Constipation is when you struggle to pass stool.
- It may result in infrequent bowel movements.
- It may result in difficulty evacuating.

The perfect bowel movement passes within seconds without pushing, straining or waiting for it to finish. It cleans easily, without messing the surrounding area. It does not cause pain, or bleeding.

It would be best to have one bowel movement a day. But it is not abnormal to miss a day, or have several in one day. So long as it’s painless, passes easily, and is not associated with abdominal cramps or bloating. Bowel motions anywhere between 3 times a day to 3 times a week are still within normal limits

- Constipation causes hemorrhoids and fissures. If hemorrhoids and fissures become well-established, they can in turn, make constipation worse.
- It makes diverticular disease more likely.
- It commonly creates abdominal pains

The common causes of constipation include:
- Insufficient fiber and water – Daily dietary recommendation is 30 grams of fiber and 64 Oz of water.
- Lack of exercise, environmental changes
- Hormonal and electrolyte imbalances
- Pain medications, iron therapy
- Hemorrhoids, or Fissures (once established)
- Strictures, tumors blocking the bowel
- Obstruction to defecation at the anorectum due to weakness of the pelvic floor and wall of the rectum resulting in the rectum collapsing on itself (intussusception) or ballooning out (rectocele).

Normal - Mild High fiber diet, plenty of water.
Mild- Moderate Psyllium Citrucel Benefiber
Moderate- Severe Miralax Amitiza, Linzess

It is best to start with a fiber supplement:
Psyllium is a natural seed. It has been shown to lower your cholesterol. It can be used to lose weight. Soluble fiber, like Metamucil, Benefiber, Citrucel, work by absorbing water into the fiber, forming a soft gel. This gel mixes into what will become the bowel movement two or three days after ingestion. It is not a laxative. It does not work immediately.

Avoid products with Senna. The health food stores sell this as a natural aid, but it is habit forming, and will make the bowel movements worse as you age.

It is important to keep the bowel movement easy, don’t push, strain or struggle.

Do not read, or sit a long time ‘trying to go’.

Depending on your age and risk factors your surgeon may ask you to obtain:
- Blood testing
- Anoscopy and Sigmoidoscopy
- Lower GI X-ray
- Colonoscopy

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