Q: I have been constipated for many years. My husband tells me not to worry, but I would like to be normal and have a bowel movement every day. What can I do?
A: For starters, you should consider listening to your husband's advice, at least with regard to this matter. A daily bowel movement is not necessary and there is no danger if your bowels do not move every day.
The frequency of bowel movements in normal men and women of all ages varies widely from as many as three daily to as few as three per week. A marked and sustained reduction in the frequency of movements or the passage of extremely hard stools might also be considered as constipation. A doctor should be consulted for true constipation or any major change in bowel habits.
A number of measures may alleviate constipation. A good place to start is to increase the fiber content of the diet by eating more grains, fruits and vegetables. Regular physical exercise and a daily intake of at least 6 to 8 glasses of water or other fluids may be helpful. Be sure you are not taking a medication that causes constipation.
It is important not to resist the urge to have a bowel movement. If constipation persists, one of the bulk-forming agents might be tried. These natural or artificial fiber or fiber-like products are safe and usually quite effective in increasing the frequency of movements and softening the stools.
(Excessive bloating and gas production may be side effects of using the bulk-forming agents or eating a diet rich in fiber.) Avoid other laxatives completely or use infrequently. They can irritate the bowel and weaken the intestinal muscles so habitual use of laxatives is needed.
Excessive use of laxatives can also cause dangerous losses of water and minerals. Enemas, especially irritating ones containing soap suds, should also be avoided unless prescribed for a specific purpose.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for faculty affairs at the school.