Constipation in Adults
Constipation is a common problem. It means either going to the toilet less often than usual to empty the bowels, or passing hard or painful stools.There is a large range of normal bowel habit. Some people normally pass stools 2-3 times per day, for others, 2-3 times per week is normal. It is a change from your usual pattern that may mean that you are constipated .Sometimescrampy pains occur in the lower part of your abdomen. You may also feel bloated and feel sick if you have severe constipation.
What are the causes of constipation?
Not eating enough fibre (roughage) is a common cause helps your bowels to work well. Foods high in fibre include: fruit, vegetables, cereals and wholemeal bread.
Less water intake may make constipation worse. Stools are usually soft and easily passed if you eat enough fibre, and drink enough fluid.
Some special slimming diets are low in fibre, and may cause constipation.
Some medicines can cause constipation as a side-effect. See the list of possible side-effects on the leaflet that comes with any medicine that you may be taking. Tell a doctor if you suspect a medicine is making you constipated.
Various medical conditions can cause constipation. For example, an underactive thyroid, irritable bowel syndrome, some gut disorders, and conditions that cause poor mobility, particularly in the elderly.
Pregnancy. About 1 in 5 pregnant women will become constipated.
Unknown cause ,This is quite common and is sometimes called functional constipation or primary constipation. Most cases occur in women. This condition tends to start in childhood or in early adulthood, and persists throughout life.
Do I need any tests?
Tests are not usually needed to diagnose constipation, because symptoms are often typical.
Required in specific cases such as:
When regular constipation is a new symptom, and there is no apparent cause, such as a change in diet, lifestyle, or medication. This is known as a 'change in bowel habit' and should be investigated if it lasts for more than about six weeks.
If symptoms are very severe and not helped with laxative medication.
If other symptoms develop. More worrying symptoms include: passing blood from your bowel; weight loss; bouts of diarrhoea; night-time symptoms; a family history of colon cancer or inflammatory bowel disease (Crohn's disease or ulcerative colitis); or other unexplained symptoms in addition to constipation.
What can I do to ease and to prevent constipation?
These measures are often grouped together and called lifestyle advice:
Eat foods that contain plenty of Fibre (roughage). It adds bulk and some softness to the stools.
Have plenty of water/ liquids. Drink at least two litres (about 8-10 glasses) a day. Most sorts of drink will do, but alcoholicdrinks can be dehydrating and so are not good.
Exercise regularly, if possible.Keeping your body active helps to keep your gut moving.
Toileting routines.As a rule, it is best to try going to the toilet first thing in the morning, or about 30 minutes after a meal.
Do not ignore the feeling of needing the toilet. Some people suppress this feeling if they are busy. It may result in a backlog of faeces that is difficult to pass later. When you go to the toilet, it should be unhurried, with enough time to ensure that you can empty your bowel.
Positioning on the toilet is also important. Western-style toilets actually make things more difficult - squatting is probably the best position in which to pass stools.
What are the treatments for constipation?
Treatment with a laxative is needed only if the lifestyle measures above do not work well. It is still worth persisting with these methods, even if you end up needing to use laxatives.
Chronic (persistent) constipation can be more difficult to treat. Laxatives are usually needed for longer periods . Chronic constipation is sometimes complicated by a backlog of hard stools building up in the bowel or even partially blocking it.
There are four main groups of laxatives that work in different ways:
- Bulk-forming laxatives: They are fibre supplements. These increase the bulk of your faeces . They can have some effect within 12-24 hours but their full effect may take several days to develop.Bulk-forming laxatives partly work by absorbing water,so its important to drink at least 8-10 glasses of water/ liquids per day.. You may notice an increase in wind (flatulence) and abdominal bloating. This is normal and tends to settle down after a few weeks .Fibre supplements include ispaghula (psyllium), methylcellulose, sterculia, wheat dextrin, inulin fibre, and whole linseeds (soaked in water).There are various branded products that contain these ingredients
- Stimulant laxatives: These stimulate the large bowel the colon and rectum, to squeeze harder than usual. This pushes the faeces along and out. Their effect is usually within 8-12 hours.Stimulant laxatives include bisacodyl, dantron, docusate, glycerol, senna and sodium picosulfate.
- Osmotic laxatives: These work by retaining fluid in the large bowel .There are two types - lactulose and a group called macrogols (also called polyethylene glycols). Lactulose can take up to two days to have any effect so it is not suitable for the rapid relief of constipation. Possible side-effects of lactulose include abdominal pain and bloating. Macrogols acts much faster, and can also be used in high doses to clear faecal loading or impaction.
- Faecal softeners: These work by wetting and softening the faeces.
Which laxative should I use and for how long?
Treatment with a bulk-forming laxative is usually tried first.
If faeces remain hard despite using a bulk-forming laxative, then an osmotic laxative tends to be tried, or used in addition to a bulk-forming laxative.
If faeces are soft but you still find them difficult to pass then a stimulant laxative may be added in.
High doses of the macrogol osmotic laxatives are used to treat faecal loading and impaction - this should be under the supervision and advice of a doctor.
You should use a laxative only for a short time, when necessary, to get over a bout of constipation. Once the constipation eases, you should normally stop the laxative. Some people get into the habit of taking a laxative each day 'to keep the bowels regular' or to prevent constipation. This is not advised, especially for laxatives which are not bulk-forming.
Constipation is usually helped by the above treatments. Mostly, laxatives are taken by mouth (orally). In some cases, it is preferable also to treat constipation by giving medication via the anus (back passage).,these are called suppositories.theysact as a stimulant within the rectum, encouraging the passing of stools. Sometimes, an enema is a liquid that is inserted into the rectum and lower colon, via the anus.,may be needed in severe constipation.
Are there any complications of chronic (long-term) constipation?
Short-term constipation or intermittent bouts of constipation are unlikely to cause any long-term problems. Sometimes a split or tear in the anal skin (an anal fissure) can occur with the passage of a particularly big or hard stool. This is very painful, and there may be a small amount of fresh red blood on the toilet paper.
Chronic constipation and long-term use of laxatives can mean that your bowel becomes sluggish and 'lazy'. Constipation then becomes a vicious cycle and even more chronic. Try to avoid getting into this situation in the first place, and consult your GP for advice. Some people with persistent and severe constipation do require regular laxatives.Severe chronic constipation can result in faecal impaction. This is something that is more likely in the elderly and infirm. Higher doses of laxatives ,enemas or suppositories may be required. After the large mass of stool is cleared, laxatives are often needed for a while to prevent the problem recurring.
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