“I suffered with constipation for a year just because I wouldn’t mention it to my doctor.”
— Liz B.*, Connecticut

“I’m bothered by constipation when I travel, probably because of differences in water or food.”
— Ruby S., New York

Constipation is an embarrassing subject, but somebody must be talking:
This “taboo” accounts for 2.5 million visits to physicians every year.
What’s more, Americans spend $725 million annually on laxatives. But
there’s no doubt that many women are suffering in silence. A recent
survey found that most would rather reveal their age, discuss their
weight, or try on bathing suits than discuss or even mention
constipation.

Sometimes, worries about this “hush-hush” problem are needless.

The
idea that everyone should have a daily bowel movement is a
myth—“regularity” differs from person to person and can range from
three times a week to three times a day. Doctors define constipation as
having fewer than three bowel movements a week, sometimes only after
considerable bloating, straining, and discomfort. They consider the
problem to be chronic when people have at least two symptoms that occur
on and off or consecutively for three months over a period of six
months, says Satish S.C. Rao, MD, professor of medicine and director of
neurogastroenterology and gastrointestinal (GI) motility at the
University of Iowa. Those symptoms include excessive straining, hard
stools, a feeling of not fully eliminating, and/or being blocked in the
rectal area.

Fiber and fluids to the rescue
Sometimes constipation stems from not eating enough fruits, vegetables,
and whole grains, which provide the fiber needed for healthy bowel
function. (The goal is to get 20 to 35 grams daily, but most Americans
get less than 14 grams.) Or, you may not be drinking enough liquid.
Water is best; caffeinated beverages and alcoholic drinks can make
matters worse. For reasons doctors don’t fully understand, lack of
exercise also plays a role. And, as you may have noticed, constipation
occurs most frequently when your daily routine changes, during
pregnancy, or as metabolism slows with age. Another common cause:
ignoring the urge to “go” because you’re too busy or don’t want to use
a public toilet.

Sometimes constipation is a side effect of medications or a
complication of a neurological problem (e.g., a stroke), metabolic
condition (e.g., diabetes), or hormonal disturbance (e.g., low thyroid
function). Constipation is also a common feature of irritable bowel
syndrome (IBS).

Greater understanding, more treatment options
“We now understand constipation so much better than we used to and have better ways to treat it,” says Dr. Rao.

Treatment
for constipation should begin with some healthy lifestyle changes—more
fiber, water, and exercise. You can safely try that on your own, says
Dr. Rao, but see the doctor if it doesn’t help. If you’re over 50,
consider discussing the issue with your doctor if lifestyle changes
don’t provide relief. Doctors may recommend fiber supplements to bulk
up stool, stimulant laxatives to trigger the muscle contractions that
promote elimination, or stool softeners to help prevent straining. A
variety of other laxative types are available for people with more
complicated cases.

Don’t let embarrassment keep you from visiting your doctor—he or
she has heard it all before. You’re likely to come away with a
diagnosis—and a treatment that will provide relief.
*Pseudonym