Constipation
Constipation Support Materials
Bowel Record Chart
Fibre Content Summary Sheet
What is constipation?
As many as 14 million people in the UK suffer from constipation, ranging from the very young to the old. It is more common in women than men and increases in the elderly with age.
It is defined as a change in a person's normal bowel habit, such as visiting the toilet less often than usual, or when it becomes difficult to pass a motion. Bowel habit varies from person to person, so your normal bowel habit may not resemble the bowel habit of any of your friends or relatives, it is what is normal to you as an individual.
The severity of constipation can vary greatly from short irregular episodes (acute) to a more long-term chronic condition. Indeed in severe cases this can actually result in the condition known as faecal impaction, in which the faecal material, due to its dryness and hardness in the bowel becomes unable to move without some form of intervention. It can also result in faecal incontinence where there is an involuntary leaking of faecal material through the rectum from around the faecal mass stuck within the bowel.
Constipation can have various causes, including:
- Drinking too little water
- A low fibre diet
- Pregnancy
- Various medical conditions, or treatments
Or it can be idiopathic (no known cause).
What are the symptoms?
These will vary from person to person, but the main symptoms are as follows:
- Fewer bowel movements than usual
- Difficulty in passing faecal matter, this may cause straining that can lead to piles or rectal bleeding
- Faecal matter is hard, and dry
- There may be a 'bloated' feeling, which may develop with the feeling of sickness
- A feeling you have not completely emptied the bowel
Diagnosis
Usually there will not be a requirement to carry out any tests to diagnose constipation, in fact many people will treat themselves by various ways detailed under the next section. Further tests may be required if the following occurs:
- this is a new condition with no apparent trigger
- symptoms persist for a long time
- other symptoms appear, like blood in the faeces, or increased abdominal pain and discomfort
- medication does not improve the situation
- unintentional weight loss occurs
Prevention and Treatment
The treatment of constipation falls into two main categories:
- Non-medicinal
- Medicinal
Non-medicinal
- Lifestyle changes - becoming more mobile and taking regular exercise.
- Diet -
eating more fibre in the diet such as fruit, vegetables, cereals and wholemeal bread. Also drinking more fluids, such as water (at least two litres a day is recommended). Alcohol is not recommended due to its dehydrating effect.
- Go to the toilet regularly. Holding off will stop the natural movement of the faecal matter and cause blockage and more liquid to be absorbed from the faeces. This causes a hardening of the faecal matter and an increase in the degree of constipation.
- Trying to keep stress levels to a minimum.
Medicinal
If non-medicinal interventions don't resolve the constipation, or the cause of the constipation is through medication, then medical intervention may be required. In most cases this takes the form of laxatives. The choice of laxative prescribed / recommended will be determined by symptoms, patient preference, side-effects and the costs involved in treatment. There are 4 main types of laxative:
- Bulk-forming agents - These can also be called fibre supplements. Examples of these are ispaghula husk, methylcellulose and stericula. The mode of action of these drugs is to 'bulk up' the faeces in a similar way to fibre. Adequate amounts of liquid are required when taking these types of laxatives, as intestinal obstruction can occur if there is not enough liquid in the bowel. Bulk- forming laxatives can take several days to work so are of more use in chronic constipation than acute. Abdominal pain and flatulence can be common side-effects of these medicines.
- Stimulant laxatives - Examples of these are senna, bisacodyl and also (although its use is restricted) dantron. These products actually work on the nerves within the bowel to cause a movement of the faecal matter by stimulating the muscles in the bowel wall. This causes them to contract more than usual and push the faecal matter along. Most stimulant laxatives take 8 -10 hours to act and so are better taken before bedtime with normal bowel opening the next morning. Abdominal cramps are the main side-effect, but use long-term can result in weaknesses in the natural contractions of the bowel wall causing the condition sometimes known as 'lazy' bowel.
- Faecal softeners/ lubricants - Examples of these are docusate sodium, with some bulk-forming laxatives also exerting some of their effect in this way. These laxatives work as the name suggests by softening the faeces and so making the faecal matter easier to pass along the bowel. However, over a prolonged time, some of these laxatives can cause a coating over the bowel wall and so restrict the absorption of some essential vitamins.
- Osmotic laxatives - Examples of these are macrogol and lactulose. Some like macrogol may also have salts such as sodium chloride in their formulation. They can work in two ways within the large bowel. Either firstly by restricting absorption of fluid from the bowel into the body or the opposite, drawing fluid out of the body into the bowel. Products like lactulose may take a couple of days to work, so it is more useful for chronic constipation, and not for rapid relief. Accompanying increase in fluid intake is also encouraged. Side-effects include abdominal cramps and flatulence.
If you suspect you have constipation you should contact your doctor or pharmacist who can advise you on the best treatment. Prolonged use of laxatives can cause dependence by the bowel on that laxative, so once the treatment has worked and your bowel habits are back to normal, you should discontinue usage unless specifically told otherwise by your clinician.