CONSTIPATION 

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Constipation can refer to more than one kind of problem.  Sometimes the term refers to stools that are inadequate in volume, that are too hard or  infrequent  (i.e. fewer than 2-3 times per week).  Often individuals will feel as if they have to strain and that the bowels do not empty effectively. 

DIAGNOSIS

Constipation is diagnosed by your physician based on both symptoms and an exam.  Although the most common cause of constipation is simply predisposition, other possibilities need to be considered.  Sometimes medications can be a cause; a big clue in that case would be if constipation begins or worsens  about the time medication is started or increased.  Sometimes narrow areas in the bowel can impede or slow down the flow, common causes being polyps or tumors.  Occasionally problems with the blood such as high calcium,  diabetes or  thyroid issues can present in this manner.  Depending on your doctor’s assessment, blood tests and/or a colonoscopy may be required to rule out these causes. 

ALARM SYMPTOMS

Often individuals deal with constipation on their own, but if there are alarm symptoms they should see their physician. Alarm symptoms include:

  •  severe constipation 
  • associated change in bowel habits
  •  associated blood in the stools
  •  associated new abdominal pain

 TREATMENT

It is  important when dealing with constipation to get into a routine, whether it is regulating the time of day when you try to move your bowels, eating at regular times or  taking fiber supplements or laxatives. 

 Taking Advantage of your Body’s Signals

Individuals often ignore their body’s signals  i.e. ignoring  the urge to go to the bathroom, because we are busy doing other things.  Sometimes if practiced  long-term this habit can suppress the usual signals and reflexes associated with moving your bowels.   Usually the strongest urge to go to the bathroom occurs after breakfast. If you are having problems with constipation, it is important not to ignore these signals. If you do not get a good signal in the morning, often using a glycerin suppository will help this.  If you listen to your body’s signals, with time it often becomes easier.

Fiber

Fiber is the cornerstone of treatment for most individuals suffering from constipation.  Again, it is important to get into a routine.   Even in  individuals who are eating healthy diets (probably consuming 20-25 grams of fiber per day), fiber supplements will help to increase  the 35-40 grams of fiber that these constipated individuals need. It is important to increase fiber supplements slowly because if one is too enthusiastic, there can often be bloating and cramps. Done slowly, over the course of 6-8 weeks of increasing the amount of fiber ingested, this can be less of an issue and the bowels become more regular.

There are many fiber supplements available from your grocery or local pharmacy:

  •     Psyllium (Metamucil®)
  •   Wheat dextrin (Benefibre®)
  •     Polycarbophil (Prodiem®)

Start with one dose of the fiber supplement every day, increasing that amount after a week to  2 doses per day; one  in the morning plus another dose at supper or before going to bed.  If needed a week later, increase the dose again.  Slowly increase your fiber supplement amounts every week until you are on the maximum dose. Once on the maximum dose stay on it a good 6-8 weeks to allow your system time to get into a routine.

Laxatives

If fiber alone is not effective, the next step would be to add a ‘safe laxative’ such as  Polyethylene Glycol (PEG) or Lactulose.

Polyethylene Glycol (PEG) - brand names PegaLAX®, Lax-A-Day®, SeaLAX®, RestoraLAX®.

These can be obtained over–the-counter from your local pharmacy.

PEG works by increasing the water content of the stool and increasing stool frequency. 

It only needs to be taken once a day, one dose being 17 grams.  Start with one dose per day and after a week, if you still are having problems with constipation, increase it to 2 doses (i.e. 34 grams  per day.) You can take both doses at once—they do not have to be taken at different times of the day.

Lactulose (brand name Acilac®) 

It can also be obtained from your pharmacy without  prescription, although often the pharmacist keeps it behind the counter and you have to ask for it. 

Lactulose is a type of sugar that is not absorbed by the gut.  Although it tastes sweet, because it is not absorbed there are no calories associated with it.  Lactulose works by increasing water content of the stool as well as frequency.

 Usually dosage is started at 1 tablespoon (30 ml) a day for 4 or 5 days.  If this is not enough, it can be increased to 2 tablespoons per day, one in the morning and one around supper time or before going to bed.  If  Lactulose twice a day for 4-5 days is not enough, dosage can be increased to 1 tablespoon 3 times a day—before breakfast, around supper time and before going to bed.  You can slowly increase it if necessary to about 4 tablespoons per day in divided doses.  Again the important thing is to take it regularly, every day. 

There can sometimes be associated abdominal bloating and gas or flatulence with Lactulose and this may limit the amount an individual can tolerate.   If it is increased slowly, this is often not as much of an issue.

Stimulant Laxatives—Bisocodyl (brand names Dulcolax®) and Senna 

These can be obtained over the counter from your pharmacy.  

They work by increasing the contractions of the bowel, thereby increasing frequency of bowel movements.  These types of laxatives are best used intermittently and one should be careful about taking them chronically.

 Natural Laxatives 

Certain foods such as prunes, apples, pears and peaches are natural laxatives. In individuals with mild constipation, increasing consumption of these fruits can often alleviate constipation.

 Summary

Constipation is a chronic disorder that most individuals can deal with on their own.  This said, if individuals have alarming symptoms they should seek medical attention. The cornerstone of therapy is dietary fiber, but sometimes the amount of fiber the individual can tolerate is limited by the development of bloating, cramps, gas or flatulence.   PEG is the laxative that is best tolerated.  Stimulant laxatives are useful when taken as needed, but caution should be used when taking them chronically.  When dealing with constipation it is important to get into good routines and listen to the body’s ‘signals’.