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Hello. I believe that I'm suffreing from a severe case of constipation. Since July, I can go anywhere from 1 week to a week and a half before I have a bowel movemnet. This is causes very bad abdominal pain for me and then when I do have a bowel movement it is very painful. I'm not sure exactly what to do. I have took laxatives and they work but I really don't like to take them on a regular basis. I try to wait it out to see if my body will do its thing but it never seems to. What should I do?


I sympathise with your situation. My girlfriend suffers severe constipation before her period most months, and like you she can go a week or more without having a bowel movement. By then, her stools are dry, hard and very large in diameter, which makes them terribly difficult and painful to pass. It is distressing to witness what she has to endure when she finally manages to move her bowels.

First of all, I think it would be worthwhile consulting your doctor. You say you have been troubled by this since last July, which suggests that you had no problem before that time. A sudden change in the functioning of your digestive system might have an underlying cause that should be investigated – there are many conditions and medications that can cause constipation. In the meantime, here are some things that might help, based on my girlfriend's experience and research. Most of these things don't help her, sadly, but that doesn't mean they won't help you.

1. Water. Drink lots of it, at least eight glasses a day, even if you don't feel thirsty or don't think that you need it. Dehydration often causes or aggravates constipation. Drinking a lot of water is a good preventative measure.

2. Dietary fibre. It isn't just a "mother's remedy" or old wives' tale: eating a lot of fibre – bran cereals, wholegrain bread and rice, pulses, lots of fruit and vegetables – does help the digestive system to work better and to produce bulky, soft stools that are easy to pass. A healthy fibre intake is a good preventative measure, and can help relieve constipation when you have it. It's a good idea to cut down on foods that don't have much fibre, like meat, cheese and processed foods.

3. Laxatives. Just occasionally, if you really feel the need for extra help, then try a gentle laxative. But you are right to be cautious about the use of laxatives, as it is easy to become dependent upon them, which is ultimately bad for you. For that reason, my girlfriend does not like to use them either. Also, in her case she has not always found them to be very effective. On the last occasion she tried a laxative, a full day passed without any effect, then she felt sudden and painful abdominal cramping and an urgent need to "go". The laxative perhaps triggered a bowel movement, but did nothing to ease it – her stools were as big and hard to pass as ever.

4. Exercise. Nowadays there is some debate in the medical community about whether exercise really helps, and in any case when you are feeling rather sluggish it can be difficult to motivate yourself. However exercise is one of the few things my girlfriend finds can help her. Sometimes after reasonably vigorous exercise, she will feel an urge to defecate.

5. Trying to go. You said, "I try to wait it out to see if my body will do its thing". When you are constipated, it doesn't really do to just wait until you feel a natural urge – you may just become even more constipated. You need to try to move your bowels. However, you should guard against excessively vigorous or prolonged straining – apart from anything else, you could give yourself haemorrhoids. When my girlfriend is constipated, the normal urge to defecate is completely absent for days. She gets so bloated, full and uncomfortable that she becomes desperate for relief, and when I first met her she was inclined to go to the bathroom and sit on the toilet for up to an hour at a time, trying off and on to force her bowels into action. I persuaded her that this was not good for her, and suggested that if she cannot do anything within about 10 to 15 minutes, she should give up and try again later. Nowadays when she is constipated, she will go to the bathroom and try three or four times a day, but not for more than about 10 minutes unless she feels she is close to success.

6. Manual stimulation. This may sound rather gross, but in the same way that some treatments work by irritating the rectum, inserting your finger into your rectum might stimulate a bowel movement.

7. Posture for defecation. Sitting on the conventional Western flush toilet is not actually the best posture for defecation. Research has shown that it causes the "recto-anal angle" to be obstructive and actually make it more difficult to expel stool. By contrast, squatting with the thighs flexed against the abdomen actually encourages the bowels to move and less effort is needed to pass stools – a boon when your stools are difficult. And when you do really need to push, it's more effective when squatting than sitting. When my girlfriend's stool is so big that she can't even begin to pass it sitting down, or she begins and then it becomes stuck, the simple trick of changing to a squatting posture makes it a bit easier for her to push it out. Squatting might be impractical in a lot of situations, but my girlfriend finds it so much better that whenever possible, such as when she is trying to move her bowels at home, she squats. Squatting, combined with manual stimulation, is occasionally effective in stimulating her bowels to move in the first place.

I hope this helps you deal with the effects of constipation, but don’t ignore my advice to consult your doctor.