When it comes to treating patients with constipation (infrequent bowel movements or dry, hard stools), Dr. Deutsch first asks a lot of questions.
“I tell people that their normal may not be my normal or the next person’s normal. We are all very different when it comes to bowel habits,” she says. “I need to know what the stool looks like, from the color to the length, and how long it takes you to go. If someone is only going once or twice a week and the stools are looking like little rabbit pellets, I need to tease that out.”
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To help explain, Dr. Deutsch often shows patients a bell-shaped curve from a study published in Gastroenterology. “On the national average, people poop anywhere from three times a week to three times a day,” she says. “That is a huge range. I stress that if you don’t feel good, we need to make you feel good. If you are worried that you are sitting on the toilet for an hour and passing small, hard pellets, we should see if you are getting enough fiber or physical movement every day. Or maybe we need an over-the-counter or even prescription-strength laxative.”
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Dr. Deutsch also doesn’t shy away from sharing her own experiences. “It can be TMI, but I let people know that we all deal with these problems once in a while,” she says. “If I don’t go to the gym and I don’t eat any fruits and vegetables for a week, my poop looks like something my cat would produce.”
For treatment, many over-the-counter medications help in different ways. Colace, for example, is a stool softener that draws water into the stool to make it easier to push out. Because it is not a laxative, it may take a few days for it to work. Senokot is a laxative stimulant that propels stool forward. Meanwhile, Dulcolax and Miralax are osmototic laxatives that draw water into the colon to make it easier to push stool out.
“People should definitely talk to their doctor about what to use. I always recommend starting with Miralax if you want to try something over the counter. It’s very gentle and easy and works after a few days of taking it,” Dr. Deutsch says.
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There are three “flavors” of constipation, she adds. Chronic idiopathic constipation is “your run-of-the-mill constipation from not eating enough fiber, drinking enough water, or moving around enough,” she says. “We can overcome this simply by adding more fiber into your diet and maybe using Miralax.”
Slow transit constipation is when pelvic floor muscles “become a little lazy,” Dr. Deutsch explains. “If you are pushing and straining and doing acrobatics on the toilet, like rocking back and forth or twisting side to side, then the muscles forget how to work well together,” she says. “We may need to do a rectal exam to figure out what is going on and refer you to physical therapy for help.”
The third type of constipation, colonic inertia, is rare, Dr. Deutsch says. “This is when the electrical impulses in the colon are weakened and the motion to move stool forward is not as strong as it should be,” she says. “We don’t know what causes this, but there is an oral medication that helps.”
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