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Food and Common Sense

The Cause and Cure of an All-Too-Common National Ailment


In polite company, it may still be considered an indelicate subject. But judging from the swelling size of the laxative industry, constipation seems to be an all-too-common national ailment. In 1982, Americans spent no less than $368 million on the more than 120 preparations available over the counter.

How do these products work, when should they be used, and most important, how do you prevent the problem in the first place?

Laxatives can be grouped into four major categories: softeners and lubricants, osmotic agents, stimulants and bulking agents. A single product may contain a combination of these ingredients. When the need for a laxative is indicated, it is important to read the label carefully to see exactly what is inside.

Softeners act by facilitating the mixing of intestinal water and the fatty substances in the stool, softening the fecal matter and easing its passage through the intestine. Docosate sodium is the substance most commonly used in these preparations.

Altering Fluid Balance

Lubricants, such as mineral oil, coat the stools, making them easier to pass. Osmotic agents, which contain magnesium or sodium, alter the fluid and electrolyte balance in the colon. As a result, water is retained in the bowel, and the increased pressure stimulates intestinal movement. Magnesium may also act by stimulating the release into the gut of a hormone called cholecystokinin, which itself promotes fluid accumulation.

Stimulants such as senna, danthron, bisacodyl, phenolphthalein and castor oil are believed to work by both initiating muscle contractions in the colon and by causing increased intestinal water retention.

Finally, bulking agents derived from polysaccharides or cellulose take on water and swell in the colon, increasing stool bulk and thus encouraging intestinal muscle activity.

Unfortunately, the misconception seems to be afloat that these products are completely safe, perhaps because they are advertised widely and are available without prescription. Yet they do have side effects. Stimulants, which cause abdominal cramping, are believed to be the most abused of all laxatives. An alarming number of weight-conscious women use these products to try to purge themselves of calories after a meal.

Damage to Colon

Not only is this an ineffective antidote to overeating, but, more importantly, excessive use of stimulants can lead to fluid and electrolyte imbalances and cause serious, permanent damage to the colon. Mineral oil, when used over an extended period, may impair the absorption of the fat-soluble vitamins A, D, E and K. And whereas bulking agents are probably the safest alternative, they must be taken with adequate fluid to prevent complications.

Individuals using other medications, and particularly the elderly who may be taking several different drugs, should check with their doctor or pharmacist before taking any laxative to make sure there is no risk of undesirable interactions. Some laxatives can decrease the absorption of orally administered medications. On the other hand, some drugs and over-the-counter preparations such as anti-convulsants, calcium-containing antacids and iron supplements can lead to constipation in some individuals.

Pregnant women, many of whom suffer from constipation, should also be sure to ask the advice of their physician before choosing a laxative. Those containing stimulants are to be avoided. This is true also for nursing mothers, since these drugs will pass into the milk.

As an alternative to laxatives, which carry varying degrees of risk, three non-pharmacological, truly "all-natural" measures can both treat and help prevent constipation. In fact, they are usually the first to be prescribed by a physician.

Increase Fiber Consumption

First, increase consumption of fiber, a food component often in short supply in the American diet. Dietary fiber acts by a mechanism similar to that of the bulking agents, increasing stool volume and thereby stimulating intestinal movement. High-fiber foods include bran, whole grains, fruits, vegetables and nuts.

Second, get daily exercise. Just walking may be enough. Exercise increases the activity of the intestinal muscles, facilitating the movement of the stool through the colon. Also, get in the habit of allowing a regular time to respond to the urge to have a bowel movement. Often this is a period after a meal.

Finally, we must emphasize that whereas constipation may be a common condition and one for which treatments are readily available, it can mask far more serious medical problems. Self-treatment of constipation for more than a few days without seeking medical advice is risky business.

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