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Most cases of chronic constipation are caused by lifestyle factors, particularly insufficient dietary fiber and inadequate exercise. But in some cases, underlying problems slow bowel function; Table 1 lists some causes of constipation. Although constipation can be caused by a number of serious illnesses, it's usually not a threat to health. Still, the first step is to determine why you are constipated. Lifestyle factors, including lack of dietary fiber, consuming too few calories, lack of exercise, and dehydration.
Medications, including aluminum-containing antacids, calcium-channel blockers, antihistamines, tricyclic antidepressants, narcotics, non-steroidal anti-inflammatory drugs, anticholinergics, and anti-Parkinson's disease agents.
Endocrine disorders, including diabetes and an underactive thyroid gland. Metabolic imbalances, including low potassium levels and high calcium levels. Neurologic disorders, including multiple sclerosis, Parkinson's disease, and spinal cord disorders. Bowel diseases, including tumors, irritable bowel syndrome, inflammatory bowel disease, strictures scarring , and rectal disorders.
Your doctor will review your general health, your medications and supplements, and your family history, with an emphasis on bowel disease. A physical exam may reveal clues; abdominal and rectal exams are particularly important.
But in most cases, a detailed review of your diet, exercise, and bowel habits will provide the most important information. Although there are no specific lab tests for constipation, your doctor may check for blood in your stool and for anemia, diabetes, thyroid abnormalities, and blood potassium and calcium levels. Men with constipation warning signs may benefit from additional tests, such as colonoscopy , sigmoidoscopy , or barium x-rays.
And even without warning symptoms, every man over 50 should have regular screening tests for colon cancer to detect polyps and tumors long before they cause constipation. Chronic constipation does not itself lead to serious medical conditions. But straining can trigger painful rectal problems. Hemorrhoids are the most common; they are swollen rectal veins that can cause rectal bleeding or, if they become clotted thrombosed , severe rectal pain. The combination of straining and hard stools can tear rectal tissue, producing anal fissures that are so painful that patients avoid moving their bowels.
In older men and women , hard, dry stools can become impacted trapped in the rectum, preventing normal bowel movements. Straining can also push rectal tissue out through the anus; these rectal prolapses may require surgical repair. And the low-fiber diets typically associated with chronic constipation are associated with diverticulosis and diverticulitis , common colon disorders that can cause bleeding or inflammation with pain and fever. Even without any complications, the discomfort associated with chronic constipation provides good reason to seek treatment.
The goal of treatment is not regularity, but comfort. Success is not judged by the number of bowel movements you have in a week, but by the ease and comfort of bowel function. To reach that goal, every man with chronic constipation should make the lifestyle changes that can help. And if more help is needed, your doctor can help you find appropriate laxatives and medications. Simple lifestyle changes can prevent or treat many cases of chronic constipation.
Four things are important:. Dietary fiber. Chronic constipation is rare in "primitive" societies that rely on traditional, unrefined foods, but it's extremely common in industrial societies.
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The missing element is dietary fiber. Dietary fiber is a mix of complex carbohydrates found in the bran of whole grains, in the leaves and stems of plants, and in nuts, seeds, fruits, and vegetables "" but not in any animal foods. Because dietary fiber cannot be digested by the human intestinal tract, it has very little caloric value "" but it still has plenty of health value.
By making the stools bulkier, softer, and easier to pass, fiber protects against constipation and other intestinal disorders. By producing a sensation of fullness and by lowering blood sugar and cholesterol levels, fiber also helps improve general health see Table 3. The Institute of Medicine recommends 38 grams of fiber a day for men before age 50 and 30 grams a day for older men for women, the recommended amount is 30 grams a day before age 50 and 21 grams a day thereafter. Most Americans get much, much less. Table 4 lists the fiber content of some foods and supplements.
Let’s talk about those hemorrhoid symptoms.
Fiber is important for bowel function and general health, but it can be hard to get used to. Many people feel bloated and gassy when they start a high-fiber diet, but if they stick with it, these side effects usually diminish within a month or so. Still, it's best to ease into a high-fiber diet. Increase your daily intake by about 5 grams per week until you reach your goal, and be sure to have plenty of fluids as well. For most people, a high-fiber cereal is the place to start, but if breakfast isn't your thing, you can have it any time during the day.
Exercise speeds the transportation of wastes through the intestinal tract. It's one of the reasons people who exercise regularly enjoy substantial protection against colon cancer.
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And like dietary fiber, exercise has many benefits beyond preventing constipation. It reduces the risk of heart disease, stroke, high blood pressure, diabetes, obesity, erectile dysfunction, and many other problems.
For the sake of your heart and your health, as well as your bowel function, you should exercise nearly every day. A minute walk is a great way to start. Doctors no longer believe that everyone needs eight glasses of water a day. But everyone with chronic constipation should have six to eight glasses of fluids a day.
A good routine. Always try to "heed the call" and head for the bathroom whenever you feel the urge to move your bowels.
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Holding back gives your guts the wrong message. In addition, set aside some time to sit on the toilet every day. Since eating stimulates the colon, a few minutes after a meal may be best. Since coffee also stimulates the colon, many people find after breakfast best "" particularly if they've been smart enough to start the day with bran cereal. Medications can bring relief to people with chronic constipation.
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An interesting case of anal melanoma caused liver metastases due to misdiagnosed as hemorrhoids. Akar T. Management of retrorectal hematoma after stapled transanal rectal resection for prolapsed hemorrhoids associated with occult rectal prolapse and obstructed defecation syndrome. Antonacci N Taffurelli G. Hemorrhoids during pregnancy: Sitz bath vs. Shirah BH Hawsawi MMA. Hemorrhoids: what are the options in ? Jacobs DO. Oxidized cellulose as hemostatic agent to prevent bleeding after high-risk endoscopic resection of rectal laterally spreading tumor overlying hemorrhoids.
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