Chronic Constipation

Nov 30, 2018

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I like my job. Most days. But, the days when I have to track down thirteen different invoices for the ingredients of a child's compound I've made because Non-Insured Health Benefits has decided to audit the costs of a prescription that they already agreed to pay for, it can be frustrating. On those days, it takes a little extra effort to be nice to people. Even if you don't want to, it is important to go that extra mile. That senior with the bulky packages doesn't really care about my paperwork woes. She just wants to get to her car safely across an icy parking lot. So, I carry the boxes. I try to keep my paperwork grumbling to myself. I really should stop feeling sorry for myself. There are lots of people in Dauphin who go out of their way to do something nice. Recently, Eric was the recipient of someone's good deed. It all started when Doris picked him up from MacKenzie Middle School for a doctor's appointment.

A common complaint that might come up at your next doctor's appointment is constipation. Constipation is especially common in care homes. In care homes, often we have people on medications that make them constipated. And often care home residents can't do the simple things the rest of us can do to prevent 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 don't 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.

Constipation in the care home is so common, we often have people on chronic constipation medications. Docusate sodium and docusate calcium are very common choices. They are both stool softeners, and have been used in hospitals and care homes for over 50 years. Docusate is a surfactant, so that is very similar to soap. It breaks the surface tension of the stool which lets water in. That softens the stool, and makes it easier to pass. Or at least that is what we were taught in pharmacy school.

It seems lately that when the docusate studies were looked at, they weren't very well done. One docusate study done in 1968 only had 15 elderly patients in it. A study in 1998 compared docusate to psyllium in 170 patients. The patients on the psyllium did better helping with constipation. In 2010 researchers actively looked for docusate studies and only found one double blind placebo controlled trial that they thought was done well enough to write about. And that study only had 22 people in it. The Canadian Agency for Drug and Technologies in Health (CADTH) only found 5 relatively poorly done studies on docusate from 2004 to 2011. And unfortunately, those studies didn't find docusate to be any better than placebo at decreasing constipation or constipation symptoms.

What should we use instead of docusate? In the care homes, we are using PEG 3350 now. It has brand names like Restoralax and Lax-a-Day. It is a white powder you dissolve in water and drink. It has almost no taste, so much nicer to take than those old milkshakes of milk of magnesia and senna syrup. PEG 3350 is an osmotic laxative. That means it draws water into the bowel, and help everything just flush along. It is safe to use daily. It is safe to use in children, adults, the elderly and pregnant women.

Somewhere between getting picked up at MacKenzie School and getting to the doctor's appointment, Eric realized his phone was missing. He didn't however, make it plain to Doris and I that the phone was missing until that night. Early the next morning, Eric and Doris scoured the snowbanks around MacKenzie School, the pharmacy and the doctor's office. No luck. Finally, they went to the office at MacKenzie School to look in the Lost and Found. Just then, a lady from Advic's dropped off a lost phone. I never got any names from Eric, but his version of the story goes like this. The owner at Advic's found the phone near his shop. He took it in and even took it home that night hoping the cell phone owner would call it. Because we didn't know it was missing, we didn't call it. Then the female employee from Advic's took time out from her day to bring it into MacKenzie School the next morning. A couple of people who didn't know Eric at all went out of their way to get Eric his phone back. Hooray for Advic's! And Hooray for everyone in Dauphin who goes that extra mile to help someone even when NIHB is bugging them for stupid extra paperwork.

I am Trevor Shewfelt from the Dauphin Clinic Pharmacy. The Pharmacy Feature is heard here every Tuesday on 730 CKDM

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.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

 


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