Dr Caitlin: The Frustration Of Constipation

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Dr Caitlin O’Connor of Tralee Medical Centre, St Brendan’s Park, gives advice on treatment of constipation…

Constipation has varied meanings for different people. Stools may be too hard or too small for some, while for others defecation is too difficult or infrequent. In constipation, a change in your bowel habits is important.

Constipation is the most common digestive complaint in the general population – the prevalence is approx 15%. In the over 65 years age group, approx 26% of men and 34% of women complain of constipation.

What causes constipation?

Factors that can lead to constipation include a low roughage diet, inadequate fluid intake, being inactive (especially with disabled or older adults), and a number of medical conditions, including an underactive thyroid, pregnancy, irritable bowel syndrome, diabetes, multiple sclerosis, Parkinson disease, spinal cord injuries, and colon cancer.

In addition, medications used for pain, muscle spasms, depression, mineral deficiencies, high blood pressure, and heart disease can often be associated with constipation. In most cases of constipation, there is a combination of causative factors responsible.

Commonly, the mixture is of a low fibre diet, not drinking enough fluids, inactivity, obesity, and a persistent failure to respond to the urge to defaecate.

How do I know if I am constipated?

The clinical features of constipation include:

• Infrequent, incomplete evacuation of stools – generally this is taken to be less than twice a week; however, normal bowel habit is less than two bowel motions per week for some.

• Loss of appetite and vague abdominal discomfort

• Diarrhoea – constipation may cause overflow or spurious diarrhoea, especially in the elderly, when faecal fluid intermittently escapes past an impacted faecal mass

• Abdominal pain – usually in children and the elderly Constipation is uncomfortable and can interfere with a person’s quality of life. In addition, chronic constipation can aggravate haemorrhoids, lead to abdominal pain, nausea, vomiting, or painful tears in the anal canal that can be caused by passing a hard stool.

How do I treat constipation?

Changes in lifestyle and a high fibre diet will help. Laxatives should be used when the changes and fibre are ineffective.

The most important issues for treating constipation include understanding normal bowel function, eating foods high in fibre, and using laxatives when required.

Lifestyle changes – 
The bowels are most active following meals, and this is often the time when stools will pass most readily.

If you ignores your body’s signals to defecate, the signals become weaker and weaker over time. By paying close attention to these signals, you may defecate more easily.

Diet -Eating a diet high in fibre is important. Many fruits and vegetables can be particularly helpful in preventing and treating constipation. This is especially true of citrus fruits, prunes, whole grains and some breakfast cereals. A number of other fibre supplements are also available. Drinking a caffeine-containing beverage in the morning may be helpful for stimulating bowel action.

Medication for constipation

In general, laxatives can be categorized into the following groups.

Bulk forming laxatives – This essentially is fibre. These work by increasing the water content and bulk of stool, which tends to decrease the time needed to pass through the colon.

Hyperosmolar laxatives – These reduce water absorption from the colon, thereby wetting the stool. Stools usually become soft, but they are still formed.

Stimulant laxatives – These stimulate the bowel to evacuate it’s contents. These can be overused. Excessive use of stimulant laxatives can cause side effects, including low salt levels.

When should I see my GP about my constipation?

Talk to us if the problem:

• Is new (ie, represents a change in your normal pattern)

• Lasts longer than three weeks

• Is severe

• Associated with any other concerning features such as blood on the toilet paper, weight loss, fevers, or weakness.

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