Constipation and its Management

Jun 18, 2012

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Dave Shoesmith was our midget hockey coach. Originally from England, he was a good coach, ran good practices and was fun to play for. In fact, in our last year of midget we won provincials. However, you could tell Dave didnt skate as a kid. If he ever joined us in a scrimmage, we could skate circles around him. It was kinda fun! In the spring, Dave acted as an assistant coach for our high school soccer team. He still looked the same. He still had gray hair, and a gray beard. But on the soccer pitch, Dave wasnt so easy to go around. Actually, we couldnt get around him at all. And if Dave had the ball, we couldnt take it from him. Funny what happens when a bunch of Canadian kids who grew up skating face someone who grew up dribbling a soccer ball. Gray haired and gray bearded Dave Shoesmith made ball control look effortless and the Canadian teenagers looked awkward and uncomfortable.


Although it isnt something we talk about in polite company, we all want going to the bathroom to be effortless. Constipation, though, can make it awkward and uncomfortable. 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, pregnancy and medications. If you suspect your constipation is caused by a disease, pregnancy 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 and because it is a stimulant laxative there would be some 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.


The really important thing with constipation is prevention. If you increase your fibre and fluid consumption it will be like you are doing taps on the soccer ball to confuse the defender. Then you make a cross-legged kick like Maradona to your mid-fielder. Your mid-fielder will cross it to the striker in front who will bicycle kicks it in like Pele. GOOOOOOaaaaal! All things inside and outside the bathroom should be that effortless!


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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