ALL YOU NEED TO KNOW ABOUT CONSTIPATION

What is constipation?

Although constipation is a common term, from a medical perspective it's hard to define precisely.
The dictionary definition is: 'A condition in which bowel emptying occurs infrequently or in which the stools are hard and small or where bowel movement causes difficulty or pain.'

But defining infrequent is difficult when some 90 per cent of people in Western countries have a bowel pattern that ranges from three bowel movements a day to three per week.
And it's possible to move your bowels every day and still be constipated if the stools are hard and difficult to pass. Equally, a daily bowel movement is by no means essential for, nor a sign of, good health.

Provided the bowels move regularly and without discomfort, it doesn't matter if your natural bowel frequency is once every two or three days.
 

How common is it?
Constipation is thought to affect one in seven adults at some time and one in three children.

Constipation is more common in the elderly because:

•     the power of the bowel muscles diminishes with age

•     they tend to take more medicines that have constipating side-effects.

Bypass diarrhoea

This happens when a hard plug of stool in the lower bowel (faecal impaction) stops a proper evacuation. Only the more liquid stool from higher up in the bowel can then be passed. For this reason correct diagnosis is important.

Medicine to slow the bowel down will make the condition worse if a person is actually constipated.
 

What are the symptoms of constipation?

•     Tummy pain associated with bowel movements.

•     A feeling of incomplete emptying of the bowel.

•     A bloated feeling in the stomach region.

•     Diarrhoea: constipation is one of the most common causes of diarrhoea, especially in the elderly in care. Diarrhoea caused by constipation is known as bypass diarrhoea.

What causes constipation?

•     Poor general health.

•     Immobility or an inactive lifestyle.

•     Insufficient fluid intake.

•     A diet low in fibre. Fibre retains fluid and makes the stools light and soft.

•     Irritable bowel syndrome (IBS).

•     Inadequate toilet facilities.

•     An underactive thyroid gland.

•     Spinal injury.

•     Multiple sclerosis.

•     Colon or rectal cancer.

•     Kidney failure.

•     Too much calcium in the blood.

•     Tumours and other lesions of the bowel.

•     Pregnancy.

•     A high temperature, ie with a cold or flu virus.

•     Anxiety or depression.

Certain medicines, eg codeine-containing painkillers (co-dydramol), anti-epileptic medications, antidepressants, anti-psychotic medications, and anticholinergics such as procyclidine (eg Kemadrin) (used in Parkinson's disease).

Constipation should not simply be accepted or ignored.

Persistent constipation or any change in bowel habit (whether towards constipation or looseness) should be investigated, especially in adults over 40 years and lasting for over 6 weeks.

However, for most people with long-standing constipation – there's no identifiable cause.
 

What can help prevent constipation?

•     A well-balanced diet high in fibre, including bran, fruit and vegetables, is often helpful.

•     Cutting down on white bread, cakes and sugar.

•     Drinking at least 6 to 8 glasses of water a day. Hot beverages, such as coffee, tea or hot water, may stimulate bowel movements.

•     Prunes and plum juice can also be beneficial.

•     Regular exercise improves digestion and reduces stress.

•     A regular bowel habit. The best time is usually the first hour after breakfast. Don't hurry and sit for at least 10 minutes, regardless of whether you manage to pass a stool. Don't strain. Try and have your feet on a small stool as this makes it easier to have your bowels opened.

What are the complications of constipation?

•  Haemorrhoids. 

These are swollen veins at the anus, caused by straining at a stool over a long period of time. If large enough, they will be visible from the outside. They can be painful or cause local bleeding.

• Dependency on laxatives. The bowel in someone who has abused laxatives over a long period of time becomes sluggish and eventually dependent on the use of these drugs.

• Hernia (bulging of the abdominal contents through a weak point in the abdominal wall). This is made worse by too much straining when trying to get rid of hard stools.

• A prolapse of the womb or rectum. These complications result from excess straining and weakness of the muscles in this area

• Anal fissure – this is a small crack in the skin of the anus which can cause bright red painful bleeding during and after a bowel movement.

What medicines are used to treat constipation?

• Bulking agents, such as bran and ispaghula husk. These work gently and are the most common type of laxatives (examples are Fybogel). They don't need to be in the form of medicines – increasing the fibre content of your diet should be the main treatment. Bulking agents should always be taken with plenty of fluids.
• Stimulant laxatives that cause the bowel muscles to contract, such as senna (eg Senokot) or bisacodyl (eg Dulco-lax).
• Osmotic laxatives (such as lactulose) that increase the amount of water in the stools by drawing water in from the bowel lining.
• Detergents that break down surface layers in the stool, letting water penetrate and soften it (such as docusate sodium (eg Dioctyl)).
• Macrogols (polyethylene glycols). These are administered along with extra fluids, so they don't draw more water into the bowel from the body. Examples are Idrolax and Movicol. Macrogols may be of long-term benefit to patients with persistent constipation and faecal impaction.

Which treatment is best?

• Laxatives

Large amounts of laxatives are bought over-the-counter every day. This is due in part to the belief that it's desirable to move the bowels daily. Laxatives of all types are among the most commonly prescribed medicines.

Yet little detailed medical research has been done to work out the best ways of treating constipation. There are many different combination laxatives available both on prescription and over-the-counter.
None of these laxatives is superior to any other, and in most people the choice is an individual one.

Sometimes, a medicine prescribed for a separate condition may have constipating side-effects. Changing this medicine will be all that's required to get rid of the constipation.
Someone who has had a period of immobility will probably find their constipation improves once they are up and about again.

Lifestyle measures are the best and safest treatment for constipation, whenever possible.

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