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I Can’t Go
Nov 15th, 2010 Tales from the Clinic

A 31-year old woman comes to clinic complaining of abdominal pain.  She describes the pain as dull and crampy and worse after eating.  She has also noted worsening bloating and belching.  She occasionally feels nauseated but has not vomited.  She denies problems with urination, fever, cold symptoms, back pain, vaginal symptoms.  Her periods have been regular.  Upon further questioning, she admits that she hasn’t been “regular” for quite awhile.  Her last bowel movement was three days ago and was painful to pass.

On exam, the patient appears comfortable.  Her abdomen is not tender to touch.  The rest of her exam is unremarkable.  Her urine tests are normal.  An X-ray of her abdomen shows a large amount of stool in the large intestine and rectum.

Discussion

“Normal” bowel movements vary from person to person.  Some people “go” every day, others every 2-3 days.  Some people have consistently soft stools.  Some people have firm stools.  But if you have difficulty passing stool, have hard stools, or are passing stool less frequently than normal, you probably suffer from constipation.

Most people will have constipation at some point in their lives.  You’re at risk if you don’t eat a lot of fiber (you should take in about 25-30 grams a day), lead a sedentary lifestyle (exercise helps promote contraction of bowel muscle), and don’t drink enough fluid (water keeps the stool from becoming hard and dry).  Other conditions that can lead to constipation include irritable bowel syndrome, pregnancy, thyroid disease, and certain medications (like narcotic pain killers and iron).

The best way to stay “regular” is to include lots of high-fiber foods in your diet, e.g. vegetables, fruits, and whole grains.  Avoid foods that contain a lot of fat and sugar like processed foods, sweets, and cheeses.  These can make constipation worse.  You can also use an over-the-counter stool softener or fiber supplement on a regular basis.

Once you develop constipation, you may need to turn to over-the-counter remedies like laxatives, rectal suppositories, or enemas.  You can ask your pharmacist or physician for recommendations.  Do not give laxatives or enemas to children without first asking their pediatrician.

If the constipation persists or if you have severe abdominal pain, rectal bleeding, or vomiting, call your doctor.

Follow-up

The patient was given a prescription for an enema and a stool softener.  She was also advised to increase the amount of fiber in her diet.  A few days later, she was feeling much better.



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