Constipation

Understanding and Managing Constipation

Constipation is a common digestive issue, often characterised by infrequent bowel movements, hard stools, or difficulty passing stool. It can cause discomfort, bloating, and abdominal pain. Fortunately, constipation can usually be managed effectively with dietary and lifestyle changes, and sometimes with medication.

Lifestyle Changes to Help Relieve Constipation

1. Increase Oral Fluids

• Hydration is Key: Aim for 6–8 glasses of water or other non-caffeinated drinks daily. Staying well-hydrated softens stools, making them easier to pass.
• Limit caffeine and alcohol, as these can contribute to dehydration and worsen constipation.

2. Dietary Changes

• Eat More Fibre: Fibre adds bulk to stools, helping them move through the digestive system.
  • High-Fibre Foods: Whole grains (like oats and whole-wheat bread), fruits (especially apples, pears, and berries), vegetables, and legumes (like beans and lentils) are excellent sources.
  • Gradually Increase Fibre: Introduce more fibre slowly to avoid bloating and gas, and make sure you’re drinking enough water, as fibre without fluids can worsen constipation.
• Include Natural Laxatives: Some foods, like prunes, figs, and apples, contain sorbitol, a natural laxative that can help promote bowel movements.

3. Regular Exercise

• Physical activity can stimulate bowel movements by encouraging intestinal muscle contractions.
• Aim for 150 minutes of moderate activity per week, like brisk walking, cycling, or swimming. Even light exercise, like stretching or yoga, can be helpful.

4. Abdominal Massage

• Gentle Abdominal Massage: This can help relieve constipation by stimulating the digestive tract.
  • Start at the lower right side of your abdomen and gently massage in a clockwise circular motion up to your ribcage, across, and down the left side.
  • Repeat a few times, applying gentle pressure but stopping if you feel any pain.

Over-the-Counter Treatments for Constipation

If lifestyle changes aren’t enough, there are various over-the-counter (OTC) treatments available at pharmacies in the UK. Always consult with a pharmacist to find the most suitable option for you.

Types of OTC Laxatives

1. Bulk-Forming Laxatives (e.g., ispaghula husk, found in Fybogel)

   • How They Work: These absorb water, swelling to form a gel-like mass that adds bulk to the stool, making it easier to pass.
   • How to Use: Take with plenty of water to avoid causing a blockage.
   • Onset: Typically takes 1-3 days to work.

2. Osmotic Laxatives (e.g., lactulose)

   • How They Work: Osmotic laxatives draw water into the bowels, softening the stool and making it easier to pass.
   • Onset: Can take 2-3 days to be effective.
   • Common Side Effects: May cause bloating and gas initially.

3. Stimulant Laxatives (e.g., senna, bisacodyl)

   • How They Work: Stimulate bowel muscle contractions to move stool through the intestines.
   • Onset: Usually works within 6-12 hours, so it’s best taken at bedtime for a morning bowel movement.
   • Use Short-Term: These are not recommended for long-term use as they can cause dependency.

4. Stool Softeners (e.g., docusate sodium)

   • How They Work: Softens stools, making them easier to pass. Often recommended post-surgery or during pregnancy to reduce straining.
   • Onset: Typically within 12-72 hours.

Prescription Medications for Constipation

If constipation persists or OTC options are insufficient, a doctor may prescribe medications that are more effective or tailored to individual needs.

1. Lactulose

• How It Works: Lactulose is an osmotic laxative that draws water into the bowel, softening stools.
• How to Use: Typically taken as a liquid, usually 15-30 ml once or twice daily.
• Common Side Effects: Gas and bloating, especially at the start of treatment.
• Onset: May take 1-2 days to work.

2. Fybogel (Ispaghula Husk)

• How It Works: Fybogel is a bulk-forming laxative that absorbs water and swells, adding bulk to stools and helping them pass.
• How to Use: Taken as a powder mixed with water, usually once or twice daily. It’s crucial to drink enough water throughout the day to avoid blockages.
• Onset: Usually takes 1-3 days to be effective.
• Good to Know: Bulk-forming laxatives are gentle and suitable for long-term use.

3. Laxido or Macrogol (Macrogol 3350)

• How It Works: An osmotic laxative that pulls water into the colon, softening stool and promoting movement.
• How to Use: Often taken as a sachet mixed with water once or twice daily, depending on severity.
• Common Side Effects: Bloating or mild stomach cramps.
• Onset: Usually works within 1-3 days.
• Good to Know: Macrogol is effective for chronic constipation and safe for longer-term use, under medical supervision.

4. Senna

• How It Works: A stimulant laxative that encourages bowel contractions to move stool along.
• How to Use: Typically taken as a tablet in the evening, so it works overnight (6-12 hours).
• Common Side Effects: Stomach cramps and urgency.
• Important Note: Not recommended for long-term use, as it may lead to dependency and can cause the bowel to become “lazy” over time.

Tips for Safely Using and Stopping Laxatives

• Follow Dosage Instructions: Always take medications as directed by your doctor or pharmacist. Overuse can lead to side effects or dependency, especially with stimulant laxatives like senna.
• Increase Fluid Intake: Especially with bulk-forming and osmotic laxatives, drink plenty of water to help the medication work effectively and avoid blockages.
• Avoid Long-Term Use of Stimulants: Long-term use of stimulant laxatives can lead to dependency, where the bowel needs the medication to function properly.
• Talk to Your GP Before Stopping: If you need to stop a prescribed laxative, consult your doctor for guidance, especially if you’ve been using it long-term.

When to Seek Medical Help

If constipation persists despite lifestyle changes and OTC treatments, or if you experience symptoms like severe abdominal pain, unintended weight loss, or blood in the stool, speak with your GP for further investigation and guidance.

Summary: Managing Constipation

To relieve constipation, aim to:

1. Increase fibre and fluids in your diet.
2. Stay active to promote natural bowel movements.
3. Consider OTC treatments for short-term relief.
4. Use prescription laxatives only as recommended by your doctor.

Making these adjustments can often relieve constipation and improve digestive health. If you’re unsure about any of these treatments or need additional support, your GP or pharmacist can help guide you towards the best options for managing constipation effectively and safely.