Q Hello Dr. C. I am an eighty-one year old woman and I have suffered from constipation for many years. Nothing really works. I have had a hysterectomy in the past. I read in a bulletin from the Mayo Clinic that acupuncture may help. Where may I find a list of competent acupuncturists in the region?

A. Thank you for the thought-provoking question, Betty. First, constipation is a common problem for patients of all ages. Some definitions are in order as I consider your question. Physicians define constipation as a problem when bowel movement frequency is less often than one time per seven to ten days. Patients may however feel bloated and uncomfortable when stool frequency is less often than that interval that is normal for them, and that may be daily or every other day. For other patients constipation is present when stools are difficult to evacuate due to hardness, associated rectal discomfort, or excessive straining even if the interval for stooling is normal. You stated that constipation has been a long-standing problem. That would indicate that the basis for your problem has been present as well for as many years. The first and most important cause of constipation is our diet. In western, industrialized societies there is a general lack of adequate fiber in the diet. Over the years, the common medical problems that are likely due to a lack of adequate fiber include appendicitis, hemorrhoids, and diverticulosis. The last mentioned disorder may relate to your problem. When the diet is low in fiber, inadequate water reaches the lower bowel and the stools become firm. The pressures in the colon may rise and over time cause small out-pouchings or diverticuli. They are common over the age of sixty years of age and usually do not cause any symptoms. If they become numerous, the colon may become narrowed in sections and lead to more and more difficulty in evacuation as you have described. It would be very important for you to have a physician order the studies needed to define the anatomy of your bowel. A barium contrast x-ray (also known as a barium enema) or a colonoscopy would be very helpful in defining the anatomy of the colon and developing a plan to deal with any narrowing or obstruction that may have slowly evolved over the past twenty years. You mentioned that you have had a hysterectomy. In this regard, on rare occasions constipation may result from adhesions from that surgery that may also narrow the bowel lumen. Finally, any person with a change in bowel habits and constipation over a period of six months must be concerned about the growth of a colon cancer that is slowly narrowing the bowel lumen. In some women, the pelvis is angulated such that the colon is functionally narrowed as the bowel passes from the abdominal cavity to the pelvic region. This problem, pelvic outlet dysfunction, is diagnosable and is medically managed.

From your question, I will assume that you have had a recent physical examination and perhaps a colonoscopy to rule out any of these structural problems, namely diverticulosis, adhesions, pelvic outlet dysfunction, and colon cancer. You may have acquired a disorder in which the motility of the bowel is abnormal. In the condition of constipation-predominant irritable bowel syndrome the patient has poorly organized contractions of the bowel and stool transit is impaired. The disorder begins usually in the second and third decade of life and if you have had a problem of constipation all your life you may have developed the disorder long ago and it has continued all these years. Now we come to the issues of your age and the treatments that have been tried over the decades. As our society as a whole ages and enjoys otherwise vigorous health, constipation due to a loss of colonic muscle tone is being increasingly recognized. In years past we used the terms of laxative colitis and laxative dependence. (Remember the old worry: dont take laxatives because you will become dependent on them) The actual case is that most often the laxatives are needed for a comfortable evacuation frequency in patients with slowing evolving loss of colonic motor tone. This disorder is known as chronic pseudo-obstruction. The disorder may begin in the third to fifth decade of life, is more common in women, and may be distinguished from constipation-predominant irritable bowel syndrome by a test of colonic motor function known as a colon transit time study. Treatments vary from use whatever is needed including fiber, stimulants, salt laxative (i.e. Citrate of Magnesia), and the polyethylene glycol , i.e Golytely preparations to the extreme, but at times appropriate removal of most of the non-functioning colon.

As for the use of acupuncture in bowel disorders, it has been used most often to relieve abdominal pain of irritable bowel syndrome. While less successful for the bowel dysfunction, it may promote relief from muscle spasms and improve bowel function. In Savannah, you may wish to contact Dr. E. Daniel Biggerstaff, who is a leading gynecologist also highly experienced in the application of acupuncture in womens health issues. I hope this gives you some direction in finding a successful program for your difficult but common medical problem.

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