Patients with colorectal or anorectal problems are generally
unaware of how their own bowel habits may vary from normal.
Since their problems usually stem from childhood, representing
lifelong habits, and since they have no standards for comparison,
most patients assume that their function is normal.
Most patients who develop colon cancer, diverticulosis, diverticulitis,
hemorrhoids, fistula and fissure have had a lifelong history
of difficulty with their bowels. In most instances, they suffer
from chronic habit constipation.
The usual cause of chronic constipation is a lack of adequate
dietary fiber. Dietary fiber is generally obtained from plant
foods, and consists of that portion of the plant which is
not digested by man. While the sugars, starches and vitamins
are broken down into nutrients and are absorbed by our intestines,
the cell walls are not digested and go on to form an important
component of the stool, the bulk or roughage. An example of
dietary fiber is cellulose, and a food which is high in fiber
is wheat bran.
Correcting the fiber inadequacy in one's diet will help one
to achieve normal bowel movements and normal bowel habits.
If damage has taken place, as in the development of diverticulitis,
the adjustment of one's dietary fiber intake may prevent further
deterioration of the damage over time. The decision as to
how much fiber to use in the face of pre-existing conditions
should be made in consultation with your doctor.
For the bowels to work properly, a lifelong daily intake
of 25-30 grams, or about one ounce of dietary fiber daily,
is required. After the digestion of all proteins, fats and
carbohydrates, and the absorption of water and other nutrients
in the small intestine, the colon (the last five feet of the
intestine) receives approximately one pint of liquid stool
together with the undigested fiber.
Under normal circumstances, the colon gradually removes the
remaining water, and forms a shaped stool, which moves toward
the rectum as a result of gentle pressure waves. In people
who eat too little of fiber-containing foods, the stool becomes
hard, dry and small. Whereas the soft, bulky stool can move
easily along the passage of the colon, the hard, dry stool
sticks to the dry wall of the colon and requires that the
colon develop high-pressure waves to be moved. Years pass,
and the colon is no longer capable of generating such high
pressure waves. The colon now requires assistance to push
along the hard, dry stool, and the abdominal muscles begin
to contribute the necessary force. This we call "straining."
The straining produces pressure on all of the abdominal wall,
forcing the development of hernias, varicose veins (due to
pressure on the long veins of the legs), hiatus hernia (upward
pressure forcing the stomach into the chest), diverticulitis
and diverticulosis (weakening and infection of the colon wall),
hemorrhoids, anal fissures and fistulae. Colorectal cancers
may also be more common in patients with lifelong habit constipation.
This may be due to the concentrated exposure of carcinogens
to the colonic surface, as a result of the hard dry stool
and its slow movement or evacuation.