Constipation is something that most everyone suffers from at one time or another, but few people want to talk about.

Constipation is typically defined as having a bowel movement fewer than three times per week. With constipation, stools are usually hard, dry, small in size and difficult to eliminate. Some people who are constipated find it painful to have a bowel movement and often experience straining, bloating and the sensation of a full bowel.

“It’s one of the most common things that I see,” said Dr. Nina Sax of Albany Gastroenterology Consultants. “I think what’s really more important than the clinical definition, is what a person feels. In other words, for some people it’s normal to move their bowels once a week. For others, it’s once a day. So everyone is a little different.”

More than 4 million Americans have frequent constipation, accounting for 2.5 million physician visits a year. Those reporting constipation are most often women and adults age 65 and older. Pregnant women may have constipation, and it is a common problem following childbirth or surgery.

“To be considered constipated, these symptoms have to be present for three months or more,” said Dr. Timothy Litynski, chief of gastroenterology at Ellis Hospital.

Understanding process

To understand constipation, it helps to know how the colon or large intestine works. As food moves through the colon, it absorbs water from the food while it forms waste products or stool. Muscle contractions in the colon then push the stool toward the rectum. By the time stool reaches the rectum, it is solid, because most of the water has been absorbed.

Constipation occurs when the colon absorbs too much water, or if the colon’s muscle contractions are slow or sluggish causing the stool to move through the colon too slowly. As a result, stools can become hard and dry.

“The function of the large intestine is to reabsorb water back into the body,” explained Sax. “What happens is, if the colon doesn’t move things along fast enough, then more fluid is reabsorbed into the body and the stool gets harder and sits and becomes very difficult to pass.”

A number of factors can cause people’s digestive systems to slow down.

“The first things we are concerned about is if there could be a blockage,” said Litynski. “So we look for tumors or polyps.”

Other medical conditions such as irritable bowel syndrome, diabetes or thyroid disease also can cause constipation.

In addition, constipation may develop as a side effect of medications, including drugs to treat pain, Parkinson’s disease, high blood pressure, allergies and depression.

Everyday causes

More often than not, it’s caused by everyday factors such as:

-- Diet imbalances. Diets high in protein, fats and refined sugars and low in fiber can lead to constipation.

-- Inattention to bowel habits. Putting off the urge to go to the bathroom can lead to constipation.

-- Inadequate fluid intake. Not consuming enough fluid can lead to dehydration, which leaves little water left to moisten the stool after your body draws out what it needs.

-- Lack of physical activity. Constipation is common in people who are on bed rest or who are inactive for a long time.

Although bothersome, constipation usually isn’t serious. But rarely, it may be caused by a serious underlying condition.

“Certainly chronic constipation in someone over age 50 should be evaluated,” said Litynski.

Other warning signs include an unexplained weight loss of 10 pounds, a family history of colon cancer, rectal bleeding, anemia, and acute onset of constipation in elderly patients.

“Actually anyone of any age who has chronic constipation should see their family doctor,” Litynski suggested.

Even children can become constipated, added Sax.

“Sometimes, they are outside playing, and they ignore the urge to go,” she said. “So when you have the urge, you should always go.”

Lifestyle changes

The safest and most practical way to begin treatment for constipation and prevent its recurrence is through lifestyle changes such as:

-- Drinking fluids. Even if you don’t feel thirsty, try to drink at least three to four glasses of water a day. Limit caffeinated and alcoholic drinks, which can cause you to lose water.

-- Adding fiber rich foods to your diet. Gradually increase your intake of fresh fruits, vegetables, beans and peas, and whole-grain cereals and breads.

-- Staying active. Engage in regular exercise such as walking, biking or swimming on most days. Being physically active may promote movement of your colon muscles.

If those measures aren’t enough, your doctor may recommend a fiber supplement such as psyllium (Metamucil) or methylecellulose (Citracel.) Fiber supplements can help bulk up your stool and psyllium has been shown to increase stool frequency. Doctors suggest adding fiber slowly to your diet to avoid gas and bloating, and drink plenty of water or your constipation may be made worse.

In some cases, your doctor might recommend a short-term course of laxatives.

“I think a common misconception is that people will become dependent on laxatives,” said Litynski. “Laxative dependency is usually not a problem.”

“You don’t, of course, want to be abusing laxatives,” added Sax. “You’d like to do the more healthful things first. But there are times when people need what we call a rescue laxative when people haven’t moved their bowels for a long period of time.”

Sax said the main thing to remember is that everyone gets constipated at one time or another, and that many people think they are constipated if they don’t move their bowels every day, and that’s not true.

“Sometimes, people move their bowels every two or three days — that’s their usual pattern,” she said. “So you don’t have to have a bowel movement every day.”