Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Jeremy Swartzberg

Jeremy Swartzberg, MD

Hospital Medicine

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Oakland Medical Center
Appt/Advice: 510-752-1190

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Constipation means having fewer than 3 bowel movements in 1 week. Your stool may also be hard, dry, and painful to pass.

Constipation is common, usually temporary, and not serious. However, you may tear the anus when passing large, hard stools. This can cause bleeding and other problems.  

You do not need to have a bowel movement every day. If your stools are soft and pass easily, you are not constipated.

Treatment for constipation includes:

  • Getting more fiber in your diet
  • Drinking more fluids
  • Exercising regularly 

We may recommend a stool softener or a gentle laxative. Call us right away if you have constipation that occurs suddenly with abdominal cramps and you are not able to pass gas or stool.


During digestion, food moves through the colon where water is absorbed and waste products (stools) form. Muscle contractions push the stool toward the rectum. If the colon absorbs too much water or if muscle contractions are slow, the stool moves too slowly. It can become hard, dry, and difficult to eliminate.

Common causes are:

  • Diets low in fiber
  • Not enough physical activity
  • Ignoring the body's signals to have a bowel movement
  • Overuse of laxatives
  • Certain medications
  • Pregnancy 

Certain health conditions can also cause constipation, such as:

  • Irritable bowel syndrome (IBS)
  • Stroke
  • Underactive thyroid (hypothyroidism)
  • Diabetes
  • Parkinson's disease
  • Spinal cord injuries

Risk Factors

Your risk of constipation is higher when you:

  • Are female.
  • Are 65 years old or older. 
  • Take certain medications.
  • Have certain health conditions, such as diabetes.
  • Have mental health problems, such as depression, severe anxiety, and eating disorders.
  • Have experienced physical or sexual abuse.
Older adults may not get regular exercise. They may also have health conditions that cause constipation.


Symptoms of constipation include:

  • Difficulty having a bowel movement or straining to pass stools.
  • A feeling of fullness or that the bowels are not empty after a bowel movement.
  • Hard stools.
  • Low number of stools (usually fewer than 3 bowel movements in 1 week).
  • Cramps and pain in the rectum from trying to pass hard dry stools.
  • Nausea and bloating. 

If stool is stuck in the rectum, you may leak mucus and fluid around the impacted stool. You may even involuntarily pass some stool. This is called fecal incontinence.

Additional References:


We will talk to you about your symptoms and examine you. We may also order tests, depending on the severity of your symptoms. However, most people do not need further testing. If your symptoms are severe or do not go away, we may check your abdomen, anus, and rectum.

Common Questions

To determine the causes and best treatment for constipation, we may ask you a few questions.

Bowel movements

  • How long have you been constipated?
  • How frequent are your bowel movements?
  • What is the consistency of the stool?
  • How difficult is it to pass the stool?
  • Do your bowels feel empty after the bowel movement passes?
  • Have you seen blood with your bowel movements, mixed with the stool or in the toilet?


  • What medications and supplements are you taking?
  • Have you started new medications or changed the dosage recently?


  • Do you exercise regularly?
  • Are you under any unusual stress?
  • Do you regularly eat dairy products?
  • How much daily fiber do you eat?

Emotional health

  • Do you feel depressed or hopeless?
  • Do you feel anxious or overwhelmed?
Additional References:


Constipation can usually be treated at home. 

Treatment includes:

  • Improving your bowel function
  • Eating more fiber
  • Taking recommended laxatives when needed

Be sure to call us if you develop blood in your stools or sharp abdominal pain.

Eating More Fiber

A high-fiber diet is key to having healthy bowels. Try to eat 20 to 35 grams of fiber daily. 

If you are not currently eating a high-fiber diet, gradually increase the amount of fiber you eat each day over several weeks. Slowly adding fiber to your diet helps you avoid cramping and bloating as your colon gets used to processing more fiber.

Read the labels on the foods that you buy. Generally, whole grains are better than refined grains. Whole fruits and vegetables contain more fiber than juices.

Drink 8 glasses of water each day to help keep your stools soft.

Fiber in Common Foods

FoodFiber content
Fiber One cereal14 grams / ½ cup
Oatmeal5.3 grams / cup cooked
Apple, medium-sized3.5 grams
Banana2.5 grams
Orange2.6 grams
Prunes11.9 grams / 11 prunes
Strawberries3.0 grams / cup
Broccoli5.0 grams / stalk
Carrots4.6 grams / cup
Cauliflower2.1 grams / cup
Green beans3.4 grams / cup
Peas7.2 grams / cup
Potato with skin2.3 grams / medium potato
Spinach4.1 grams raw; 8.0 grams chopped
Lettuce1 gram / ½ cup
Kidney beans, cooked7.4 grams / ½ cup
Baked beans18.6 grams / cup
Bran muffin6.3 grams / muffin
Whole-wheat bread1.66 grams / slice
White bread0.55 gram / slice
Brown rice2.4 grams / cup cooked
White rice0.6 gram / cup cooked
Oat bran8.3 gram / oz.
Wheat bran12.4 gram / oz.

Treatment with Medications

Fiber supplements

If you cannot eat 20 to 35 grams of fiber every day, fiber supplements may help. You can buy them at any pharmacy or natural food store. They are safe to take on a regular basis and include:

  • Calcium polycarbophil (FiberCon, Fiber-Lax, Mitrolan)
  • Methycellulose (Citrucel)
  • Psyllium (Konsyl, Metamucil, Perdiem)
  • Wheat dextrin (Benefiber)

Fiber supplements are made from natural products. While they are the safest type of laxative, they may cause uncomfortable bloating.

Other Laxatives

In addition to lifestyle changes, we may recommend laxatives. These are effective treatments, but do not overuse them.  

Saline and hyperosmolar laxatives include:

  • Milk of Magnesia. Do not take this if you have long-term (chronic) kidney (renal) failure.
  • Miralax or Lactulose.
  • Sorbitol.

Stimulant laxatives. These include:

  • Senna (Senokot or Castoria)
  • Ex-lax
  • Castor oil
  • Bisacodyl (Dulcolax, Correctol)

Avoid herbal laxatives that contain dried bark (cascara sagrada). These can cause long-term damage to the bowel.

Other Methods

Stool softeners (Colace) are safe and may be helpful for some people.

Flax seed can be an effective laxative. Flax seeds come from the flax plant and contain soluble fiber, like that found in oat bran. You can mix whole or crushed seeds with water or juice.  

Enema. We also may suggest enemas. Be aware that:

  • Tap water enemas can lower your blood salts if they are overused.
  • Enemas should be avoided if you have heart or kidney problems.
  • You should talk to us before using enemas. It is important not to overuse them.


To prevent constipation:

  • Eat a high-fiber diet. Slowly add fiber to your diet to reduce gas and bloating.
  • Limit low-fiber foods that are high in fat and sugar and low in fiber content, such as ice cream, cheese, and processed foods.
  • Drink 8 glasses of water daily.
  • Increase physical activity. Walking can stimulate intestinal function.
  • Go to the bathroom when you feel the urge to have a bowel movement.
  • Try over-the-counter fiber supplements.
  • Take stimulant laxatives with caution because they can be habit-forming.

Constipation Caused by Medications

Some medications can cause constipation. Examples include pain medication and calcium channel blockers. To prevent this we may recommend:

  • Stool softener(docusate 100 to 250 milligrams daily)
  • Senna
  • Miralax

If you cannot take medication by mouth, use:

  • Dulcolax suppository
  • Saline enemas, if you do not have heart or kidney problems

Ask us about other prescription laxatives if you still have constipation.

When to Call Us

Call us if you:

  • Have constipation that does not go away after several days of home treatment.
  • Are unable to have a bowel movement without using laxatives.
  • Have blood in your stools.
  • Have painful or bleeding veins around your rectum and anus (hemorrhoids).
  • Have alternate diarrhea and constipation.
  • Have sharp abdominal pain.
  • Have unexplained weight loss.

With hemorrhoids, you might notice small amounts of bright red blood on your stools. This is caused when overly hard stools are pushed through the anus and tear the tissue.

Call us immediately if:

  • You have heavy rectal bleeding.
  • The blood is reddish brown or black.
  • The bleeding continues after constipation improves. Blood in your stools may be a sign of a serious condition.
  • You lose control of your bowels.
  • Your stools have become pencil-thin or extremely thin.
Additional References:

Your Care with Me

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

For general medical advice, our Appointment and Advice line is available 24 hours a day, 7 days a week.

If you have urgent concerns or issues while my office is closed, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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