Constipation

This general guide is designed to provide background and general advice about the causes and treatment of constipation.  It aims to supplement my verbal discussion and to answer common questions.  It cannot cover in detail every aspect of your individual circumstances and may not deal with some areas that are of particular concern to you.  It should not be a substitute for specific, individual advice from your doctor.

What is Constipation?

Constipation is a spectrum of symptoms.  It may include one or more of the following: - infrequent defaecation, the passage of hard stools, difficulty in opening the bowels (straining) and painful defaecation (which may be due to a fissure related to the constipation).  It may also be associated with bloating and a feeling of fullness which can be thought of as the "swelling of the banks of the river due to the dam down stream".

As the stool moves through the colon water is absorbed and the stool becomes harder.  The muscles of the bowel have to contract hard to push a hard, as opposed to a soft, stool through the colon.  There are many causes for this.  Many are ‘life style’ issues (see below), but it is also important that correctable causes, like medications and under active thyroid are identified.

The average frequency of defaecation in the general population varies from once every three days to three times per day.  You are not required to empty your bowels on a daily basis.  Not to defaecate each day is not ‘failure’, but the normal variation that everybody experiences.  A change in your normal habit is more important to report than the habit itself.

Four Goals to Improve Constipation

Although there are many causes of constipation the common causes are a low fibre diet, inadequate fluid intake and a lack of regular exercise.

A Fibre-Rich Diet

Many modern foods lack the fibre found in more traditional diets.  This results in a hard, small stool that is difficult to propel through the large bowel.  Such stools are a contributing factor to many cause of constipation.  A separate high fibre advice sheet is available.  You need about 25-30 grams of fibre per day.

Generous Fluid Intake

Fibre binds water into the stool, making it softer and bulkier.  It is then easier to pass.  You must ensure that you drink plenty of water.  Drink at least 2 litres each day, more in summer.  Note that fruit juices and many fizzy drinks (e.g. colas) are high in calories.  Caffeine and Alcohol drinks do contribute to your hydration but also tend to make you pass more urine as they stimulate the kidneys.

Toilet Habit

Prolonged visits to the bathroom with straining are very detrimental to many disease related to constipation including piles and fissures.

Medication

Some common medications will cause constipation.  These include pain medication (especially those with codeine), some antacids, anti-depressants and iron tablets.

Initially an artificial bulking agent may be prescribed to supplement your diet whilst you increase your fibre intake.  Normally a husk based agent such as Fybogel will be recommended or an osmotic laxative such as lactulose.  These work by absorbing water so a high fluid intake is required.   Many patients will be able to stop laxatives once they have adjusted to their lifestyle goals.