" What causes a ripple in the colon? I have
a problem trying to have a normal bowel movement.
My doctor claims the rippling effect is causing blockage
so the stool cannot come out. Is there anything that
can be done for this problem?
I am age 69, with Non-Hodgkins Lymphoma (in remission),
taking Estrace ® for hot flashes. "
Lorrie
Constipation is only a symptom of many different
diseases and conditions. Normal bowel movement frequency
varies from 3 times a week to 3 times a day. The definition
of constipation is a bowel movement 2 times a week
or less. Some people are under the misconception that
they must have a bowel movement every day and if not,
they call themselves constipated. As many as 15-25%
of women consider themselves as suffering from constipation
(1).
In the normal situation, any food you eat is digested
in the stomach into a liquid soup. It passes through
the small bowel where the nutrients are absorbed.
When it gets to the large colon, all the water that
is left is absorbed into the blood stream through
the colon wall. This leaves dry, undigestible waste
products that form the stool. If you do not drink
enough water or eat enough fiber, the stool is turned
into very hard lumps. To avoid constipation normally,
you do not have to drink excessive water but you have
to make sure your are not at all dehydrated because
any excess water in the stool will be resorbed in
the colon. If you eat mostly food made from refined
white flour instead of foods with whole grains and
fiber-rich foods, you will have a tendency toward
being constipated.
What causes a ripple in the colon?
I believe your doctor is using the term rippling to
refer to the peristaltic waves of colon muscle contractions
that move stool down to the rectum. If there is a
section of colon that does not "ripple",
you become constipated. At the point of blockage of
the peristalsis, there may develop excess "rippling"
that causes discomfort and pain because gas and liquid
behind the solid stool distend the colon. Thus it
is not the ripple that causes constipation, but the
lack of "rippling" or peristalsis of a section
of colon is one of the causes. The only way you would
know for sure if you have this problem is to have
had a bowel transit time xray in which you swallow
some dye capsules and they are followed through the
bowel by xray.
Most chronic constipation can be treated with dietary
and activity change. Sometimes current medical therapy
needs to be altered or temporary laxative therapy
started. In a very small percent of cases there is
a section of colon that has a nerve dysfunction that
cannot be overcome with non surgical therapy (2).
These suspected cases need further diagnostic work
up including colonoscopy and bowel transit studies.
If colonic inertia, or slow transit constipation is
found, there may be a need for surgical intervention
to remove part of the colon that does not peristalt
(3). The removal of a section of the colon (colectomy)
for constipation has a variable success rate (40-100%)
so it should only be considered after all other causes
have been ruled out and non surgical treatments tried
(4).
What medicines cause constipation?
Many different medicines can decrease bowel motility
and lead to constipation. While certain classes of
drugs that are known to cause constipation are listed
below, every prescribed and over-the-counter medication
you are taking should be looked up to see if it is
associated with causing constipation.
Antacids such as aluminum hydroxide
Calcium Carbonate
Anticholinergics (Ditropan ®, Detrol ®)
Antidiarrheals
Antiparkinson's
Antidepressants (especially tricyclics and lithium)
Antihypertensives/Antiarrhythmics (calcium channel
blockers especially verapamil)
Metals such as bismuth and iron
Opioid (narcotic) pain medicines
Laxatives (used chronically)
NSAIDs (ibuprofen, naproxen)
Sympathomimetics such as pseudoephedrine in decongestant
medications
If your doctor is unable to substitute a non constipating
medication for the above medications you are taking,
you will need to make an extra effort with dietary
and lifestyle changes.
Are there dietary changes that will get rid of constipation?
We have discussed why adequate, but not excessive
water intake is necessary to avoid constipation. The
other major dietary component is undigestible fiber
which forms the bulk of the stool. If a woman is dieting,
or in the case of elderly women who just have a decreased
appetite or require dental soft foods, the lack of
a usual volume of food will lead to constipation.
This may also occur at the time of surgery or hospitalization
for illness when the amount of food is restricted.
A diet consisting of breads, rolls, pastries, bagels,
pretzels, noodles, desserts and dairy products leads
to very hard stools, while one with fruits, green
vegetables, whole grains, beans and nuts will soften
the stool. Coffee stimulates the colon. Flaxseed is
a good natural laxative and there are even some cereals
that have it added. Vitamin C and magnesium supplements
may also help with constipation but you have to be
careful not to take too much.
At your age of 69, you have to be careful that the
constipation problem is not just due to eating too
small amounts of food and drinking too few liquids.
If you are not already doing so, you may want to go
for a couple of weeks and:
drink eight glasses of liquid a day
cut out all simple carbohydrates
eat added small amounts of fiber such as celery, popcorn,
beans, nuts, flaxseed
make sure you are getting 30 minutes of brisk physical
activity each day
Don't just try one or two of these and think you have
made an effort. Do all of them!
What if I feel full but just can't move my bowels?
Sometimes the stool seems to get to the rectum and
the feeling of a need to defecate is present, but
an individual just cannot move their bowels at all.
In general there a two possible causes for this type
of "outlet" obstruction. One is where there
is a herniation of the rectal wall through the pelvic
diaphragm muscles called a rectocele. In this condition
there is a loss of sensation and an overfilling of
the rectum with stool, while at the same time there
is muscle weakness in initiating the defecation mechanism.
About 50% of women with rectoceles have constipation
and difficulty with defecation and when they undergo
surgical repair of the hernia, about half of those
are significantly cured (5).
A second type of "outlet obstruction" is
a nerve or muscle dysfunction called anismus or anal
sphincter dyssynergia. Basically when the sphincter
muscle is supposed to be relaxed, it is closed. It
is parallel to a urine voiding condition called detrusor
sphincter dyssynergia and a vaginal condition called
vaginismus in which there is an involuntary contraction
of the vaginal opening muscles. Everyone has experienced
this defecation difficulty, perhaps in a crowded public
restroom like at an airport, or just the occasional
inability to relax the sphincter when it is needed.
The woman who has this constantly ends up being constipated
and uncomfortable most of the time. This condition
is best treated with biofeedback techniques in which
a person is taught to consciously relax the anal sphincter.
Kegel exercises are also used to help learn relaxation
(6).
What are other causes of constipation?
There can be causes of constipation other than the
ones discussed above although they are somewhat uncommon.
Other causes are:
stricture due to cancer of colon
chronic laxative abuse (destroys innervation of colon)
colon or rectal ulcers
congenital or acquired aganglionosis (lack of nerve
connections)
hypothyroidism
irritable bowel syndrome (see IBS)
lupus erythematosis
megacolon
multiple sclerosis
Parkinson's disease
scleroderma
stroke
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