Constipation: Everything You Want to Know But Are Afraid to Ask
No matter how old or young you are, everyone has experienced constipation at some point in their lives. Dr. Linda Lee answers all of the questions you may have about constipation but are maybe too embarrassed to ask.
Featured Speaker:
Linda Lee, MD
Dr. Lee is Board Certified in Internal Medicine and Gastroenterology and treats patients with a broad array of digestive symptoms. She brings a holistic approach to the care of her patients, acknowledging the importance of the gut-brain interactions and the role of diet in gut health. Dr. Lee is passionate about understanding what her patients value, and partnering with them in developing their diagnostic and treatment plans. She is committed to helping all of her patients achieve an optimal state of well-being. After completing all of her medical training, Dr. Lee practiced medicine for most of her career at Johns Hopkins (JH) Hospital in Baltimore where she eventually earned the title of Associate Professor of Medicine for her involvement in medical education, gastrointestinal and cancer research, and medical leadership. She was inducted into the Miller-Coulson Academy for Clinical Excellence at Johns Hopkins in 2015. She is a Fellow of the American Gastroenterological Association and a Fellow of the American College of Physicians. Prior to joining Maimonides, she also worked abroad as a Chief Medical Officer at an international hospital, helping to advance the expansion of its clinical services and responsiveness to the community it serves. Transcription:
Constipation: Everything You Want to Know But Are Afraid to Ask
Maggie Mckay: It's not a topic that usually comes up in conversation, but it is a fact of life. We're talking about constipation. And no matter how young or old we are, everybody experiences it at some time. Joining us is Dr. Linda Lee, the Director of Gastroenterology at Maimonides Medical Center. She's going to answer everything you ever wanted to know about constipation, but we're too embarrassed to ask.
This is my Maimo Med Talk. I'm your host, Maggie McKay. Thank you for making the time to be here. As we said, I'm going to get right into it because we have a lot of questions for you. When my son was at toddler, he was having the issue of constipation. His pediatrician said, "Just feed him any fruit that starts with a P," like prunes, pineapple peaches, plums. Is that accurate? And if so, does it apply to adults? Does it work?
Dr. Linda Lee: Well, I think in general, you know, eating a very well balanced diet, but I always advocate eating a high fiber diet. So a diet that has a lot of whole grains in it as opposed to processed grains can be also very beneficial. We should be aiming to get about 25 to 30 grams of fiber in the diet every day. So sometimes with my patients who are mildly constipated, and then it's just an acute thing, meaning it just happened this past week, sometimes asking them to increase their fiber and water and activity level can help. But unfortunately, that doesn't always work for people who have chronic constipation.
Maggie Mckay: So is it possible to have too much fiber and does that backfire?
Dr. Linda Lee: That's so funny that you put it that way. It's not harmful to have too much fiber, but for some people, what happens with the fiber is that it gets fermented by the bacteria that live in our colons, and so that can produce a lot of gas. So some people find that very uncomfortable, particularly if they have a very sensitive gut. That's like what we would see in irritable bowel syndrome. So excessive gas production by eating foods that contain fiber or other kinds of sugars that get fermented can create a lot of discomfort for people who have what we call visceral hypersensitivity, but it's not necessarily harmful in that, you know, it won't land you in the hospital typically.
Maggie Mckay: Do you recommend eating foods high in fiber or taking a supplement?
Dr. Linda Lee: Oh, I absolutely recommend going the diet way, but I know it's really hard, you know, especially if you're traveling or if you have a busy schedule. Who wants to be counting how much fiber they eat every day, like looking at every single label? So. We'll find it easier just to take a fiber supplement. And as long as the fiber supplement gives you about five grams of fiber, it's probably going to be helpful. We know that the average American eats, you know, the American diet is generally about 15 grams of fiber a day. So if you get an extra five, that can be very helpful.
Maggie Mckay: And you mentioned water. How important is that in staying regular? How much should we be drinking?
Dr. Linda Lee: Well, you know, I think that really depends on the individual. And, you know, I am not one of those people who want to put a specific amount as to how much people should be drinking, but you should be drinking enough water so that you are urinating several times a day and what's coming out looks nice, clear yellow, not dark yellow, right? So that's probably, you know, one indicator. But you know, just drinking water alone isn't going to prevent you from getting constipated from time to time.
Maggie Mckay: Okay. What are the most common causes of constipation? What foods or lifestyle?
Dr. Linda Lee: Well, I would say that a diet that's very low in fiber. So if you're somebody who eats a lot of processed foods, meaning that things that are very refined, that's not very full of fresh fruits or vegetables, that you may be more likely to experience constipation. We see some people experiencing constipation when they travel, that is not uncommon. And that probably has something to do with, you know, the change in diet when you travel and when you're at home, you know, you've got your granola there or your oatmeal. But maybe when you're traveling or on vacation, you don't have those kinds of things readily available to you, so we see people getting constipated mildly when they travel sometimes.
Maggie Mckay: How do you know when it's time to see a doctor about your constipation? Like, let's say maybe you've been constipated for a week and you think something's abnormal?
Dr. Linda Lee: Yeah. I think that if you're starting to experience abdominal pain, if it's really interfering with the quality of your life and your ability to do things, if you find that you're not wanting to go out, because you're worried about not being able to have a bowel movement or that something urgent is going to happen, I think that these are reasons to seek help. Definitely, if you're passing any blood, when you have a bowel movement, you definitely need to tell your doctor about that; if you're experiencing any weight loss or if you've had any like major radical change in the frequency of your bowel movements.
People ask me all the time, like "What's the normal number of times I should be having a bowel movement?" And you might be surprised, it is highly variable. Some people go every day. Some people go once every few days. There are some people who, since the day they were born, only go once a week or once every two weeks and they're completely comfortable. Yeah, hard to believe, right? They are outliers. It's true. That's not the majority of people, but it can be "normal". This is how they are their entire life and they don't experience discomfort associated with it.
So if there's suddenly a change, if you're a person who normally goes every single day and you start going only once a week, that's a problem. That's very different than somebody who's only gone once a week their entire lives.
Maggie Mckay: What do you say to patients who don't tell you about their constipation because they're embarrassed?
Dr. Linda Lee: So many people are embarrassed. I can't tell you how many people. You know, when they come to the office and they're here because they have abdominal discomfort or they do have a change in their bowel habits, just getting people to describe what their stool looks like or what their bowel habits are like can be very challenging because socially, and I think especially for women, it's not very culturally acceptable for us to be very open about the fact that we actually have bowel movements and make gas just like guys do.
What I sometimes do is I warn people that I'm going to ask them a lot of personal questions about their bowel movements and that whatever we talk about is shared only in the office. And then sometimes I even use a little visual aid. It's called a Bristol stool chart, and it has pictures, like drawing, drawing, not live pictures, but drawings of what different consistencies of stool look like. And so that can be a helpful visual aid because the patient can then just point and say, "This is what my poop looks like most of the time." And that is a great help to me.
Maggie Mckay: I bet. When it comes to treating mild constipation, like at home, what's the best method? Dulcolax or...?
Dr. Linda Lee: Yeah. Well, I think it really depends. So we should define what constipation is. So often people think that constipation means you don't go very frequently. And while that's one definition of constipation, we also say that people are constipated if they, A, have to strain to initiate or complete a bowel movement or, B, if they feel incompletely evacuated, when they go.
So even if you go every day, but you're straining, right? And you are feeling incompletely evacuated, and maybe you're passing what looks like little rocks and pebbles, you are constipated despite the fact that you're going every day. And so depending on the type of constipation you have, then there are different kinds of laxatives that might be helpful to you to sort of help you get over it.
If you are somebody who tends to have very hard stools and taking fiber or taking something called polyethylene glycol 3350, which is a powder not absorbed into the body, but just staying in your GI tract to keep your stool soft, can be very beneficial, but you have to use it on a regular basis to prevent yourself from getting that hard stool.
If you're somebody who's been backed up for a couple of weeks and you're really in a lot of discomfort, then Dulcolax can also be very helpful or what we call bisacodyl, that's the generic name, or senokot, Senna tablets, which is derived from a plant. These actually stimulate contractions in the colon to help you move things forward.
Maggie Mckay: Doctor, is there any connection between colon cancer and constipation?
Dr. Linda Lee: Well, you know, there's been a lot of speculation about that. People who tend to be chronically constipated are not necessarily at higher risk for developing colon cancer in the future. However, this is why I say that if you're somebody who has been having regular bowel movements, despite whatever frequency that is your entire life and suddenly that changes, that could be a sign of an early colon cancer, if you stop going as frequently as you used to go, and that's a reason for you to go get checked out by your doctor, particularly if you're over the age of 45.
Maggie Mckay: Okay. Thank you so much, Dr. Lee. We appreciate you joining us and shedding some light on a topic many people find embarrassing, like we said, but one that's important to understand.
Dr. Linda Lee: Well, thank you so much. And any time if you have more questions, let me know.
Maggie Mckay: Okay. Thank you. To find out more, call (718) 283-5900 Monday through Friday 9:00 AM to 5:00 PM for an appointment or go to my maimodocs.org. That's my Maimo, M-A-I-M-O docs dot org. This has been my Maimo Med Talk. I'm your host, Maggie McKay. Thanks for listening.
Constipation: Everything You Want to Know But Are Afraid to Ask
Maggie Mckay: It's not a topic that usually comes up in conversation, but it is a fact of life. We're talking about constipation. And no matter how young or old we are, everybody experiences it at some time. Joining us is Dr. Linda Lee, the Director of Gastroenterology at Maimonides Medical Center. She's going to answer everything you ever wanted to know about constipation, but we're too embarrassed to ask.
This is my Maimo Med Talk. I'm your host, Maggie McKay. Thank you for making the time to be here. As we said, I'm going to get right into it because we have a lot of questions for you. When my son was at toddler, he was having the issue of constipation. His pediatrician said, "Just feed him any fruit that starts with a P," like prunes, pineapple peaches, plums. Is that accurate? And if so, does it apply to adults? Does it work?
Dr. Linda Lee: Well, I think in general, you know, eating a very well balanced diet, but I always advocate eating a high fiber diet. So a diet that has a lot of whole grains in it as opposed to processed grains can be also very beneficial. We should be aiming to get about 25 to 30 grams of fiber in the diet every day. So sometimes with my patients who are mildly constipated, and then it's just an acute thing, meaning it just happened this past week, sometimes asking them to increase their fiber and water and activity level can help. But unfortunately, that doesn't always work for people who have chronic constipation.
Maggie Mckay: So is it possible to have too much fiber and does that backfire?
Dr. Linda Lee: That's so funny that you put it that way. It's not harmful to have too much fiber, but for some people, what happens with the fiber is that it gets fermented by the bacteria that live in our colons, and so that can produce a lot of gas. So some people find that very uncomfortable, particularly if they have a very sensitive gut. That's like what we would see in irritable bowel syndrome. So excessive gas production by eating foods that contain fiber or other kinds of sugars that get fermented can create a lot of discomfort for people who have what we call visceral hypersensitivity, but it's not necessarily harmful in that, you know, it won't land you in the hospital typically.
Maggie Mckay: Do you recommend eating foods high in fiber or taking a supplement?
Dr. Linda Lee: Oh, I absolutely recommend going the diet way, but I know it's really hard, you know, especially if you're traveling or if you have a busy schedule. Who wants to be counting how much fiber they eat every day, like looking at every single label? So. We'll find it easier just to take a fiber supplement. And as long as the fiber supplement gives you about five grams of fiber, it's probably going to be helpful. We know that the average American eats, you know, the American diet is generally about 15 grams of fiber a day. So if you get an extra five, that can be very helpful.
Maggie Mckay: And you mentioned water. How important is that in staying regular? How much should we be drinking?
Dr. Linda Lee: Well, you know, I think that really depends on the individual. And, you know, I am not one of those people who want to put a specific amount as to how much people should be drinking, but you should be drinking enough water so that you are urinating several times a day and what's coming out looks nice, clear yellow, not dark yellow, right? So that's probably, you know, one indicator. But you know, just drinking water alone isn't going to prevent you from getting constipated from time to time.
Maggie Mckay: Okay. What are the most common causes of constipation? What foods or lifestyle?
Dr. Linda Lee: Well, I would say that a diet that's very low in fiber. So if you're somebody who eats a lot of processed foods, meaning that things that are very refined, that's not very full of fresh fruits or vegetables, that you may be more likely to experience constipation. We see some people experiencing constipation when they travel, that is not uncommon. And that probably has something to do with, you know, the change in diet when you travel and when you're at home, you know, you've got your granola there or your oatmeal. But maybe when you're traveling or on vacation, you don't have those kinds of things readily available to you, so we see people getting constipated mildly when they travel sometimes.
Maggie Mckay: How do you know when it's time to see a doctor about your constipation? Like, let's say maybe you've been constipated for a week and you think something's abnormal?
Dr. Linda Lee: Yeah. I think that if you're starting to experience abdominal pain, if it's really interfering with the quality of your life and your ability to do things, if you find that you're not wanting to go out, because you're worried about not being able to have a bowel movement or that something urgent is going to happen, I think that these are reasons to seek help. Definitely, if you're passing any blood, when you have a bowel movement, you definitely need to tell your doctor about that; if you're experiencing any weight loss or if you've had any like major radical change in the frequency of your bowel movements.
People ask me all the time, like "What's the normal number of times I should be having a bowel movement?" And you might be surprised, it is highly variable. Some people go every day. Some people go once every few days. There are some people who, since the day they were born, only go once a week or once every two weeks and they're completely comfortable. Yeah, hard to believe, right? They are outliers. It's true. That's not the majority of people, but it can be "normal". This is how they are their entire life and they don't experience discomfort associated with it.
So if there's suddenly a change, if you're a person who normally goes every single day and you start going only once a week, that's a problem. That's very different than somebody who's only gone once a week their entire lives.
Maggie Mckay: What do you say to patients who don't tell you about their constipation because they're embarrassed?
Dr. Linda Lee: So many people are embarrassed. I can't tell you how many people. You know, when they come to the office and they're here because they have abdominal discomfort or they do have a change in their bowel habits, just getting people to describe what their stool looks like or what their bowel habits are like can be very challenging because socially, and I think especially for women, it's not very culturally acceptable for us to be very open about the fact that we actually have bowel movements and make gas just like guys do.
What I sometimes do is I warn people that I'm going to ask them a lot of personal questions about their bowel movements and that whatever we talk about is shared only in the office. And then sometimes I even use a little visual aid. It's called a Bristol stool chart, and it has pictures, like drawing, drawing, not live pictures, but drawings of what different consistencies of stool look like. And so that can be a helpful visual aid because the patient can then just point and say, "This is what my poop looks like most of the time." And that is a great help to me.
Maggie Mckay: I bet. When it comes to treating mild constipation, like at home, what's the best method? Dulcolax or...?
Dr. Linda Lee: Yeah. Well, I think it really depends. So we should define what constipation is. So often people think that constipation means you don't go very frequently. And while that's one definition of constipation, we also say that people are constipated if they, A, have to strain to initiate or complete a bowel movement or, B, if they feel incompletely evacuated, when they go.
So even if you go every day, but you're straining, right? And you are feeling incompletely evacuated, and maybe you're passing what looks like little rocks and pebbles, you are constipated despite the fact that you're going every day. And so depending on the type of constipation you have, then there are different kinds of laxatives that might be helpful to you to sort of help you get over it.
If you are somebody who tends to have very hard stools and taking fiber or taking something called polyethylene glycol 3350, which is a powder not absorbed into the body, but just staying in your GI tract to keep your stool soft, can be very beneficial, but you have to use it on a regular basis to prevent yourself from getting that hard stool.
If you're somebody who's been backed up for a couple of weeks and you're really in a lot of discomfort, then Dulcolax can also be very helpful or what we call bisacodyl, that's the generic name, or senokot, Senna tablets, which is derived from a plant. These actually stimulate contractions in the colon to help you move things forward.
Maggie Mckay: Doctor, is there any connection between colon cancer and constipation?
Dr. Linda Lee: Well, you know, there's been a lot of speculation about that. People who tend to be chronically constipated are not necessarily at higher risk for developing colon cancer in the future. However, this is why I say that if you're somebody who has been having regular bowel movements, despite whatever frequency that is your entire life and suddenly that changes, that could be a sign of an early colon cancer, if you stop going as frequently as you used to go, and that's a reason for you to go get checked out by your doctor, particularly if you're over the age of 45.
Maggie Mckay: Okay. Thank you so much, Dr. Lee. We appreciate you joining us and shedding some light on a topic many people find embarrassing, like we said, but one that's important to understand.
Dr. Linda Lee: Well, thank you so much. And any time if you have more questions, let me know.
Maggie Mckay: Okay. Thank you. To find out more, call (718) 283-5900 Monday through Friday 9:00 AM to 5:00 PM for an appointment or go to my maimodocs.org. That's my Maimo, M-A-I-M-O docs dot org. This has been my Maimo Med Talk. I'm your host, Maggie McKay. Thanks for listening.