.

Speaker 1 (04:31)
That's fair. All right. So we're talking about constipation because it is one of the most common concerns and especially one of the most common digestive complaints in the United States that people show up to the doctor for. It seems like more than 2.5 million Americans seek medical attention for relief of their constipation each year. But does constipation look the same for everyone is like a really common question.

constipation for one person versus constipation for another person. They all look the same,

Speaker 2 (05:02)
Yeah, it could be different. Like some people...

Everyone's pooping patterns are different. Right? So like some people like you might poop like three times a day. And then some people might only do once. Maybe there's the every other dayers. Like if someone who pooped every other day, one person might poop every other day and that's fine. But if you're a three poop a dayer and then suddenly you're only pooping once every other day, that's vastly different.

Speaker 1 (05:11)
So different.

Right, which is fine.

Speaker 2 (05:38)
Right. One might say you're constipated.

Speaker 1 (05:40)
So a change from your baseline is something that's definitely something that we think about. And it doesn't always mean just less pooping. It can mean passing small hard stools, which is also a sign of constipation. And it happens in any age, infants all the way through seniors. So it's extremely common. And usually when we think about the frequency to think about constipation, you mentioned every other day. I would say when it gets to like every third day, like that's still normal, but

much longer than that, I think the time itself could be considered to diagnose constipation. What are some other symptoms that someone might experience if they were experiencing constipation?

Speaker 2 (06:22)
So you might be straining during your bowel movement. You may not, or you may feel like you haven't completely emptied after you go to the bathroom or just bloating, abdominal discomfort.

Speaker 1 (06:40)
which I feel like is really common. So this could be on the list for a lot of people who have tummy aches. So there are a couple of things to think about. Obviously on this show we're not giving medical advice, but we want to highlight some things that you should pay attention to, that you should take a moment and think, is it time to go see a doctor? So what are those few things that someone should think about that it's time to go reach out?

Speaker 2 (07:04)
If it's something that's new or unexpected, if it lasts longer than three weeks without any kind of like improvement, which we'll talk about ways to improve that with like diet. yeah, huge part. kind of medicines, but like if you're doing those things and it's not getting better, or if it's severe and you're having like blood in your poop when you go to the bathroom, unexplained weight loss or fever and weakness. Yeah. Which are all kind of extreme, but. Sure. Definitely reasons to go to the doctor.

Speaker 1 (07:33)
Yeah, there's like a ton of underlying conditions that could be causing constipation. mean, we're talking obstructed bowels, inflammatory bowel disease, colon cancer. And so sometimes you should be thoughtful about this and you may not think it's a lot, but you should go see your doctor if you're constipated and especially with those three things that you mentioned. You mentioned unexpected. I find people get constipated when they travel.

Speaker 2 (07:59)
Yeah.

Speaker 1 (08:00)
So that's something that's like reasonable.

Speaker 2 (08:02)
Well, that's why when we go on vacation, we have a travel squatty potty. Honestly, we should. I would be their biggest advocate. Travel squatty potty, also have a regular squatty potty in our house. And we like, you know, wake up and take some shots of Metamucil or Mira- yeah, Mira-lux. You got to keep it regular. You do. We don't shy away from poop talk in our doctor nurse house.

Speaker 1 (08:07)
We should get sponsored by them.

You go.

No, a big poop talk family.

Speaker 2 (08:32)
But

like when you're on vacation and especially if you're on like a beach vacation and you're in a bathing suit all the time, like no one wants to be bloated because you haven't pooped. Right. You keep it regular.

Speaker 1 (08:43)
And you're

keep it regular. So you can almost preempt that sometimes constipation. Yeah. So in the next portion of our episode, we are going to discuss common causes of constipation. So one of the major common causes of constipation are dietary factors. And specifically a diet low in fiber and water can lead to harder and more difficult to pass stools. In past episodes, we've talked about using 20 to 35 grams of fiber per day.

is probably the gold standard. And we encourage you, again, to evaluate in your life how much fiber you're taking. But we're going to talk a lot more about how to treat your constipation with fiber later.

Speaker 2 (09:30)
There are a whole slew of meds that can make you constipated. The biggest one and most common probably are the pain meds, iron supplements, some antidepressants and some blood pressure meds can make you constipated. Zofran, that's another one.

Speaker 1 (09:50)
Yeah, it's

a big time. There are chronic conditions that can make you constipated. So we'll have you know that diabetes, hypothyroidism, irritable bowel syndrome or IBS or other neurological diseases can slow down bowel movements as well.

Speaker 2 (10:07)
Yeah. We also, speaking of chronic conditions, one of our really good friends, we're not going to name any names, but she hasn't pooped in 26 years.

Speaker 1 (10:17)
Gosh, yeah, she's an anomaly where she's going to be put up in a museum at some point because in 26 years she has not had a bowel movement. You know who you are.

Speaker 2 (10:29)
And then kind of going back to the travel thing, like lifestyle factors, travel is definitely a big one. Stress, general lack of physical activity, and just, you know, changing your routine are also not helpful.

Speaker 1 (10:46)
Totally. And I want to spend a little bit of time here because this is so interesting is that if you ignore your normal bowel urges, that also can lead to constipation. And so usually your body signals when you have to go to the bathroom, right? Like everyone gets that urge. But if you ignore that over time, your body will stop responding to that signal.

It's almost like saying like, what's the use if you're not going to use this, you're going to lose it. One of the most specific ones is called the gastro colic reflex. And so when you eat a meal, there's a bolus of food that obviously goes to your stomach and it actually sends a signal to your colon to become activated so that your body will have a bowel movement and make room for the new food that's coming to be digested.

Speaker 2 (11:20)
You'll lose it.

Speaker 1 (11:44)
And that usually happens in the morning. Our bowels are most active in the morning when we wake up. And say you eat breakfast, you may notice that you're going to have a bowel movement a couple of minutes later. And no, that's not the food that you just ate running through your body. It takes food much longer to be digested. But it's your body's normal mechanism to help move things along. And if you ignore it, it goes away over time.

Speaker 2 (12:08)
Listen to your body.

Speaker 1 (12:10)
Listen to your body. I know there are certain times in a day when people might not be able to. Say you're a teacher, you can't run to the bathroom and leave the kids behind. But the best you can, take the opportunities when you can to go sit on the porcelain throne.

Speaker 2 (12:23)
With your squatty body.

Speaker 1 (12:26)
With your squatty potty. Well that actually changes the angle, right? It changes the angle, it makes it more natural.

Speaker 2 (12:31)
Yeah. Or if you're like.

Speaker 1 (12:35)
Mm-hmm.

Speaker 2 (12:36)
We're gonna name any names again. No. our other friend gets naked and gargoyles on the toilet.

Speaker 1 (12:43)
He certainly does. This might be our clip. I want him to see it. Yeah, he gets up and there's no video portion here. If you can imagine what a gargoyle looks like, both of his feet without socks on go on the actual toilet, public and private bathrooms alike. And there he sits or squats. not entirely sure, but probably squats.

Speaker 2 (13:07)
probably.

Do you think his fiance knows that?

Speaker 1 (13:11)
She does. She does?

Yeah, yeah she was.

I tried to get him a squatty potty. So maybe that's changed his life. Yeah. He says it was one of the best guests he'd ever gotten.

Speaker 2 (13:24)
he has one. I was going to say we can get him one for his wedding. We can get him a travel one as a wedding gift to take on their honeymoon.

Speaker 1 (13:31)
That

sounds great and much more affordable than any other gift we're gonna give. So the next part, so now that we've covered what constipation is, what common things can cause constipation, we're gonna really hit the nitty gritty valuable parts of this episode where we talk about the things that you can do at home to treat your constipation. Most constipation can be treated with using things like behavioral changes, dietary adjustments, and if needed,

medications. And so we're going to go each of those three things next.

Speaker 2 (14:05)
So the first and I guess easiest way to treat this is from our foods that we eat, namely eating more fiber, so more fruits, more vegetables.

Definitely start slower when you're eating a lot more because you probably will be bloated and uncomfortable. And you probably already feel bloated and uncomfortable if you're a little constipated. But also important when you are increasing your fiber to also increase your water. And that'll help flow everything. Because if you're eating all this bulky fiber stuff and it's kind of just sitting in there and then the water just absorbs and helps it all move out.

So if you're increasing your fiber, increase your water.

Speaker 1 (14:56)
Absolutely. Is there a certain so 20 to 35 grams of fiber is a benchmark that everyone should try to hit. And so it's important to know where you are when you're going to assess where you're going. So many people count calories. It's a pretty simple thing that people know how to do. Try counting fiber. See how much you're getting in the course of your day and see how you can increase it. There are several high fiber foods out there that

are easy to get your hands on. I'm thinking of things like citrus fruits, berries, prunes. Our geriatrics love prune juice. They're excellent sources of fiber. There are certain vegetables like leafy greens, broccoli, carrots, Brussels sprouts, and whole grain categories like brown rice, oats, quinoa, and other whole wheat products, all that have higher tides of fiber in

Speaker 2 (15:35)
Love prunes.

And then there are the over-the-counter medications, which is Eddie's favorite aisle in the store. The laxative aisle. All right, so first under the over-the-counter meds, since we just talked about fiber and eating fiber, there also are fiber supplements that you can take. Our favorite is Metamucil. We're a big Metamucil family.

Speaker 1 (16:03)
False claim.

Speaker 2 (16:22)
Eddie has to take it every night. buy it in bulk from Costco.

Speaker 1 (16:25)
Not true.

So that's also called psyllium for those, if you're looking for an alternate brand, Metamucil is the brand name. Well, before we get there, I kind of wanted to say that there are other, so there's psyllium, which is a powder that you mix with water and you drink quickly at the end of the night. But the idea is that you still have to drink a lot of water with it. And there are others that come in tablet forms, like a medicine called FiberCon or calcium polycarbophyll, which is why.

Speaker 2 (16:56)
Fiber.

Speaker 1 (16:57)
I understand why it's called fiber con. So that's an actual like tablet that. Yeah, so you can just eat that tablet down the throat and then boom, increase fiber. So that's another option.

Speaker 2 (17:02)
with the tablet.

Okay Eddie, tell us about the mushers and the pushers.

Speaker 1 (17:15)
So a musher is, in its scientific name, a hyperosmolar laxative. Well, what the heck does that mean? It means that these laxative work by drawing water into the colon and help softening the stool, kind of making it easier to pass. The classic ones that we think about are polyethylene glycol, which is otherwise named brand name Miralax. It's widely available over the counter, which is super convenient.

basically is the thing that is used to prepare for colonoscopies, but to treat constipation on a much lower scale. There are also other substances like magnesium hydroxide, which goes by milk of magnesium, or magnesium citrate, which is another medicine widely available. We've used that over the phone. You've told me war stories about when your shifts were changing at work or you were traveling that that seemed to be very helpful for you in your journey.

Speaker 2 (18:11)
Yeah,

me and this girl were... One time for fun decided to drink some.

Speaker 1 (18:12)
I'm thrown.

Just to see what it, yeah, mess around and find out. So these work similarly by drawing water into the stool, but should be used cautiously in patients who have known kidney issues because a whole electrolyte that you're introducing. So you should be careful in this population. There are other ones like lactulose or sorbitol. And these are also things that just draw water into the colon to mush it up. So in short, those are mushers. Mushes it up.

Speaker 2 (18:44)
What

about the pushers?

Speaker 1 (18:47)
So the pushers are called stimulant laxatives. These take a bowel that are sleepy and wake them up. They activate the muscles of the intestines to help push stool through more quickly. And while they're effective, you should maybe think twice about using them all the time, because you may end up depending on them a little bit to have bowel movements. There's a little wishy washy evidence on long-term use of them. But when you need to use them, it's fine.

long-term, like decades maybe, it's something to think about. Common names for these are medicines like Senna, otherwise known as Xlax or Senna Cop, or other ones like Bisacotl, which has a brand name, Dolcolax. We should know that these can cause electrolyte imbalances and dehydration if you have constipation that changes to diarrhea. And these are things that your doctor will worry about, but if you use them too much,

You could cause harm. So just be careful. We'll say there's a common myth that the pushers cause some sort of long-term damage to the colon. And that specifically is a myth. There's no evidence that shows it causes long-term damage. in the neurogenic aspect of your colon, maybe you have a sleepy colon that depends on a stimulant laxative. That's something to think about as well.

Speaker 2 (20:14)
And then, so those are all the medications that you can treat from the top down. So you take by mouth. And then there are other ones that you can get over the counter that you treat from the bottom up. So they are administered rectally. Like an enema or a suppository.

Speaker 1 (20:34)
They certainly are.

Speaker 2 (20:37)
Sometimes you gotta go from the top and the bottom.

Speaker 1 (20:39)
Sometimes you got to do both. So these tend to work more quickly because they actually stimulate the rectum directly and there's quicker absorption there. And while these are wildly effective, as you might imagine, many people find them uncomfortable and are unwilling to do this. But sometimes duty calls.

Speaker 2 (20:57)
And it's time for the placement.

Speaker 1 (20:58)
And it's time for the placement.

There are other medicines that are more like big gun medicines that honestly don't prescribe that much in primary care, probably more on the gastroenterologist level. These are for severe constipation. These are medicines that go by the name Linaclotide or Lubypristone. I'm thinking of a brand name called Linzest. I've seen it used a couple times, but really only when the gastroenterologist recommends trying it. So probably not in the scope of our little DIY at home constipation treatment.

So now that we've reviewed all of the nuts and bolts of constipation stuff, let's kind of break outside of all of that and just go back and forth about what we think about all this.

Speaker 2 (21:46)
About what I think about it, well, it's something that's common and easily treatable at home. Can change your diet. And I mean, in the long run, if we're adding more fiber into our diets, you're eating more fruits and vegetables and that's only helping you in the long run, you know?

Speaker 1 (22:10)
Yeah, it all just comes together and it's just better for you as a whole. I guess there's something to be said about the warning signs. If you're losing, if you're someone who's losing weight and newly constipated, go get checked out. This isn't a silly concern. Like, yeah, we're talking about doing this at home, but like in reality, you should probably be checked out to make sure everything's okay. And we gave you those warning signs earlier in the episode, but I really feel like this is something that like,

a lot of people have been affected by maybe almost everyone at some point in their life, whether they were, they realized it or not. And they were a kid. we could probably do a whole other episode on constipation and PEDs, but as you can kind of tell this was mainly girl. my gosh, the clean up, but we want to promote that like bowel movements and pooping is normal, healthy, and should be celebrated rather than shamed.

Speaker 2 (22:52)
Oh, I was on clean out.

Speaker 1 (23:05)
frankly in our bathroom, have a picture of our intern who it's just four, four photos of him actually in the act of pooping and it's inspiring every time we sit down and it's great. I'm obsessed with it. was a really great interior design idea in our home here. So as you can tell, we really are a poop forward family.

Speaker 2 (23:27)
We are. Eat your vegetables. Drink your menomuscle.

Speaker 1 (23:32)
So thank you for coming back to another episode of your checkup. We're so happy you were able to join us here again today. And hopefully you were able to learn something about constipation for yourself, a loved one, or please look out for our website.

Speaker 2 (23:44)
constipated neighbor.

a neighbor with constipation.

Speaker 1 (23:50)
Find us on Instagram. Send us some fan mail. We're open to taking requests on different topics that you would like covered. And we've got a bunch of great diverse episodes coming up for you here that we're really looking forward to giving you. And keep an eye out for an extra episode in the middle of this week because we realized that we left you hanging last week. And so this one is specifically for our most loyal listener.

Speaker 2 (24:16)
specifically for him, who think texted us both separately asking where the episode was.

Speaker 1 (24:21)
last

week. Both separately and multiple interesting pieces of fan mail. So keep an eye out for another little ditty episode in the middle and come back next week. Please spread the good word. Tell your friends, your family about what we're doing here because why not spend a couple minutes listening and trying to improve your health in the easiest way possible at your convenience. And most importantly, stay healthy, my friends. Until next time, I'm Ed Delesky

Speaker 2 (24:49)
I'm Nicole Aruffo

Speaker 1 (24:50)
Thank you and goodbye.

We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor. And make sure you go get your own checkup with your own personal doctor.

Speaker 2 (25:30)
I am not your nurse.