What is constipation?

There are some different definitions for constipation. One basic one is that bowel motions (stools) are hard, lumpy, difficult to pass and infrequent. But what is infrequent and what is normal? Nineteen out of 20 people have between three and 21 bowel motions a week. Everyone is different – therefore, it is when your usual bowel habit has changed that you may find you have constipation.

Identifying constipation in children can be further complicated by how well toilet trained the child is and whether he or she also soils their clothes. Two weeks of problems with delayed, hard or large stools should prompt you to seek advice.

Who gets constipation?

Anyone can get constipation, and most people get it at some time or other – up to one in 10 people at any time have it. It tends to affect women more than men, and is more likely if you are older or if you are immobile for any reason, have a poor diet or have been ill. Children also can easily become constipated.

The most common reasons for constipation are:

• diet – eating too little, or eating low bulk or milky foods
• dehydration – drinking too little fluid, vomiting or excessive sweating
• being immobile – forced bed rest or disability
• pain or other medical conditions
• use of medicines.

Quite often, people can become constipated for no apparent reason, starting as early as childhood and continuing through life. Unexplained or ‘idiopathic’ constipation affects
women much more often than men, and they are found to have a generally underactive bowel.

Constipation caused by medicines

Many commonly used medicines can cause constipation as a side effect. These include stomach antacids, iron supplements, opioid pain relievers such as codeine and stronger drugs, diuretics (water tablets), drugs for Parkinson’s disease, some heart drugs, antidepressants and tranquillisers, and (strangely) overuse of some stimulant-type laxatives. If you take medicines and you have problems with constipation, let your doctor know.

Constipation in the elderly

Older people are at particular risk of constipation because they usually have a smaller appetite, a less bulky diet, perhaps a lack of fibre, greater use of medicines, other health conditions that can cause constipation and perhaps at times they are immobile or unable to move about much.

Constipation in pregnancy

Constipation is a common complaint in pregnancy. It is caused by the change in hormones, which slows a woman’s bowel movement. As the baby grows, this also presses on the lower bowel. And women taking iron supplements in pregnancy can also find these cause constipation.

Constipation in children

Healthy babies and children vary greatly in the frequency and firmness of their stools. If your child passes a stool less than once every three days, however, he or she is likely to be constipated. Also, if your child is toilet trained but still soils their clothing, constipation could be the problem.

Constipation in children often involves pain. Pain felt while passing stools may cause the child to ‘hold on’, causing constipation. Sometimes, abdominal pain is relieved when the child is able to go to the toilet.

Constipation can often cause children to wet themselves or the bed, and it can be constipation that is the problem rather than anything to do with the child’s bladder.

What can I do to help myself?

The two most important things most adults can do to ease or prevent constipation are to be as mobile as possible – get up and go for walks – and adjust your diet if necessary.

Look into how you can eat more fibre

It is important to include enough fibre from vegetables, fruits, wholegrain breads and cereals and to make sure you drink enough fluid – about 1.5L a day minimum, unless you are elderly or your doctor advises differently. Fibre and fluids help to bulk out and soften bowel motions by trapping water. This also helps your bowel to keep stools moving along.

Men should eat at least 30g of fibre a day, and women about 25g a day. Children between four and 18 years need only slightly less (about 18–28g a day). There is no upper limit in the recommendations and getting your fibre from a range of cereals, grains, nuts, beans, lentils, fresh and dried fruits (not fruit juices) and vegetables is recommended.

High fibre foods

• 1 serve (45g) All Bran = 12.4g fibre
• 2 Weet-Bix type biscuits = 3.3g fibre
• 1 slice multigrain bread = 1.8g fibre
• 1 cup cooked wholewheat spaghetti = 6.3g fibre
• 1 cup cooked brown rice = 3.5g fibre
• 1 cup tinned baked beans = 13.9g fibre
• 1 cup green peas = 8.8g fibre
• 1 medium baked potato (skin on) = 4.6g fibre
• 1 medium apple (skin on) = 3.3g fibre
• 100g almonds, brazil nuts, pistachios = 8-9g
• Packaged foods labelled as 6g or more fibre per 100g serve.

How can my doctor help?

Your doctor needs to know about your bowel movements, their timing and any other symptoms. Your doctor may also need to feel your abdomen, listen to the sounds it makes or examine your rectum.

Tests are usually not needed unless the constipation is severe, persistent or new and there is no ready explanation, or you also have blood loss, vomiting, occasional diarrhoea, pain or weight loss.

Do I need fibre supplements?

If you cannot get enough fibre from your diet, fibre supplements (also called bulk-forming laxatives) may help. There are several, which your doctor may recommend.

Common ingredients include psyllium, bran fibre, methyl cellulose, isphagula and polycarbophil. For these to work, you also need to drink 2L of water a day, which is not easy if you are older or frail. Fibre supplements can be a good way to relieve constipation and are best taken early in the day. They usually have some effect within 24 hours.

Do I need laxative medicines?

There are some different general types of laxative:

• fibre supplements (bulk-forming laxatives)
• laxatives that draw water into the stool, some from the body (osmotic laxative) or only consumed water (iso-osmotic laxative)
• stimulant laxatives acting on the bowel’s nervous system
• stool softeners.

Laxatives can help if diet changes and fibre supplements have not worked or are unsuitable for you. The types of laxative vary in:

• how quickly they start working
• how helpful they are in different situations
• possible side effects (eg, pain, bloating, flatulence)
• whether they alter the absorption of fluids and essential nutrients from your diet
• safety in pregnancy, the elderly and children
• whether they can be taken rectally
• how much they cost and how they taste.

Laxatives should be used only as recommended by your doctor or pharmacist and not for longer than advised.

Original material provided by everybody, November 2010.