Chronic Constipation

Dec 11, 2019

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

My job at the Winnipegosis Clinic Pharmacy is easy now. If someone comes in and asks me for health advice, I just say, "Just do what Mike Kolochuk does." Should I take a Vitamin B12 pill? Just do what Mike Kolochuk does. Should I use ibuprofen or acetaminophen? Just do what Mike Kolochuk does. Claritin or Reactine? I defer to Mike Kolochuk. I mean, why do I even need to go up to the Winnipegosis Clinic Pharmacy anymore? Did I get mentioned by Denis Beyak on TSN during the Jets vs Sharks game? I don't think so. But you know who did? Mike Kolochuk.

I don't know what Mike's views on constipation are, so I'll still give a little advice. Constipation is a common complaint and it seems to increase as we age. 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 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 had less 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, and it is 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.

The streets of Winnipegosis were packed with well-wishers when Mike Kolochuk had his 100th Birthday party at the New Horizons Center. One hundred years....World War One had just ended. Although cars were more common than horses, horses weren't gone as a means of transport yet. In 1919 there was the Winnipeg General Strike, then the Depression, World War Two, a couple Atomic Bombs dropped on Japan, Newfoundland joined Canada, the St. Lawrence Seaway opened, The Beatles, Trudeau Number 1, men on the moon, the October Crisis, John Lennon died, the Canadian Constitution came home, Space Shuttle Challenger blew up, Berlin Wall fell, Iraq War 1, Kurt Cobain died, 9-11, Iraq War 2, iPods, iPhones and Trudeau Number 2. And that barely scratched the surface of the last 100 years. How do you live for 100 years? I don't know. You better just do what Mike Kolochuk does.

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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