Constipation and its Management
Feb 27, 2013
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
My daughter Emily loves having a dog. Sheldon loves her back and has lots to teach her as well. Emily has learned not to procrastinate. If she doesnt take Sheldon outside right after he wakes up, Sheldon will pee on her math homework. Emily has learned humility. Emilys PeeWee girls hockey team had a great home tournament. They got second place in the tournament and Emily got a goal in one of the games. That goal even got mentioned in the Dauphin Herald. Emily was quite tickled. Sheldon, however, pulled the Sports Section out of the folded paper and started chewing on her article. We stopped him before he ate much of the print, but apparently dogs dont care about celebrity. Sheldon has also taught Emily the value of being regular. Every time Emily takes Sheldon for a walk, her parents ask her if Sheldon had a poop. Emily knows everyone in the house is happier if Sheldon poops at least once a day.
Although being regular isnt something we talk about in polite company, we all want going to the bathroom to be effortless. Constipation, though, can make the bathroom an awkward and uncomfortable place. Lets talk about what can be done to make bowel movements more effortless.
The gastrointestinal tract is basically a long tube which connects the mouth to the anus. When food is eaten, it passes from the mouth into the stomach where digestion begins with stomach acid and some enzymes. Then it is off to the small intestines where food is broken down, and the proteins, vitamins, minerals, fat, carbohydrates, water, and anything else the body needs from food are absorbed. The leftover waste continues to be pushed by muscular contractions, called peristalsis, through the large intestines and towards the rectum. When sufficient waste accumulates, the individual feels the need to have a bowel movement. A bowel movement occurs when the muscles in the anus are voluntarily relaxed.
The time it takes for food to pass from the mouth to the anus is highly variable. Normal bowel movement frequencies vary from three bowel movements per day to three bowel movements per week. So the best way to define constipation is a change from the individual's normal bowel frequency or stool consistency. It is experienced occasionally by almost everyone in the Western world. Constipation can be caused by a number of factors including several different diseases, and medications. If you suspect your constipation is caused by a disease, or medication, contact your doctor. This article will deal with simple constipation.
Simple constipation is usually caused by lifestyle. Ignoring the urge to empty your bowels, and a low fibre diet often contribute to constipation. Other lifestyle factors like not drinking enough fluid, not eating breakfast, and not exercising may lead to constipation as well. The elderly are constipated more often than younger people, and women are constipated more often than men. Constipation can cause different symptoms in different people. Some commonly reported symptoms are difficulty and straining in passing a stool, uncomfortable abdominal bloating, cramping, headache, and lack of interest in food.
Prevention of simple constipation should begin by using non-drug measures. These measures include eating 15-30g of food fibre per day. This is actually quite difficult to achieve, so 10 g of fibre per day is a good minimum to strive for. A person should drink 6-8 glasses of water per day. There has been some debate lately if you really need that much water per day. In this case water really does help the fibre do its job. A person should respond to the urge to empty the bowels as soon as possible, but dont strain when on the toilet. Regular, moderate exercise is also good for you in many ways. Some of the reading I did said exercise is good at preventing constipation, but that is not definitive. But, as exercise is good for you in so many other ways, it is a good recommendation.
Next are the red flags. These are the signs you should see the doctor, and not self treat your constipation. The warning signs are: rectal pain or bleeding; blood in the stools; fever, abdominal pain, nausea or vomiting; very narrow (i.e. pencil thin) stool; constipation lasting more than 2 weeks or keeps recurring for over 3 months. If you have these signs, do not go to the laxative aisle in the pharmacy. Go directly to see your doctor.
If you choose to use laxatives, they shouldn't be used for more than 3 days for simple constipation. If they are, the body can get used to them, and it may become harder to go to the bathroom without them. Fibre supplements like metamucil work in 1 to 3 days. PEG 3350 works in 1 to 3 days. Lactulose works in 24 to 48 hours. Stool softeners like docusate calcium work in 12 to 72 hours. Milk of Magnesia works in 0.5 to 3 hours. Laxatives containing cascara, senna, and bisacodyl work in 6 to 12 hours with the oral pills and about 30 minutes as a rectal suppository. Glycerin suppositories work in about 15-30 minutes.
If you came into my pharmacy complaining of constipation and you didnt have any of the red flags mentioned earlier, here is what I would say. Start with a glycerin suppository to get your bowels moving quickly. Glycerin suppositories are safe and have no medication in them to cause other problems. If you refused the suppository, I would recommend you start with bisacodyl 10 mg oral tablets. Bisacodyl will take longer to work than the suppository. Because it is a stimulant laxative, bisacodyl can cause cramping, and shouldnt be used long term. Once you had a bowel movement, I would recommend you take a stool softener like docusate calcium or an osmotic laxative like PEG 3350 every night for 2 weeks to a month to keep your bowels moving. I would recommend you look at increasing the amount of water you drink and consider either eating more fiber or using a fiber supplement. If these measures didnt work, you should see your doctor.
Emily has the job of following a furry four legged friend around with plastic bags in her pocket. This exercise has taught her that being regular is important in the canine world. Being regular is important in the human world too. If you exercise, eat fibre and drink lots of water, you will find going to the washroom can be an effortless part of your day as well.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
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