Constipation

We all experience constipation at some point in our lives. In order to prevent and manage this condition you need to first understand what causes it.

Constipation is a very common condition that can occur in people of all ages. Constipation sufferers can be affected in a variety of ways including;

• Hard and lumpy stools
• Unusually large or small stools
• Not being able to pass stools regularly
• Not being unable to completely empty your bowel.

The severity of constipation varies from person to person – constipation is when you are passing stools less frequently than you would normally. For many people constipation is an acute, short term issue that is easily treated. For others it can be a chronic, long-term issue that can cause considerable pain and discomfort, affecting ones quality of life. The type of constipation you suffer with will affect the type of treatment used.

Your colon extracts water from your food. However, as waste builds in your colon, it can lose too much of its water content, making it dry and harder to pass and hence resulting in constipation. Constipation has many causes, the most common being:

• Lack of dietary fibre
• Sedentary lifestyle/lack of exercise
• A change in routine or eating habits
• Side effects from certain medications including antacids, antiepileptics, antipsychotics, painkillers and iron supplements.
• Not drinking enough fluids
• Ignoring the urge to pass stools
• Being underweight or overweight
• Certain medical conditions such as depression, anxiety, IBS, diabetes, hypothyroidism, Parkinsons, MS and bowel cancer.
• Pregnancy
• Age - as you get older, your digestive tract muscles are not as active as they once were.

To put it simply, a reduction in the number of times in which you would normally pass a stool could be a symptom of constipation. If you need to strain or feel as though you are unable to completely empty you bowel then you may be constipated.

The symptoms of constipation may include:

• Dry, hard and lumpy stools.
• Stools that are an abnormal size.
• Stomach aches and cramps.
• Feeling bloated and sick.
• Loss of appetite.

Diagnosis of constipation will rarely include any tests or procedures. Normally constipation can be self-diagnosed and treated although you should see your GP if you experience:

• Rectal bleeding
• Haeorrhoids/piles caused by straining
• Faecal impaction (when stools become hard and dry and collect in your rectum)

If you decide to visit your GP, they can make a diagnosis based on your medical history and symptoms. Performing this diagnosis will usually involve questions about your bowel habits, diet and levels of exercise. It is important not to feel embarrassed about discussing this with your GP as it could affect their decision and choice of treatment. 

If a physical test is required it will usually involve the GP feeling the abdomen. An internal examination will involve a lubricated, gloved finger being inserted into the rectum, where the GP will be able to feel for any hard, dry stool that has collected (faecal impaction). If symptoms are severe, your doctor may need to perform blood or thyroid tests to rule out the possibility of any underlying conditions.  

Treatment for constipation will vary, depending on the cause, severity and how long you have suffered.

In most simple cases it is possible to relieve the symptoms through simple dietary and lifestyle changes. For example:

• Increasing your daily fibre intake.
• Add bulking agents such as wheat bran.
• Drink plenty of water to avoid dehydration.
• Resting your feet on a low stool when on the toilet so that your knees are above the hips (this can make it easier to pass stools).

If these lifestyle choices aren’t sufficiently adequate then you may wish to try a laxative. Laxatives are medicines designed to help you pass stools. There are several different types of laxatives available, which all work in a different way.

Stimulant laxatives are best suited if your stools are soft but you still experience difficulty passing them. These laxatives work by stimulating the muscles in your digestive tract, which helps progress the stool through the large intestine and into the anus. The most common example of stimulant laxatives are Senna (Senokot, ExLax), Bisacodyl (Dulocolax), Sodium Picosulphate (Picolax, Dulcolax Pico). These laxatives are fairly fast acting and usually take effect within 6-12 hours. This form of laxative is ideally suited for short-term use only.

Bulk-forming laxatives contain high levels of fibre which swells when in comes into contact with water in the gut. This will increase the volume of the faeces, making them easier for the digestive to push through the system and pass. The absorbed fluid also helps to keep them soft, again making them easier to pass. Examples of bulk-forming Laxatives include; Ispaghula Husk (Fybogel) and Sterculia (Normacol). 

It’s important when taking bulk-forming laxatives to drink plenty of fluids. It’s also advised not to take them immediately before going to bed, as it may solidify and get stuck in the throat if taken when lying down. The effects take a little longer to take effect in comparison to stimulant laxatives, usually between 2-3 days.  Bulk-forming laxatives are usually a GP’s first line of treatment for most cases of constipation and are particularly useful where problems are caused by low faecal volumes. They should not be used in cases of faecal impaction as they can make the problem worse due to adding extra bulk to an already blocked system.

Osmotic laxatives have a similar effect to bulk-forming laxatives; they increase the amount of fluid in the bowels. This helps to stimulate the bowel and soften the stools. Osmotic laxatives are usually used if bulk-forming laxatives have been tried without success. Common examples of Osmotic Laxatives include Lactulose and Macrogol (Movicol). As with the bulk-forming laxatives it usually takes 2-3 days to have an effect. Osmotic laxatives are a popular first choice for people suffering with occasional constipation due to their more ‘gentle’ effects.

Suppositories and enemas are usually used to treat faecal impaction where osmotic and stimulant laxatives have been unsuccessful. They are generally a more serious intervention and usually act very quickly.

There are several steps you can take to prevent getting constipated. Making sure you’re eating enough fibre is very important, as most adults do not get enough. The recommended intake of dietary fibre is 18 grams a day. Food rich in fibre includes; fruit, vegetables, seeds, nuts, oats, wholemeal bread, wholegrain rice, whole-wheat pasta. By eating more fibre your bowel movements will become more regular as it helps move food through your digestive system with more ease. It is recommend to slowly introduce more fibre into your diet. An excessive, immediate increase may cause stomach cramping and or discomfort, bloating and increased flatulence. 

Exercise is important in preventing constipation. Staying active will not only reduce your chances of experiencing constipation, it will also make you feel better, healthier with increased energy levels. The minimum recommended amount of physical activity per week is 150 minutes.

Drinking plenty of fluids will help prevent constipation. Staying hydrated, particularly when partaking in exercise or when it’s hot is very important to keep the bowels functioning properly. Cutting back on the amount of caffeine, alcohol and fizzy drinks you consume will also reduce the risk of developing constipation.

Don’t ignore the call to go to the toilet. Ignoring the urge to go to the toilet can lead to constipation so it’s important to always answer the call of nature. When you go to the toilet try to ensure you have enough time and privacy to comfortably pass stools in a relaxed environment.