Constipation

Teens might not talk about it, but it’s a fact that everyone, once in a while, has trouble having a bowel movement or “BM” (pooping). The good news is that this usually isn’t a serious problem.

What does it mean if you are “constipated”?

A person who is constipated might:

• Have fewer BM’s each week
• Have pain during a BM
• Have BM’s that are too hard or too small
• Strain when they try to have a BM
• Feel like they don’t have a complete BM

Everybody’s bathroom habits are different, but you are likely to be constipated if you’re having 3 or fewer BM’s in a week. Sometimes people may wait so long to try and have a BM (because they think it’s going to hurt), that they get even more constipated.

What causes constipation?

These are some causes of constipation:

• Some medical conditions such as diabetes, irritable bowel syndrome, and low thyroid
• Medications such as strong pain pills, antidepressants, and antihistamines (check with your health care provider if you have questions)
• Waiting too long to go to the bathroom
• Not having enough fiber in your diet

The good news is that changes in your eating habits and lifestyle can keep you “regular” and help you feel better.

What are the signs of constipation?

Although there is no “right” number of BM’s a person should have, you will generally feel better if you have a BM every day or at least every other day. Not having regular BM’s can cause stomach pain. Most people have pain before they pass a large, hard BM.

Some people may notice bright red blood on the toilet paper or a streak of blood on their BM. This bleeding is a sign that the anus (the hole where the BM comes out) has been irritated. This can cause an “anal fissure” (a tear in this area) or a “hemorrhoid” (swollen tissue near the anus that is painful and often bleeds when a hard BM is passed). It can be scary to see blood, but the soreness and bleeding will generally go away when you start having regular and soft BM’s. You should make an appointment with your primary health care provider (PCP) so he/she can tell you what can help you. Your PCP may suggest warm baths, a high-fiber diet, drinking more water, and over the counter medicines and/or ointments to make you feel more comfortable and help the fissure heal.

What helps constipation?

When you’re very busy with school, sports, and other after-school activities, it can be a challenge to find a bathroom (and privacy). However, if constipation is making you uncomfortable, you can take the following steps to feel better:

• Plan ahead by knowing where the bathrooms are, whether you are at school, playing sports, or hanging out in other places.
• Slowly add more fiber to your diet and drink more water.
• Exercise. It’s important for good health and can help your digestive system.

Other tips:

• Pay attention to your body’s signals.
• When you feel the urge to go, find a bathroom.
• Start a habit of going to the bathroom at the same time every day, such as 20-30 minutes after a regular meal. You can usually get into a routine if you eat your meals around the same time each day.
• Get up early enough to have breakfast, then get dressed an dleave some time to go to the bathroom before you leave for school or work.
• Try not to be in a rush when you finally get to a bathroom, because it’s easier to go when you’re relaxed.
• Eat a high fiber diet (see below).
• Drink plenty of water.
• Exercise. For example, walking is a great way to start increasing activity.

Will the food I eat make a difference?

Yes. Foods containing fiber can help your digestive system break down food and prevent constipation. Fiber is found in fruits, vegetables, whole grains, beans, legumes, and nuts. Increase fiber in your diet gradually rather than all at once in order to prevent stomach pain.

How can I work on getting more fiber in my diet?

Below are some tips for increasing your fiber intake.

At breakfast:

• Eat high-fiber cereal or a bowl of oatmeal. When reading the Nutrition Facts Label look for a cereal with at least 4 grams of fiber per serving.
• Try whole wheat pancakes or waffles. If making your own, try adding unprocessed bran or All-Bran® to the batter.
• Add some fruit. Toss some berries on your cereal, make a fruit and yogurt smoothie, or have a slice of melon.
• Switch to whole grain toast or English muffins.
• Drink a small glass of prune juice.
• Drink a hot beverage that contains caffeine (such as coffee or tea), as caffeine and hot liquids can help to stimulate your bowels.

At lunch:

• Have soup containing beans or legumes, such as minestrone, black bean, or lentil.
• Make your sandwiches on whole grain bread, or in a pita or wrap.
• Add some vegetables to your sandwich, such as tomato, avocado, or cucumber.
• Add a side salad to your meal with dark leafy greens and other vegetables you enjoy such as peppers, carrots, and broccoli.

At dinner:

• Increase your portion of vegetables. Have some extra broccoli, squash, or green beans with your meal, or add a side salad.
• Include some beans, such as navy beans or kidney beans.
• Try a side portion of whole grain brown rice, whole wheat pasta, or quinoa.

Snack time:

• Have some raw vegetables such as peppers, grape tomatoes, or carrots. Try dipping them in hummus.
• Choose a piece of whole fruit, such as an apple (with skin) instead of juice.
• Add high-fiber cereal, unprocessed bran, or flaxseeds to yogurt.
• Make some trail mix with nuts, seeds, and dried fruit or raisins.
• Try a granola or cereal bar that contains oats.
• Have some popcorn.
• Snack on edamame (soybeans).

As a supplement:

• Have a fiber supplement drink, such as Metamucil®, Citrucel®, or Benefiber®.
• Try Metamucil® wafers.
• Some brands such as FiberOne® contain added fiber. While it is better to get fiber from foods where it occurs naturally, these products can help meet your fiber goals.

Be sure to drink plenty of fluids when you increase your fiber intake. Otherwise your constipation may actually get worse. In addition, increase your fiber intake slowly so you won’t feel bloated or have diarrhea.

How can reading the food label help me?

• When reading the food label, check the amount of dietary fiber a food contains.
• Look for breads, crackers, soups, granola bars, cereals, pastas, and other grains that have at least 3 grams of fiber per serving.
• Aim for 25-28 total grams of fiber per day.
• To figure out whether a food is a whole grain, read the list of ingredients. The first ingredient should be a whole grain, such as whole wheat or oats. Some food labels advertise that a product is “high fiber,” which means that the food contains 5 or more grams of fiber per serving.

Are there any foods I should avoid if I’m constipated?

Certain foods such as, candy, cookies, ice cream and other sweets that are generally high in fat and sugar are low in fiber. These foods can actually make your constipation worse. Try to choose higher fiber foods if you have problems with constipation.

What if I don’t like high fiber foods?

If you are not a fan of high fiber foods such as fruits, vegetables, and whole grains, your health care provider may suggest that you drink a special powdered drink two or three times a day until you are no longer constipated. Drinking plenty of water and exercising each day may help, too.

What about laxatives?

Most of the time constipation will improve with a healthy diet rich in fiber including fruits and veggies, drinking lots of fluids and exercising regularly. If you continue to have symptoms of constipation your provider may prescribe an over-the-counter laxative.

There are many kinds of laxatives and they all work a little bit differently. They include: oral osmotics, oral bulk formers, oral stool softeners, oral stimulants and rectal suppositories. Some laxatives combine two types such as a stimulant and a stool softener. Most laxatives should be used for short periods of time as your body can get used to needing them to have a BM. Some laxatives such as the oral osmotics (ex. Miralax®) are mild and work by pulling water into the colon so that a BM can be passed easier. This type of laxative may be prescribed for an indefinite amount of time. Ask your primary care provider (PCP) before you decide to use these treatments.

When should I call my health care provider?

Call your health care provider if you have:

• Blood in your stools, vomiting, or stomach pain
• Loss of appetite
• Fever
• Constipation that gets worse or doesn’t get better

It’s common to be constipated once in a while, but if you have trouble or pain a lot of the time, or if you notice blood when you have a BM, you should make an appointment and talk to your primary health care provider. Decreasing foods that cause constipation, increasing fiber, drinking more water, and exercising will help keep you regular.

Additional Resources:

American College of Gastroenterology

American Gastroenterological Association

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