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I am a 21 year old female who has experienced problems having bowel movements since I was 17 (after having a knee surgery to repair and ACL). I may have a bowel movement once every 7 to 14 days and when I do, it is very large and of a hard consistancy...which normally cannot be flushed down the toilet. I am active as I walk and run a treadmill 3-5 times a week, go to college, and work. I experience some pain in my stomach, some bloating, and occasional naseau. I tend to eat regularly and most of the time healthly foods. I drink water 99% of the time. I have tried stool softeners, laxatives, enemas with no real success. The only drug that will allow me have a bowel movement is magnesium citrate which I have only used a few times because I am scared to use it regularly.
I did go see a gastrinologist about a month ago who told me to drink more cokes (caffeinated drinks) and to eat more fatty foods. He ran no tests. This has not worked and I would like a suggestion on what I need to do or what could possibly be the problem. I am afraid that by not having BMs that I could develop colon cancer.
Exercising regularly, drinking plenty of water, and eating a well-rounded diet like you describe are excellent ways to promote healthy bowel function. Many people think they need to have a bowel movement every day, but the reality is that people's bodies vary, and healthy adults range from three bowel movements per day to three per week.
Your symptoms seem to fit the definition of constipation, which is defined as having less than three bowel movements per week, a subjective sensation of hard stools, a sensation of incomplete bowel evaluation, or straining during more than 25% of bowel movements. Long-term constipation can result in damage to your large intestine or hemorrhoids caused by blood-vessel breaks from straining to pass hard stools. No evidence suggests constipation is a cause of colon cancer; and while it can be a symptom, it is somewhat unlikely in someone under age 40.
There are many potential causes of constipation, but one of the most common is lack of fiber in the diet. Fiber is the indigestible part of food, and it helps retain water and bulk as stool passes through the digestive tract. The ADA recommends that adults consume 25 to 35 grams of fiber per day. If you haven't already, you might try really focusing on increasing fiber. Vegetables, fruits, and bran (try high fiber cereal or sprinkling 2-3 teaspoons of unrefined bran on fruit) are all great sources. Scientific evidence suggests consuming fat and caffeine as recommended by your doctor may actually be more likely to cause constipation than relieve it.
Constipation can also be caused by slow transit of stool through the large intestine, which causes more water to be drawn out of the stool and results in hard, dry stools that are more difficult to pass. Over-the-counter antacids, bismuth subsalicylate (i.e., Pepto Bismol), iron salts, anticholinergic drugs, certain antihypertensives, opioids, and many sedatives can cause slow transit of stool. Metabolic conditions such as an underactive thyroid gland (hypothyroidism), high blood calcium levels (hypercalcemia), and Parkinson's disease may also cause slow transit. Obstruction of the large or small intestine by cancerous growths (again, unlikely in someone your age), foreign objects, or scar tissue following surgery can block passage of food through the digestive system. Other factors such as depression and stress are sometimes associated with constipation as well.
You're right to be wary of over-use of laxatives. Although over the counter bulk-forming laxatives with fiber are fine for occasional use, long term use can cause diarrhea, dehydration, or dependence. The magnesium citrate you used is generally not recommended to be used for more than a week.
You mentioned having knee surgery at the time you started experiencing constipation. There is no clear connection between the surgery itself and your current digestive difficulties. However, it may be a good idea to ask your health care provider if any medications you took after surgery are known to cause constipation.
You may want to consider talking with a nutritionist to evaluate how your diet is affecting your condition. If you are a Columbia University student, you can make an appointment with a dietitian by calling Health Services at Columbia at x4-2284 or logging into Open Communicator. If increasing the fiber content of your diet, drinking six to eight glasses of water a day, and continuing to get 30 minutes of vigorous physical activity on most days doesn't help, a gastroenterologist can run tests to help determine the source of the problem. A blood test can diagnose an under-active thyroid gland or high levels of blood calcium, and a barium enema or colonoscopy can diagnose blockages, including cancer. It sounds like you've been dealing with a pretty uncomfortable problem for a few years, so seeing a provider who will run some tests seems very reasonable. Here's hoping the situation passes.
