Everyone becomes constipated once in a while, but a doctor should be notified if significant changes in bowel patterns last for more than a week or if symptoms continue more than three weeks after increasing activity and fiber and fluid intake.
The patient's observations and medical history help a primary care physician diagnose constipation. The doctor uses his fingers to see if there is a hardened mass in the abdomen, and may perform a rectal examination. Other diagnostic procedures include a barium enema, which reveals blockage inside the intestine; laboratory analysis of blood and stool samples for internal bleeding or other symptoms of systemic disease; and a sigmoidoscopy (examination of the sigmoid area of the colon with a flexible tube equipped with a magnifying lens).
Physical and psychological assessments and a detailed history of bowel habits are especially important when an elderly person complains of constipation.
If changes in diet and activity fail to relieve occasional constipation, an over-the-counter laxative may be used for a few days. Preparations that soften stools or add bulk (bran, psyllium) work more slowly but are safer than Epsom salts and other harsh laxatives or herbal laxatives containing senna (Cassia senna) or buckthorn (Rhamnus purshianna), which can harm the nerves and lining of the colon.
A woman who is pregnant should never use a laxative. Neither should anyone who is experiencing abdominal pain, nausea, or vomiting.
A warm-water or mineral oil enema can relieve constipation, and a non-digestible sugar (lactulose) or special electrolyte solution is recommended for adults and older children with stubborn symptoms.
If a patient has an impacted bowel, the doctor inserts a gloved finger into the rectum and gently dislodges the hardened feces.
Maureen Haggerty, The Gale Group Inc., Gale, Detroit,