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Constipation

Constipation is a common problem. It presents as passing hard stools, with difficulty, less often than normal. Constipation usually occurs when stools remain in the colon (large intestine) for too long and the colon absorbs too much water from them, causing the stools to become hard and dry. Some people pass a stool more than once a day, while others only have a bowel movement every two to three days. It is a change from your usual pattern that suggests constipation. You may also feel bloated, have stomach cramps and lose your appetite.
Children with constipation may also be irritable and have foul smelling wind and stools. Regular soiling, often mistaken for runny diarrhoea, can be a sign of severe constipation with faecal impaction (a blockage of faeces) in children.

Causes
 Not eating enough fibre - Fibre absorbs water in the bowel, swells and ensures the stools are soft and easy to pass.
 Not drinking enough fluids - If you are dehydrated, the body will absorb water from the bowel causing the stools to become hard and difficult to pass.
 Medication - The following medicines can cause constipation: Painkillers containing codeine and other morphine based products; antacids containing aluminium; iron; antidepressants; antiepileptic drugs; antipsychotics; calcium supplements.
 Ignoring the urge to pass stools - This can be an issue in children that undergoing toilet training.
 Pregnancy - Increased progesterone levels in early pregnancy slow down the gut movements, while in the third trimester the baby takes up more space and can displace the bowel causing constipation.
 Medical conditions - The following medical conditions can cause constipation: Irritable bowel syndrome (IBS); underactive thyroid gland; diabetes; multiple sclerosis; Parkinson’s disease; colon or rectal cancer.
 Immobility or lack of exercise.


In many people, constipation does not have any direct cause. These people are said to suffer from functional or primary constipation. This can start in childhood and persist throughout life, and is more common in women.

Treatment

Lifestyle
 Eat more fibre - You should eat at least 18-30g of fibre a day. High-fibre foods include fruit, vegetables, wholegrain cereals, wholegrain rice, wholewheat pasta, nuts and seeds.
 Drink plenty of fluids - You should aim to drink at least 2L (8 – 10 glasses) of fluids a day.
 Try to get more exercise - Not only will regular exercise reduce your risk of becoming constipated, but it will also leave you feeling healthier and improve your mood, energy levels and general fitness.
 Do not ignore the urge to go to the toilet.

Laxatives
These are a type of medicine that makes it easier to pass stools. Laxatives should be used if lifestyle changes do not work. There are three main types of laxatives:
 Bulk forming laxatives eg Fybogel, Normacol - These increase the bulk of your stools and help them to retain fluid in a similar way to fibre. They can have some effect in 12 – 24 hours, but their full effect may take several days to develop. Ensure you are drinking at least 2L of fluids per day when taking bulk forming laxatives.
 Osmotic laxatives eg. Laxose, Duphalac - These work by retaining fluid in the bowel which softens the stools and makes them easier to pass. These usually have an effect in 2 – 3 days. It is important to have adequate fluid intake when taking osmotic laxatives.
 Stimulant laxatives eg Senokot, Dulcolax - These stimulate the muscles in the large bowel, helping them to move the stools along. These usually have an effect in 6 – 12 hours. They should only be used on a short-term basis. Prolonged use can cause a lazy bowel, where the muscles are less active on their own.

totalhealth pharmacist’s advice

 When increasing your fibre intake, it is important to do it slowly to prevent bloating.
 Resting your feet on a small foot stool when going to the toilet so your knees are above your hips can make it easier to pass stools.

You should see your doctor if you have any of the following symptoms:

 Blood in the stool – This may be bright red or dark brown in colour.
 Unexplained weight loss or tiredness.
 Constipation lasts more than two weeks without any obvious cause.
 Severe pain with bowel movements.

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