Constipation treatment by video in Puerto Rico, adults and children

You are constipated when you have fewer than three bowel movements a week, or when stools are hard, dry or lumpy, difficult to pass or painful. Many people also feel they have not finished.

The most common causes are too little fiber and fluid, too little movement, holding it in, travel, pregnancy and age. Some medicines are constipating too, such as narcotic pain medicines, antacids that contain aluminum and some blood pressure medicines (calcium channel blockers). Sometimes the cause is another condition, such as diabetes, an underactive thyroid, celiac disease or irritable bowel syndrome.

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Constipation is handled in a US$79 doctor visit, the same price for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the visit can’t take place. A doctor’s note is included. We do not bill insurance. See all prices. The service is run by The Health Initiative, a nonprofit.

The most common signs are:

• Fewer than three bowel movements a week
• Hard, dry or lumpy stools
• Straining or pain when you go
• Feeling you have not finished

Food and habits come first. Adults need 22 to 34 grams of fiber a day, depending on age and sex. Add fiber a little at a time so your body gets used to it, and drink more water as you do. Move more, and try to go to the bathroom at the same time each day, 15 to 45 minutes after a meal.

• High-fiber foods: whole grains and oatmeal, beans, lentils and chickpeas, fruit such as pears, oranges and apples with the skin on, and vegetables such as carrots and broccoli.
• Over-the-counter laxatives: fiber supplements, osmotic laxatives, stool softeners and lubricants. Stimulant laxatives are for more severe cases.
• Do not use laxatives for a long time without talking to a doctor.

If none of that works, the doctor may prescribe another medicine, if appropriate. Ordinary constipation does not need lab tests. The doctor orders one if she suspects another cause, such as thyroid disease or diabetes, and we refer you for a colonoscopy if there is blood, weight loss or a new change from age 45, when most people should start colorectal cancer screening. Straining also causes hemorrhoids.

In children, constipation means fewer than two bowel movements a week, or stools that are hard, dry or painful to pass. Many children hold it in: they stand on tiptoe, clench their buttocks or hide. You may also see liquid stool in their underwear that looks like diarrhea, a swollen belly or new wetting.

It is common during potty training, when a child is embarrassed to use the school bathroom or does not want to stop playing. More water, fruit, vegetables and whole grains help, as do less cheese and processed food, and pausing potty training while the constipation lasts.

Get care if it does not improve with home treatment or lasts more than 2 weeks. A baby under 2 months with constipation needs a medical evaluation. The doctor evaluates your child by video with you on camera and, if appropriate, prescribes; patients under 21 need a parent or legal guardian on camera with ID. See our online doctor for kids.

For your safety, go to the emergency room or call 911 if you have any of these signs. See when to go to the ER.

• You cannot pass stool or gas and you are vomiting
• Severe, constant belly pain, or a hard belly that is tender to the touch
• Heavy red bleeding from the rectum, or black stool
• Fever with belly pain