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Constipation - Problem in the plumbing

Updated: Feb 5, 2022

What is constipation? Constipation is when we pass hard, dry bowel movements (faeces/stools). It may be that the bowel movements are hard to pass and you find yourself straining. The hard, dry stools form when the colon absorbs too much water back into the body leading to fewer bowel movements and causing symptoms such as: - • Crampy Pain, bloating and discomfort • Excess wind • Fatigue • Poor appetite • Nausea • Generally feeling unwell • No bowel movement for several days • Not feeling hungry and weight loss

If left untreated, it may lead to a bowel obstruction or blockage, a hernia or haemorrhoids.

How often should I have a bowel movement?

• You should be having regular bowel movements, even when eating less than normal • Aim for a soft bowel movement that is easy to pass every 1-2 days • If you are concerned keep a diary of your bowel movements

See your GP if you: - • Have bowel movements that contain blood • Experience bloating, vomiting or stomach pain • Increase your intake of fibre and fluids, but your constipation does not improve

Common Causes of Constipation • Getting older • Pregnancy • Waiting too long to go to the toilet after you experience the urge • Medication (including use of too many laxatives) • Chronic illness- including certain bowel conditions and depression • Changing your routine – travel and holidays and changes to work hours • Poor Fluid intake • Poor Fibre intake • Less food • Reduced exercise and reduced ability to mobilise • Hospitalisation

Treatment of Constipation Treatment will depend on the cause, the severity and duration. Most causes will respond to diet and lifestyle change to help relieve the symptoms Your diet needs to contain enough fibre (20-35 grams of fibre each day), this helps form soft bulky stools. If you are prone to constipation, limiting foods that have no fibre or limited fibre such as ice cream, cheese, meat and processed foods can help - Drink enough water and other liquids and fluids (add some prune and pear juice). - Caffeinated drinks are also reasonable, however try to keep these unsweetened

- Daily exercise - Increasing exercise will improve the actions of the colon

- Laxatives Most people do not need laxatives; however, they can assist for a limited time. If you are prescribed laxatives, take them as prescribed eg: Movicol and Coloxyl and Senna) IMPORTANT If you increase fibre intake too quickly or start bran or fibre supplements (eg: Metamucil or Psyllium husks) without drinking enough fluids, it can make the constipation worse and cause bloating, excess wind or pain.

Types of Laxatives

1. Bulk Forming Laxatives (such as Psyllium husks / Metamucil)

How do they work? They absorb water in the colon to increase the bulk of your stools which can stimulate bowel movements. They are best used for: Constipation, Diarrhoea (as they improve the consistency of the stools).

Side effects: Excess wind and bloating and some abdominal discomfort. Best to start on a smaller dose and gradually increase, ensuring adequate water is consumed. If diarrhoea is the main problem, fluid would be reduced to help harden the stools. Time for effect: These agents can take several days to take full effect.

2. Osmotic agents (such as Coloxyl)

How do they work? They soften stools by attracting water to the stools and can also help the intestine produce additional secretions to help move the stools along. They are best used for: Constipation Side effects: - abdominal cramps, diarrhoea, nausea and rash Time for effect: - 1-3 days

3. Stimulants such as Senna, or Coloxyl with Senna or Senokot.

How do they work? The act by stimulating the nerve endings in the lining of the colon to increase the movement of the colon pushing the bowel movements along. They may also cause an accumulation of water in the colon. Side Effects: Discoloration of urine (brownish or red) Time for effect: Onset is usually 6-12 hours

4. Osmotic agent – eg: Lactulose

How do they work: As lactulose is poorly absorbed by the bacteria of the colon, its presence in the colon causes pressure in the bowel helping to stimulate contraction-like behaviours that assist with bowel movements. Most often used for Constipation Side Effects: Wind, abdominal discomfort and cramps Time for effect: Depends on the agent usually 1-3 days. Some medications can have a shorter onset; however, these are only for use under medical supervision eg: before a Colonoscopy)

References 1. Nutrition Education Materials Online "NEMO" team. (2018, February). Constipation: managing different causes. Retrieved from Queensland Government: 2. Queensland Government. (2018, July 24th). Retrieved from 3. Thomas, B., & Bishop, J. (2007). Manual of Dietetic Practice (4th ed). Carlton, Victoria, Australia: Blackwell Publishing .

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