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Constipation

Constipation is one of the most common health complaints, affecting up to 20% of the population. It is the reduced frequency of bowel movements requiring excessive straining at defacation in order to pass the stool.

Symptoms

The frequency of passing bowel motions varies greatly between individuals and as such, there is no 'normal' number of bowel movements that should be passed.

  • Reduced frequency - in general, less than three bowel motions per week is considered abnormal.
  • Straining at defacation
  • Passage of small, hard stools
  • Feeling of incomplete emptying of the bowel (incomplete evacuation)
  • Passage of liquid stool (overflow diarrhoea)
  • Pain in the anus or abdomen
  • Abdominal bloating

Transmission

There are a number of factors which may contribute to the development of constipation. These include:

  • Increasing age
  • sedentary lifestyle
  • poor diet (low fibre)
  • dehydration
  • change in routine with passing bowel motions
  • medications (iron supplements, certain antidepressants, pain relieving medications containing opiates such as codeine, aluminium-containing antacids,)
  • medical problems
    • underactive thyroid (hypothyroidism)
    • diabetes mellitus
    • chronic renal failure
    • neurological disorders (eg. multiple sclerosis)
  • bowel disease - malignancy or anal problems including fissures and haemorrhoids

Treatment

There are a number of different reasons for experiencing constipation and so treatment will depend on the individual cause. In general, lifestyle changes will be recommended, including eating a varied diet with plenty of fibre (vegetables, fruit) and increasing fluid intake (1.5L a day). A gradual increase in dietary fibre up to 20 - 30 grams of fibre is recommended, which may include dietary sources as well as fibre supplements. Your pharmacist and doctor may be able to recommend some supplements which are appropriate for you. Increased fibre intake may initially be accompanied by excess bloating and gaseousness, however, this usually subsides over several days as the body adjusts.

Undertaking regular exercise, a minimum of three times per week for 30 minutes has also been shown to improve the symptoms of constipation by assisting with movement of the bowel.

Developing a routine for passing bowel motions has also been shown to be useful strategy for treating constipation. Attempting to defacate at the same each day, for example 30 minutes after breakfast, will encourage regular passage of bowel motions.

In addition to this, your doctor may wish to alter your medications or take some blood in order to make sure there is no medical problem responsible for the reduced bowel motions. Depending on your symptoms, your doctor may suggest further investigations with some medical investigations such as a colonoscopy or barium enema to get a better view of the gastrointestinal tract and rule out any serious causes.

A trial of stool softeners or laxatives may also be of benefit. There are a number of different types of these, including osmotic laxatives, which increase the amount of fluid retained within the stool and thereby soften the faeces, and stimulants such as senna, which may be used in the short term to treat an acute bout of constipation.

Health Outcome

Most people will experience improvement in symptoms with simple lifestyle changes. Some long term complications of constipation include haemorrhoids, diverticular disease, faecal impaction and rectal prolapse.

Prevention

Regular exercise in combination with a high fibre diet and regular, adequate fluid intake will help reduce the development of constipation. Your doctor may be able to assist you with other changes including medication alterations, in order to prevent constipation.

Help and Assistance

Your doctor or pharmacist will provide you with further information regarding possible management options. In an emergency situation your doctor may be able to assist with immediate emptying of bowels should this be required.

If you have any symptoms of or concerns about constipation:

  • please contact one of our registered nurses at 13 HEALTH by phoning 13 43 25 84 or
  • speak to your doctor.

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