Word On Constipation

Constipation is a common problem and does not necessarily mean that you have a disease. It is a symptom that can mean different things to different people but the usual meaning is that a person has difficulty in opening their bowels. The information below is meant as an introduction, for more detailed data visit the website of the charity Core or ask your GP or pharmacist for advice. 

Doctors define constipation in a number of ways: 

• Opening the bowels less than three times a week 

• Needing to strain to open your bowels on more than a quarter of occasions 

• Passing a hard or pellet-like stool on more than a quarter of occasions

If you have any of these complaints you may be one of the approximately one in seven otherwise normal people who are just constipated. Two particular groups of people who are most likely to be troubled by constipation are young women and the elderly – especially those who need to take regular medicines. Constipation may be part of the irritable bowel syndrome, especially if abdominal pain is also present.

Can being constipated cause any complications?   Although people often worry about it, there is no reason to believe that constipation causes a “poisoning” of the system. You may feel sluggish and bloated, but there is no evidence that bugs or any toxins leak from your bowel into any other part of the body.

Another common idea is that constipation may lead to cancer. There is no evidence at all that long-term constipation increases your chances of getting bowel cancer. Patients can be alarmed if they notice blood when they open their bowels. You may notice some blood on the tissue after straining or passing a hard stool – this is usually due to haemorrhoids (or rarely a painful tear at the anus). This explanation will need to be confirmed by a doctor. Elderly or immobile patients may get so badly constipated that they quite literally get bunged up ("faecal impaction") and this will need prompt treatment by either the GP or hospital.

What causes constipation?  Sometimes the muscles of the intestines and colon do not seem to work properly and this results in slow movement of contents through the bowel. The urge to open your bowels may not be felt very often since, when the bowel is sluggish, the stool can become hard and small. In some people there can be a problem just inside the anus with the way that the rectum squeezes out its contents.

A large number of drugs or medicines that you may have been prescribed or have bought over-the-counter can cause constipation. If your symptoms began (or got worse) after starting one of these drugs, it may be worth asking your doctor if there are any less-constipating alternatives. 

Drugs that can cause constipation include: 

• Pain-killers (especially codeine-containing compounds) 

• Antacids (especially if containing aluminium) 

• Iron tablets 

• Blood pressure medications (not all) 

• Antidepressants (not all) 

• Anti-epilepsy and anti-Parkinson’s disease drugs 

What should you do if you are constipated?  A high fibre diet may help some patients with constipation. Try to eat a mixture of high fibre foods. Fruit, vegetables, nuts, wholemeal bread and pasta, wholegrain cereals and brown rice are all good sources of fibre. Aim to have a high fibre food at each meal and eat five portions of fruit or vegetables each day

Some people may find that it helps to take fibre in the form of fruit and vegetables (soluble fibre) rather than that in cereals and grains (insoluble). This is because insoluble fibre may lead to bloating and can worsen any discomfort.

Fibre is most helpful for patients with mild symptoms of constipation – if you are severely troubled, you will not benefit from progressively higher doses of fibre, and may even be made worse.

Regular meals and an adequate fluid intake may help in the treatment and prevention of constipation.   Keeping active and mobile also helps some people whose bowel is sluggish.

Laxatives generally work by aiming to alter the consistency of the stool making it easier to pass. Regular use of laxatives is generally not encouraged, but occasional use is not harmful.

The most common problem with laxatives is that their effects are unpredictable – a dose that works today may not produce an effect tomorrow. Also, they can cause pain and result in the passage of loose stools if the dose is high.

One further problem with long-term use of laxatives is that the bowel becomes progressively less responsive, meaning that gradually higher doses are needed. The longer you take laxatives, the less likely it is that your bowel will work well on its own, but the balance of scientific evidence suggests that laxatives do not cause permanent changes in the way the colon works.

There is no evidence that using laxatives puts you at risk of getting colon cancer. Suppositories or mini-enemas are more predictable than laxatives and tend to be very well tolerated and effective.

A key point is that certain types of laxative will work in some patients but not others. Unless your constipation improves with fairly simple measures, it might be best to use laxatives only with proper guidance.

What other treatments are available?  If you remain troubled with constipation despite strict adherence to the measures described before, you may need further treatment. A technique used only in some specialist centres is called ‘biofeedback’, where patients are trained to co-ordinate their tummy muscles better in order to help the bowel empty rather more effectively.

It can be very frustrating for patients as well as their doctors when constipation does not respond to different treatments. However, it is usually best to avoid surgery for constipation because many patients do not have a successful outcome. Indeed there are some patients who develop new symptoms after an operation such as diarrhoea, bowel obstruction or incontinence.

Other therapies and interventions may be available on prescription which work to target the multiple symptoms of chronic constipation including agents that act on the receptors in the gut to increase its motility. 

For more information  you can visit the website of the charity Core or ask your GP or pharmacist for advice.