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How do you know whether you’re pooping enough? In healthy people, the frequency of bowel movements has a surprisingly wide range. “Normal can be anything from three times a day to having one bowel movement every three days,” says Judy Nee, an instructor at Harvard Medical School and Beth Israel Deaconess Medical Center.
It’s not all about frequency, though. Constipation is usually defined as having fewer than three bowel movements per week. But if you’re defecating more often than that yet straining when you go, passing hard or lumpy stools, or feeling like a bowel movement was incomplete, you are also considered to have constipation and would probably benefit from a few strategies to retune your gastrointestinal doings.
We spoke with experts and did some research to find out which remedies work and which don’t.
The first step in addressing constipation is to make sure you’re consuming sufficient dietary fiber. You’re probably not getting enough. The Agriculture Department recommends that women get at least 22 grams per day and men get 28. But on average, most adults in the United States get only about 16 daily grams.
The reason you need more is that fiber adds bulk to your stool. “The increased bulk in the colon induces colon contractions,” propelling waste out of the bowel, says Michael Camilleri, a professor of medicine at the Mayo Clinic in Rochester, Minn.
Here’s how to fiber up:
●Make it a point to consume high-fiber foods daily. For example, a half-cup of cooked kidney beans has about seven grams of fiber, a cup of cooked rolled oats has about 14 grams, and a pear with its skin on has about five grams.
According to Camilleri, fruit may be especially helpful because the sugars it contains can help the intestines retain water, which helps waste material pass more easily through the colon. And, yes, that appears to include prunes, the dried plums that have long been thought of as a sure path to regularity.
●But if you’re having trouble getting enough fiber through food alone, try one of the over-the-counter fiber supplements. Those that contain psyllium (Metamucil, Konsyl and generic) are a good option, according to Consumer Reports’ 2015 Best Buy Drugs report on medication for constipation.
For high-fiber foods and supplements, however, be careful not to add too much to your diet too fast. “Paradoxically, it can constipate you initially,” Nee says, or cause you to feel bloated or gassy.
Instead, start with small changes; Nee advises ramping up your intake over several weeks. Spread your fiber across the day. Drink plenty of water, which helps your body digest the fiber. And get physical activity: A sedentary lifestyle may increase the likelihood of constipation, especially in older people.
Another key strategy, according to Nee: scheduling bowel movements and giving yourself enough time for them. A good time is shortly after eating, because eating, especially in the morning, Nee says, tells your gastrointestinal tract to start moving. And try to stay on that schedule even when you’re away from home.
If you’ve boosted your fiber intake but are still constipated, consider an OTC laxative, which can facilitate easier bowel movements.
Two main categories of OTC laxatives are available: osmotic and stimulant. Osmotic laxatives cause more water to be retained in the intestines and colon, which helps waste pass through the colon, Camilleri says. One of the most common active ingredients in this category is polyethylene glycol (found in HealthyLax, MiraLax and generic).
Stimulant laxatives cause colon contractions that move stool along. Common formulations include senna (ExLax, Senokot and generic) and bisacodyl (Correctol, Dulcolax and generic).
Which to consider? Consumer Reports’ Best Buy Drugs experts recommend polyethylene glycol as a good first option because it appears to have the strongest evidence of effectiveness and may have fewer side effects than others.
Stimulant laxatives can be helpful but are designed only to help resolve an occasional bout of constipation and aren’t recommended for children younger than 6. Stool softeners, like docusate (Colace and others) are also available, but evidence suggests that they may be less useful than fiber or laxatives.
Can you become dependent on laxatives, as rumor has it? The experts we spoke to said it’s unlikely. But some older adults may need to use laxatives on a fairly regular basis, according to Camilleri, who notes that laxatives can give an assist to the colon function that may slow with age.
Lifestyle changes and OTC laxatives aren’t helping enough? Talk with your doctor. A number of medications can contribute to constipation, including antidepressants, antihistamines, some blood pressure and cholesterol-lowering medications, and, notably, opioids and other painkillers. So be sure your doctor is aware of any OTC and prescription medications you’re taking.
Prescription drugs are also available for chronic constipation, but our experts say that you should consider them only if other measures have failed. These include drugs designed specifically for opioid-induced constipation: methylnaltrexone (Relistor), naloxegol (Movantik) and naldemedine (Symproic). Your doctor can help determine whether one of these medications is right for you.
And last, be aware that for some people with chronic constipation, the abdominal, pelvic-floor and sphincter muscles may not be working with each other or may be contracting at the wrong times, making evacuation difficult. If your doctor finds this to be the problem, Camilleri says, you may need a few sessions with a specialized physical therapist “to learn how to relax the sphincter muscle and the pelvic-floor muscle.”
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