I Feel Bloated & Haven’t Gone to the Bathroom, Am I Constipated?

Do you feel bloated? Do you strain when you have a bowel movement? Do you have hard stools? Do you have less than three bowel movements a week? If you answered yes to any of these questions, you might be constipated. Constipation is when you have hard stools and a reduced frequency of bowel movements in a week (less than three). Constipation can be caused by many factors. Some of these factors include inactivity, medication side effects, low water intake, increased carbohydrates, diabetes, thyroid disease, and certain diseases related to the spinal cord. Constipation is not a disease; it is a symptom. Your doctor is going to evaluate you or your child to find a cause for constipation and treat it appropriately. Constipation is not contagious.

Common Constipation Symptoms

• Hard stools
• Small stools
• Straining when having a bowel movement
• Inactivity
• Bloating
• Dry stools
• Sensation of an incomplete bowel movement
• Red blood on the toilet tissue when you wipe
• Combined diarrhea and constipation

Who is at Risk for Constipation?

Anyone, including children and adults, can be at risk for constipation. In the adult population, two people out of every ten people are constipated. Constipation is seen more in Africans, women, and the elderly. Constipation can also be caused by inadequate sleep, poor nutrition, emotional stress, and anxiety. Children are often also at risk for constipation. Women are more likely to have an issue of the bowel called irritable bowel syndrome (IBS). IBS can be with constipation or with diarrhea.

What Will My Doctor Ask me?

Your doctor is going to ask you a number of questions regarding your constipation and bowel habits. It is imperative to answer these questions honestly to help your doctor determine the cause of your constipation and how to correct it. Constipation means something different to everyone, so the first thing your doctor is going to do is ask you what you mean when you say you are constipated (do you have hard stools, infrequent stools, small stools, bloating, or pain when having a bowel movement?). Other common questions your doctor will ask you include:

• How long have you been constipated or have had symptoms?
• How often do you get the urge to have a bowel movement? Do you go when you have the urge or do you “hold it”?
• Do you strain when you have a bowel movement?
• Do you have hard, small stools?
• Do you have the feeling you could go more but nothing else will come out?
• Are loose stools (soft or diarrhea) ever present?
• Do you have abdominal pain with black stools or rectal bleeding?
• What type of foods do you eat? How often do you eat these kinds of foods? How much fiber do you eat?
• How much water do you drink a day?
• Do you ever use laxatives or enemas to assist you in having a bowel movement? How often do you use these aids?
• Do you exercise daily? And if so, for how long?
• Are you under new or increased stress?
• Are you on any medications, and if so, which ones?
• Have you recently had surgery?

Treatment of Constipation

Treat the Cause

Treatment for constipation depends greatly on the cause. If your doctor finds that your constipation is due to a thyroid issue, he/she may send you to a physician who specializes in this field (endocrinologist). If your doctor determines your constipation is due to medications or medication side effects, he/she will adjust your medications when possible to avoid causing you constipation.

If your doctor determines you have alternating constipation and diarrhea, you may have irritable bowel syndrome, and he/she will treat you for this and send you to a specialist as necessary. Irritable bowel syndrome is a disorder with abdominal pain, constipation, diarrhea, and alternating constipation with diarrhea. Your doctor may find that you have irritable bowel syndrome with constipation and can start you on a medication called Zelnorm.

Bowel Regimen

Your doctor will recommend adding fiber to your diet gradually. It can be done through foods (beans, whole wheat foods, bran, berries, broccoli, carrots, fruits, and nuts) or through fiber supplements such as Metamucil, Citrucel, or Benefiber.

Your doctor will also recommend drinking six to eight glasses of water a day. Each glass should be at least eight ounces. Your doctor will also recommend increasing your physical activity to include sixty minutes of exercise daily. With these three changes to your diet and lifestyle, you should notice a difference in your bowel habits.

Your doctor may also ask you to start journaling the amount of fiber and water you take in daily as well as how much exercise you are getting daily. Make sure to limit your daily intake of refined and processed foods and keep track of them as well.

What do I Need to Know About Constipation? – Patient Education

• If your doctor starts you on a bowel regimen with fiber, you may be more gaseous than usual for a week or two after starting the fiber intake.
• If you are taking fiber supplements per your doctor’s recommendation, drink plenty of fluids for the fiber supplement to be effective. You need to drink eight ounces of water with each dose for it to work.
• You will not see instant results after starting a fiber supplement. It will take seven to ten days before you notice results.
• Try distraction, such as going for a walk, when anxiety or stress develop.

Emergency Warning Signs/When to Follow Up

If you notice blood in your stool, black stools, abdominal pain with bloody stools, rectal bleeding, rectal pain, nausea or vomiting, or fever, go to the emergency room right away for further evaluation as these symptoms may indicate you have a disorder of your intestines.

Follow-up with your doctor in two-four weeks to determine if the bowel regimen is working and then again in six months.