The latest expert advice on how to handle uncomfortable problems like constipation, gas, and more
By Hallie Levine
Your colon plays a vital role in your well-being, absorbing nutrients and fluids from food and helping your body get rid of what you don’t need. But when problems arise, you may be reluctant to seek help.
“Many people shy away from these topics, but they shouldn’t,” says Kyle Staller, MD, a gastrointestinal specialist at the Harvard Medical School. “Many of these seemingly embarrassing health conditions are solvable.” But some may signal serious diseases, like colorectal cancer, and need to be addressed.
Here are some common problems and strategies to deal with them.
'I Don’t Go Enough'
Up to half of people ages 65 and older are dealing with chronic constipation, or a bowel movement less than three times a week on an ongoing basis. Whatever your age, if you’re dealing with chronic constipation, see your doctor, who may want to examine you for contributing problems like anal fissures or hemorrhoids.
Your doctor may also check how well your rectum and anal sphincter muscles work together to move stool along. “In women, constipation can be due to weakening and damage to pelvic-floor muscles or nerves as they age, especially if they’ve had vaginal childbirths or changes in the pelvic anatomy after a hysterectomy,” says Carol A. Burke, MD, a gastroenterologist at the Cleveland Clinic. Pelvic-floor physical therapy can help.
Go over your regular medications with your doctor. Ibuprofen (Advil, Motrin, and generics), antacids with calcium or aluminum, iron supplements, and antihistamines can promote constipation. So can some antidepressants and calcium channel blockers for hypertension. Switching to a different class of drugs may provide some relief. These lifestyle tweaks can also help:
Get fiber. Older adults should get 25 to 30 grams a day, focusing on soluble fiber (in fruits and veggies) and psyllium, found in cereals and added to some breads and cereal bars, says Brian Lacy, MD, PhD, a gastroenterologist at the Mayo Clinic in Jacksonville, Fla. (Check for psyllium, psyllium seed husk, or psyllium husk on the ingredients panel.) Kiwifruit may be especially helpful. A study in The American Journal of Gastroenterology found that eating two a day eased constipation about as much as 10 prunes or 12 grams of psyllium, with less bloating.
Have a schedule. “The GI tract goes to sleep at night and tends to awaken early in the morning,” Lacy says, “so getting up at the same time, drinking coffee or tea, having breakfast, and then having scheduled bathroom time often helps get it working on a more regular basis.”
Stay active. While research is limited, “we see less constipation in active people,” says William Chey, MD, a gastroenterologist at the University of Michigan. “Exercise wakes up all of your muscles, including the ones in your colon.” Need help while you wait for these strategies to take effect? Lacy recommends short-term daily use of a laxative like polyethylene glycol (Miralax and generics) between dinner and bedtime.
'I Go Too Much'
About 10 percent of people in their 60s and older report chronic diarrhea, or at least three daily loose stools for more than four weeks. It’s important to see a doctor for this problem because it can lead to dehydration or malnutrition.
Your doctor will want to check for autoimmune diseases such as Crohn’s disease and ulcerative colitis. Because those conditions can develop if your immune system attacks your digestive tract, you might be prescribed drugs to suppress your immune system.
Another possible cause is overflow diarrhea, where waste matter builds up in the colon and liquid stool leaks around harder stool, says Michelle Hughes, MD, a gastroenterologist and an assistant professor at the Yale School of Medicine. That requires a doctor’s visit and the use of laxatives to resolve the problem.
Some older adults may experience more significant leakage of stool—known as fecal incontinence—due to nerve damage from type 2 diabetes, a back injury or surgery, or, in women, pelvic muscle and nerve damage from vaginal births years earlier, Burke says. This is usually treated with a course of antidiarrheal medication such as loperamide (Imodium), pelvic physical therapy, and regular use of a psyllium fiber supplement.
'I’m Gassy All the Time'
Lactose intolerance (trouble digesting the natural milk sugar in dairy products) and bacterial overgrowth in the small intestine (which connects to the colon) can cause excess gas and uncomfortable bloating. For some people, regular use of proton pump inhibitors for heartburn (like Nexium and Prilosec) can also be a factor in the latter condition.
Unsure of the cause? You might try lactose-free dairy products or opting for milk supplemented with lactase (an enzyme that helps break down the milk sugar lactose). If that doesn’t make a difference, consider cutting out other common gas producers one at a time. They include fructose (in juice, sports and energy drinks, soft drinks, and fresh fruit); legumes; cruciferous veggies like broccoli or cabbage; and fructans (onions, peppers, asparagus).
If avoiding those doesn’t do the trick, see your doctor, Chey advises, to be screened for conditions like irritable bowel syndrome. Working with a nutritionist to follow a low FODMAP diet, which involves cutting out dairy, wheat, and certain fruits and vegetables, may offer a solution.
'I Can’t Do Colonoscopy Prep'
Because the bowels should be empty for a colonoscopy, you might be advised to drink up to a gallon of prep (water mixed with a laxative) the day before. If this is challenging, Lacy advises that patients go on a clear liquid diet for two days before, adding a teaspoon of the laxative polyethylene glycol to each 8-ounce glass of liquid consumed. That helps reduce the GI tract’s workload and jump-starts colon emptying, so you might need less prep. Plus, “you can mix the prep with ginger ale, 7UP, apple juice, lemonade—any clear liquid that appeals to you,” he says, noting that varying the flavors can make drinking the prep more palatable.
Also, ask about a prep that requires less total liquid, or about splitting the prep up, consuming half the night before and the rest 4 hours before the colonoscopy. (For an afternoon exam, you can down all of the prep the morning of the procedure.)
When Do You Need a Colonoscopy?
For more on when to get your first colonoscopy—a common screen for signs of colorectal cancer—see our previous article. But if you’ve already had at least one colonoscopy, most people don’t need another for 10 years. The exceptions:
- You had polyps (potentially cancerous growths on the colon lining) removed. The American Society of Colon & Rectal Surgeons advises a colonoscopy every one to five years depending on the polyp size and number.
- A benign polyp couldn’t be fully removed. You’ll need another in three to six months to try to remove it again.
- You had colorectal cancer surgery. You’ll need a colonoscopy within a year.
- You have an inflammatory bowel disease. You’ll need a colonoscopy every one or two years.
Tell your doctor right away if you have potential symptoms of colorectal cancer, like blood in your stool, a sudden change in bowel habits, or unexplained weight loss. If you’re over age 75, ask about whether to continue colorectal cancer screening.
Editor’s Note: A version of this article also appeared in the April 2022 issue of Consumer Reports On Health.
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