DR. HOOK- Stuck up: What happens when things stop moving?

"I'm on hold," is something all of us have said. With companies facing increasing demands but less profit, we're being put on hold everywhere. Even on the computer-help chat rooms, I'm put "on hold" sometimes for 30 minutes– which isn't so bad because while waiting I can play Solitaire and read the latest entertainment pages. (I'm the Honorable Master of multi-tasking!) 

I've learned to use an earpiece so that the phone doesn't burn my ear off (so van Gogh!), and I do other things while on hold like review lab results, cook dinner, or even use the commode. But what happens when your bowels are "on hold"?

Chronic constipation affects 2-7 percent of American adults. If you think I'm full of it, think again, because constipation results in 2.5 million doctor visits a year. Idiopathic constipation means we just don't know the cause, but it's not due to side effects of medication, neurological or endocrine causes, or any reversible cause we can think of.

Are you pooped from not being able to poop? I'm sure you've heard that you should drink plenty of fluids (in particular water) and eat lots of fiber. This is the hallmark treatment for constipation, but I get a lot of "crap" from my patients when I suggest this. "I drink at least one glass of water a day, and I think I ate an apple three months ago. Don't you go telling me to increase my fluids and fiber!" Hmmm...

Wheat bran offers a lot of fiber, and you can even sprinkle it on other foods such as salads. But then again, I hear people complain, "I feel like a Billy Goat eating cardboard." Breakfast is a great opportunity to poop because your colon is a-rollin' at its best in the morning, and with a hot beverage brewing and all that fiber in the stomach, poop-o-rama often occurs.

Yet during fast times in our fast-food nation, I end up recommending more over-the-counter fiber supplements, such as FiberSure and Citrucel. Psyllium, methycellulose, and calcium polycarbophil bulk up the stools and retain water to allow the colon muscles to squeeze things through. The main problem I hear from fiber-naïve patients is, "I could be a billionaire if I could sell all the gas in my belly from the fiber. Yow!" So a slow increase in fiber intake can allow the body to adapt. For those who don't drink enough fluids, the extra fiber can "rot" in the GI system like a clogged-up kitchen sink.

Stool softeners like Docusate and mineral oil aren't that great at getting the stools moving. But they can offer some relief to people who have discomfort with hard stools or if they strain or have "collywobbles." In fact, in one study, 60 percent of people who stated they have constipation but who used those remedies pooped every single dingle day!

I'm not a fan of laxatives because people can become dependent on them. However, if someone needs to get down and dirty, osmolar agents are often the next step, such as polyethylene glycol (MiraLAX), magnesium, sorbitol, and lactulose. But they can screw up your electrolytes.

Stimulant laxatives such as Senna and Bisacodyl induce the GI system to water down the stool and get the colon muscles moving, but salt overload, low potassium, and excretion of protein can result as well.

Amitiza is the newest kid on the block to help chronic constipation, but I haven't been able to read any good clinical trials on it– only review articles. So I don't know how safe or effective it really is.

Sometimes when you're on hold too long, it's appropriate to hang up. But usually it's better to be patient, especially with constipation, and multi-task: exercise, drink plenty of fluids, and eat fiber. 

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.



I tried amitiza after zelnorm was discontinued and it has worked for me better than zelnorm has. I was on Mirolax before that, but it made me bloated. So far, Amitia has been my best choice.

My father has recently begun having extremely bad constipation. He had colon surgery last year for removal of colon cancer and after that, chemotherapy from Feb 07 through Aug 07. He began having the constipation problem about two months ago ( a couple months after completion of chemo). It has gotten so bad in the last week that it has also caused him to be unable to urinate and he has had to go to the ER for relief for both, and still has a catheter for the urinary problem. Since he did not have this problem before the chemo, but now has this problem after the chemo, is it appropriate to say that this may have been caused by the chemo. Is there anything he can take that will help him. We've tried amitiza, milk of magnesia, prunes, fiber, fruit and vegetable diet, lots of water, enemas, supositories. Nothing works. Now his oncologist has given him Enusol. I hope this will work, but have a feeling it won't do anything either. Is there anything you can recommend that might help him?

Thank You.