Young woman with stomach pain

Breaking the Constipation Taboo

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India is a hard person to keep up with. From scoring goals on the hockey field as a semi-professional player, to long days spent out on shoots as a prop stylist and designer, the 25-year-old from London is constantly on the move. But a year ago, her life started to slow down as she began experiencing an uncomfortable and sometimes painful condition – constipation.

On World Digestive Health Day, we want to raise awareness of the high incidence of constipation, break the misconceptions and abolish the taboos around the condition.

Constipation is a condition that affects up to 1 in 5 people.1 It is more commonly experienced by women, with the likelihood of suffering from constipation increasing with age.2

The symptoms of constipation vary. Most commonly, people report straining during defecation, having lumpy or hard stools, bloating, feeling like you haven’t passed the complete stool, and having fewer than three bowel movements per week.3,4

India experienced some of those symptoms and began feeling emotionally drained and noticed her energy levels depleting. “I started finding it harder to concentrate and felt less motivated to see friends and be active - especially during my time on the hockey field. The worry of experiencing a sudden bout of cramping from constipation during a hockey game would stress me out,” said India.

Professor Stefan Müller-Lissner, MD a gastroenterology expert based in Germany said constipation can negatively impact a person’s quality of life. “It can significantly interfere with a person’s wellbeing. A study found women who reported persistent constipation had higher levels of self-reported depression,” Professor Müller-Lissner said.5,6

“Constipation can be triggered as a result of factors such as travel, shift work, sleep issues, stress or a lack of dietary fibre.7,8,9
In addition, intake of certain medications can result in constipation.”10

India sought medical advice to help her discover the cause of her constipation.

Young woman smiling at her desk

“I was sick of the negative impact the constipation was having on my life and am so glad I didn’t let a little bit of embarrassment get in the way of my wellbeing. Talking to the doctor was really helpful as I learned what I could do to reduce my symptoms,” India said.

“There are so many myths around constipation that it was helpful to seek clarification from my doctor. I’m now always careful to stay hydrated and consume enough fibre by eating plenty of fruits and vegetables.”

While lifestyle changes can help, sometimes this is not enough for some people and a healthcare professional can recommend other options to help.

Professor Müller-Lissner encourages those who suffer from constipation to seek advice from a healthcare professional.

“Many patients are reluctant to consult a healthcare professional about constipation as they are embarrassed and incorrectly assume there’s nothing that can be done. I encourage anyone who may be suffering from constipation to not feel embarrassed as it is a common occurrence that can affect anyone,” Professor Müller-Lissner said.

Facts and Myths

1. You should have a bowel movement every day
Myth! What’s ‘normal’ varies. Some people go 3 times a day, others 3 times a week.11

2. Staying hydrated may help
Fact! Drinking plenty of water helps prevent dehydration, which can cause constipation.12
However: No effect on constipation is to be expected from increasing the fluid intake above the recommended daily volume.12,13

3. Holding it won’t hurt
Myth! Ignoring the urge when it comes may not only make you physically uncomfortable it also may lead to constipation.11,14

4. Taking a laxative can lead to dependency
Myth! Many people may think that using a laxative frequently could lead to a dependence and therefore the body may adapt to the treatment.15 However, there is no evidence to suggest that laxatives cause physical dependence.16,17

References

  1. Higgins et al. Epidemiology of constipation in North America. Am J Gastroenterol 2004 Apr;99(4):750-9
  2. Müller-Lissner et al. Levels of satisfaction with current chronic constipation treatment options in Europe – an internet survey. Alimentary Pharmacology & Therapeutics. 2013. 37(01):137-145.
  3. Koch et al. Symptoms in chronic constipation. Diseases of the Colon & Rectum. 1997. 40:902-6
  4. Lacy et al. Bowel Disorders. Gastroenterology. 2016. 150(6):1393–1407.
  5. Koloski et al. Impact of Persistent Constipation on Health-Related Quality of Life and Mortality in Older Community- Dwelling Women. The American Journal of Gastroenterology. 2013. 108:1152–1158.
  6. Bharucha AE, Pemberton JH, Locke GR 3rd. American Gastroenterological Association technical review on constipation. Gastroenterology. 2013 Jan;144(1):218-38.
  7. Knutsson A, Bøggild H. Gastrointestinal disorders among shift workers. Scand J Work Environ Health 2010;36(2):85-95.
  8. Bron R, Furness JB. Rhythm of digestion: keeping time in the gastrointestinal tract. Clin Exp Pharmacol Physiol. 2009 Oct;36(10):1041-8.
  9. Jiang Y, Tang YR, Xie C et al. Influence of sleep disorders on somatic symptoms, mental health and quality of life in patients with chronic constipation. Medicine 2017; 96: e6093
  10. Müller-Lissner et al. Opioid-Induced Constipation and Bowel Dysfunction: A Clinical Guideline. Pain Medicine. 2017; 18(10):1837–1863.
  11. Walter SA et al. Assessment of normal bowel habits in the general adult population: the Popcol study. Scandinavian Journal of Gastroenterology. 2010; 45(5): 556-566
  12. Hicks R, Dr. Myths and Facts About Constipation. Webmd. 2017. Available Online: https://www.webmd.boots.com/digestive-disorders/ss/slideshow-constipation-facts. [Accessed May 2018]
  13. Andresen V et al. S2k guideline for chronic constipation: definition, pathophysiology, diagnosis and therapy. Z Gastroenterol. 2013 Jul;51(7):651-72)
  14. Basilisco G & Coletta M. Chronic constipation: a critical review. Digestive Liver Disease. 2013; 45(11):886-893
  15. MacLaren E, PhD. Understanding Tolerance, Dependence, and Addiction. DrugAbuse.com. 2018. Available Online: https://drugabuse.com/library/tolerance-dependence-addiction/ [Accessed May 2018]
  16. Müller-Lissner et al. Myths and misconceptions about chronic constipation. American Journal of Gastroenterology. 2005; 100(1):232-242
  17. Mueller-Lissner S et al. S1328 Patients can self-manage their stimulant laxative dose to achieve effective relief of chronic constipation, as demonstrated in two randomized trials. Gastroenterology. 2018. 138(5): S-230