Constipation

Constipation is a common complaint that most people have experienced. The cause is often a result of a combination of factors including dietary, emotional or lifestyle changes. People often experience constipation when they go away on holiday, change their diet or routine or change their toilet. There are a number of strategies you can use to prevent constipation if it occurs.

Severe constipation is by far the most common cause of bowel leakage (faecal incontinence) especially in the elderly population. Hard bowel motions are difficult to pass and may cause a partial blockage high up in the bowel, resulting in watery faeces flowing around the constipated stool without warning. This may be mistaken for diarrhoea.

Constipation is the infrequent passage of hard dry bowel actions that are difficult to pass. The myth that we must open our bowel everyday is simply not true. There is a wide variation in frequency from three times per day to three times per week. The normal bowel motion (not constipated) is soft formed, easy to pass and the perosn has a feeling the bowel is completely empty.

If you are straining to empty your bowels or your bowel action is hard and dry you are constipated and you need to take action.

More causes of constipation

• Not eating enough fibre (fruit and vegetables, wholemeal bread, high fibre cereals)
• Not drinking enough  - always drink more when you increase the fibre in your diet
• Not exercising enough or reduced activity level generally
• The side effects of some medications (eg pain killers or iron tablets)
• Not being able to go to the toilet because of poor mobility
• Some nerve disorders
• Some bowel diseases - haemorroids, irritable bowel syndrome or diverticulitis
• Anorectal pain caused by haemorroids, fissures or birth trauma
• A slow transit bowel
• Poor toilet habits
• Not sitting on the toilet properly
• Ignoring the urge to go to the toilet through habit
• Rushing on the toilet instead of sitting firmly

Using you bowels correctly

• Sit on the toilet fully and correctly
• Lean forward keeping the back straight
• A small stool may be required to firmly position your feet
• A small push is all that should be needed
• When finished, firmly pull up the muscles around the back passage
• A minute or so is all it should take to completely empty your bowel (unless you have other physical problems which prevent this - seek advice from your GP or continence professional if in doubt)

What can you do if you have constipation?

• Try to drink normally 6-8 drinks per day (ie around 1.5-2 liters). Dietary fibre absorbs water. Bowel motions will become dry and difficult to pass if you don't drink enough.
• Eat plenty of high fibre from a wide vareity of foods. Fibre is found in plant foods. These foods include wholegrain breads, grains, cereals and cereal products, fruit, vegetables, legumes, nuts and seeds. (Low fibre products include refined products made from white flour, refined breakfast cereals, cakes, biscuits and pasteries, fruit and vegetable juices, fast foods fatty foods and sugar.
• Exercise daily, exercise stimulates movement of the bowel, even gentle exercise (like walking) is useful
• Maintain a regular bowel pattern, you are more likely to use your bowels after a meal. A hot drink often promotes bowel movement. The strongest urge is usually 30 minutes after breakfast.
• When you have the urge to use your bowels do so. If you delay going to the toilet the urge may diminish and over time it may dissappear.
• When using the toilet sit down properly on the seat with your feet firmly supported. This helps to fully relax your pelvic floor and sphincter muscles.

Fibre is classified as either soluble or insoluble. Most plant foods contain a combination of both types of fibre. Insoluble fibre such as wheat bran, wholegrain breads and cereals helps to increase the dry weight and the ability of the bowel motions to hold moisture. If you increase the fibre in your diet be sure to increase fluids. This can help the bowel motion to set similar to jelly - this is useful in managing diarrhoea.

Processed foods such as biscuits, cakes, pasteries and fast foods are generally low in fibre and will contribute to constipation. Fruit and vegetable juices contain little fibre and are not a good substitute for whole fruit and vegetables.

Medications for constipation

It is best to get professional advice on laxatives, as there are three types - bulk forming agents, softeners and stimulants. The correct choice for your needs is very important and a continence nurse or your doctor can help you select the best one. Do not try to work out the dosages for yourself as the problem may get worse. Ask your health professional what to take, how much, how often and for how long. Sometimes an initial suppository or enema is needed to clear the rectum of constipated stool and is then followed up with a different regimen. Take action if you have been constipated for two to three days or more. Always consult your doctor if constipation persists. Ask for a long-term plan of managment if you get constipated regularly. Over-use of stimulant laxatives causes a lazy bowel, causing difficulty in long term bowel management.