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Poop: When going No. 2 becomes a No. 1 problem

Health
Woman with stomach ache

How often we should be going “No. 2” is often the No. 1 question patients want to ask a physician.
For Dr. Christopher Brown, a gastroenterologist with Tidelands Health, there’s not a straightforward answer.
That’s because how often you should go is determined by what’s right for your body, not necessarily by a generic standard. Clinically speaking, Dr. Brown says constipation is defined by any two of these symptoms:

  • Decrease in stool frequency from your baseline (normal frequency) over a three-month period
  • Lumpy hard stools that are difficult to pass
  • A sensation of incomplete evacuation
  • Use of digital manipulation to achieve a bowel movement
  • A sensation of an obstruction in the rectal area

“So in short, there is no set number of bowel movements a patient should have during a week or month,” says Dr. Brown, who practices at the Georgetown and Murrells Inlet locations of Tidelands Health Gastroenterology. “What’s more important is determining the normal stool frequency for each individual patient. Most people have a good idea how often ‘normal’ is for them.”
Studies show a good deal of variability in the number of weekly bowel movements by otherwise healthy people. “Normal” can range anywhere from three per week to three per day. That’s why it’s important to recognize what’s right for your own body instead of what a textbook says you should be doing, Dr. Brown says.

Constipation or not?

If you think you might be constipated, Dr. Brown says it’s important to first take account of your diet.
“Are you drinking enough water? Are you taking in enough fiber? If you have always had regular bowel movements, but something has abruptly changed, you should try dietary modification as well as seeing a physician to ensure nothing else is causing the issue,” he says.
Causes of constipation can be grouped into five broad categories:

  • Slow transit, meaning the stool moves slowly through the colon. Nervous system issues can cause this to occur.
  • Dyssynergic defecation, which means the patient has problems expelling stool from the rectum. In other words, the muscles that help your body expel waste don’t work properly.
  • Irritable bowel syndrome, an incredibly common cause of constipation also associated with abdominal pain.
  • Secondary causes such as metabolic disorders, endocrine disorders and medications, especially narcotic painkillers.
  • Idiopathic causes, which means doctors can’t determine the reason constipation is happening.

“It’s important to figure out why someone is constipated because that really helps to tailor treatment to each patient,” Dr. Brown says.
Laxatives are generally a safe way to alleviate constipation, but Dr. Brown says there are also other ways to manage the problem.

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Poop: When going No. 2 becomes a No. 1 problem

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“I stress water intake and exercise to all of my patients, despite the fact the evidence to suggest it helps is not robust. I think that diet specifically affects bowel regularity more than anything,” he says.
Fiber bulks the stool, enabling it to move through the colon with greater ease. Over-the-counter psyllium fiber helps with constipation and has been shown to help with crampy abdominal pain, he says.
If you think you’re constipated and have tried making dietary modifications, Dr. Brown says you should make an appointment with your doctor to rule out underlying conditions.

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