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Constipation (Adults)

Constipation (Adults)


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Gastrointestinal system
Constipation is a condition where bowel movements become less frequent and stools (faeces or poo) may be hard, dry and difficult to pass. It is a common digestive complaint affecting people of all ages, but it is more common in children and the elderly, and women are more likely to be affected than men. A healthy, regular pattern of bowel movement varies greatly from person to person. Some people pass stools twice a day, others only two or three times a week. In general, people are considered constipated if they have fewer than three bowel movements a week or if they find they are often straining to pass a stool.
Common causes of constipation are a diet low in fibre, dehydration, lack of exercise and bad bowel habits such as putting off the urge to 'go'. Some over-the-counter and prescription medicines like painkillers containing codeine, certain antidepressants or indigestion remedies containing calcium or aluminium, can cause constipation. Constipation can be a symptom of other medical conditions such as irritable bowel syndrome, where the intestines can go into spasm, or diverticular disease where the colon narrows, or it can be a symptom of a more serious problem such as cancer of the bowel.
The main symptom of constipation is when bowel movements become less frequent and stools may be small, hard and painful to pass. Stomach pain often accompanies constipation. Bloating, discomfort, loss of appetite and furred tongue may also be experienced. Straining to go to the toilet may cause haemorrhoids (piles), bleeding from the anus, a hernia or a prolapse of the rectum or uterus.
Constipation is best treated by a change in diet and lifestyle. The amount of fibre in the diet should be increased by eating at least 5 portions of fruit and vegetables each day. Low fibre processed foods such as white bread and white rice should be replaced by high fibre foods such as oranges, nuts, multi-grain bread and cereals. Bran added to meals or supplements may be used as additional sources of fibre. At least a litre and a half (6 to 8 medium sized glasses) of water should be drunk throughout the day. The amount of tea and coffee drunk should be reduced as these tend to dehydrate the body and make constipation worse. Regular daily exercise, ideally 30 minutes of vigorous exercise each day, will help prevent constipation and will also help protect against other illnesses. The feeling of wanting to go to the toilet should not be ignored.

If laxatives are used, they should only be used for short term, occasional constipation. They should not be used continuously. Bulk forming laxatives that include bran or ispaghula husk are particularly useful for people constipated because of a low fibre diet as they help promote activity in the gut and increase bowel movements. Stool softeners or osmotic laxatives such as lactulose and macrogols draw water into the gut, soften stools and allow them to be passed more easily. Stool softeners are particularly useful for people constipated as a result of medicines they may be taking or who experience pain when going to the toilet. Stimulant laxatives such as senna, bisacodyl and dantron may be used when stools become hard and impacted.
When to consult your pharmacist
Talk to your pharmacist if you want advice about constipation. Your pharmacist will want to know the age of the person affected and how long they have been constipated. Your pharmacist will ask you questions about diet and will want to know if any medicines have been taken to try to relieve the constipation. Tell your pharmacist if you, or the person affected, are taking any medicines prescribed by a doctor or bought over the counter, and whether any healthcare supplements are being taken.

Your pharmacist will talk to you about diet and exercise and will be able to advise you if any of the medicines being taken could be responsible for causing constipation.

Almost all laxatives are available without a prescription and, if considered necessary, the pharmacist will recommend a suitable product.
When to consult your doctor
Seek medical advice immediately if there is blood in the stools as this may indicate a more serious condition. Any major change in bowel habits, particularly if the person is middle aged or elderly, needs further investigation. Abdominal pain or prolonged discomfort also needs medical advice. Anyone taking laxatives everyday needs to see their doctor. Tell the doctor if the pharmacist has advised that some of the medicines being taken may be the cause of constipation, as the doctor may decide to prescribe an alternative product.
Useful Tips
There are a number of measures you can take to avoid constipation occurring:
  • Eat plenty of fibre (20- 30g/day) such as wholemeal bread, cereals, leafy vegetables and beans, or take a fibre supplement
  • Reduce intake of processed foods such as cheese and white bread
  • Be aware that if you are suffering from chronic constipation increasing fibre intake can sometimes make symptoms worse
  • Eat breakfast every morning as this helps to stimulate movement of the bowel
  • Drink plenty of water and avoid caffeine, alcohol and fizzy drinks
  • Have a regular toilet routine in the morning and allow your bowels time to work. The best time to go is in the hour after breakfast
  • Never ignore the urge to go to the toilet as it will only make stools drier and harder
  • Keep active and exercise regularly
  • When travelling abroad, consider taking some bran supplements, only drink bottled water and avoid sitting still for too long

Based on information supplied by: The Digestive Disorders Foundation

Freephone: 020 7486 0341

Supplied by:

Reviewed on 27/12/2009