Although every woman is different, most women have a bowel movement at least every other day, but not more than twice daily. Fewer than 3 bowel movements per week, along with the need to strain and hard stool, is often described as constipation. It affects one in three women and may be associated with a number of other symptoms including:
Cramping or abdominal discomfort
Hard or lumpy stool
Incomplete emptying of the bowel
What causes constipation?There are a number of things that cause constipation. Diet is an important consideration, but colon and pelvic floor muscle function can also be important. Lifestyle, medications, and pelvic floor disorders may also impact bowel function.
Lifestyle FactorsInadequate fiber or water in your diet are common causes of constipation. A diet with low fiber foods, such as pasta, white rice and white bread, can also lead to constipation. Exercise usually improves bowel function, while an inactive lifestyle can make constipation worse.
Medicines and SupplementsMedicines and supplements are common causes of constipation, especially medicines used to treat depression, high blood pressure, and narcotics for pain. Medicines used to treat overactive bladder are another common cause.
Irritable Bowel SyndromeIrritable bowel syndrome often known as IBS, is one of the most common causes of constipation. It is a functional disorder, which means that it results from uncoordinated contractions of the muscles in the colon wall.
Pelvic Floor DisordersSpasm of the pelvic floor muscles can cause constipation, often with associated pain. It is not uncommon to find prolapse in women with constipation, and prolapse can make constipation worse. At the same time, straining from other causes of constipation can lead to prolapse. So it is important to determine whether the constipation is leading to prolapse, or the prolapse is contributing to the constipation.
Medical ConditionsKidney disease, colitis, thyroid disorders, neurologic conditions (such as multiple sclerosis, and spinal cord injuries) and cancer can also lead to constipation.
If you have been diagnosedMany women are embarrassed to discuss their bowel function with their medical provider, but this is essential to determine the cause of your constipation. Most often, the causes of constipation can be determined based on a description of your symptoms and a pelvic exam. Sometimes, imagine studies are needed to evaluate bowel function. If you have blood in your stool, you should have a colonoscopy procedure.
Treatment optionsThe first step to treating constipation is to modify lifestyle to maximize bowel function. This includes increasing your dietary fiber, fluid intake and activity level. For example, eating whole grains, legumes, fruits, and vegetables will increase the fiber in your diet. Your goal should be 20-30 grams of fiber daily. (see high fiber foods table below) It is wise to simultaneously increase fluid intake, while gradually increasing fiber to minimize bloating. Regular exercise will also improve bowel function. Some women find that changing their position during bowel movements makes a big difference. Put your feet on a small stool at the base of the toilet. This position helps to relax the pelvic floor muscles making it easier for the stool to pass.