How to Know When Constipation Is an Emergency

Bloated bellies don’t lie. It’s been a few days since your last bowel movement — and things are starting to feel … well, backed up.

It’s normal to be constipated every once in a while, but when is constipation sounding the alarm for a bigger problem? Colorectal surgeon Massarat Zutshi, MD, gives us the 411 on No. 2.

Q: What causes constipation?

A: Constipation happens when your bowel movements occur less often or cause more strain than usual. Dr. Zutshi says there are three kinds of constipation:

• Normal transit constipation.
• Slow transit constipation.
• Outlet defecation syndrome or ODS, a type of chronic constipation involving hard stool and an inability to pass stool that occurs at least once a week for six months.

Normal transit and slow transit constipation are both considered motility disturbances. And to understand motility, look no further than the morning commute.

Motility is how well the roads — or in this case, the muscles in your gastrointestinal (GI) tract — are moving.

• Normal transit is like driving the speed limit until some roadwork at your exit derails your expected arrival time. Stool moves through your GI system normally, but a problem such as hard stool makes it difficult to pass.
• Slow transit is bumper-to-bumper traffic the whole way through. The muscles in your GI system contract slowly, causing the stool to take a long time to get to its final destination. You go less often, with more straining and harder stool.

And just like there are many causes for snarled roadways, there are different reasons your inner streets are backing up, such as a lack of:

• Fiber.
• Water.
• Exercise.

You have less control over these other constipation causes:

• Medical conditions, including diabetes, irritable bowel syndrome (IBS) or even a spinal cord injury.
• Medications such as antidepressants or herbal supplements.
• Being pregnant.
• Stress.

Q: So how do I know if I am constipated? What’s normal?

A: While the nursery school book “Everyone Poops” still rings true, how often they do so is another story.

“There’s no real normal. Men are different from women. Age changes things. Pregnancy changes things,” adds Dr. Zutshi. “As long as you have a bowel movement that occurs regularly — not too few in a week — and has a regular consistency, you’re fine.”

But what’s “not too few,” you ask? “Constipation is defined as less than three in a week.” Uh-oh. So now what?

Q: How long is too long to be constipated?

A: Dr. Zutshi explains: It depends if you’re regularly regular or not.

“People who have constipation frequently know what to do when it strikes. They’ll try home remedies during the two or three weeks they don’t have a bowel movement. And then if nothing works, they see a doctor,” says Dr. Zutshi.

But if you’re someone who doesn’t usually experience constipation, see a doctor sooner. Dr. Zutshi recommends making an appointment if constipation lasts longer than a week.

Q: Is constipation ever an emergency?

A: It can be, but most often is not.

“It would be an emergency if you hadn’t had a bowel movement for a prolonged time, and you’re also experiencing major bloating or severe abdominal pain,” notes Dr. Zutshi.

Slight symptoms will not take you to the emergency room. You should go to the emergency room if your symptoms are severe.

Other warning signs to watch for are:

• Vomiting.
• Blood in your stool.
• Unexplained weight loss.

Q: How can I prevent or get rid of constipation?

A: Dr. Zutshi emphasizes the big three: Water first. Fiber next. Exercise third.

• Water: Drink a lot. Juices, water, tea and coffee count toward your water intake. People who have normal bowel movements should aim for at least 64 to 80 ounces (eight to 10 glasses) of water daily. Those who tend to be constipated should drink more.
• Fiber: If you can’t get enough fiber from food, talk to your doctor about a supplement. Good supplements to try include Metamucil®, Citrucel® or Benefiber®.
• Exercise: Increasing your exercise can be as simple as walking more. You don’t need to be a hardcore athlete.

If you think you’re having issues with constipation, Dr. Zutshi advises you to be proactive.

“See a gastroenterologist to figure out if everything is OK. And if you have not had a colonoscopy, and you’re over 50, it’s time to schedule one.”