by Dr Deborah Lee, Dr Fox Online Pharmacy
https://pixabay.com/users/derneuemann-6406309/
Constipation is far from trivial – it’s a serious healthcare problem. Over 200 adults are admitted to NHS hospitals every day in the UK, with constipation.
Over three quarters are admitted as an emergency – because too often people are reluctant to discuss their bowel problems with their GP.
The cost of these hospital admissions is £81 million – although the total sum including GP consultations, home visits, and prescriptions, means the true costs are likely to have been much higher.
How to know if you have constipation
Constipation is said to be present if –
- You are passing less than 3 stools per week.
- Your stools are hard and lumpy.
- Even if you go more often, when you go, you need to strain to pass a stool.
- You may have lower abdominal pain, distension, or bloating.
- You often feel you don’t completely empty your bowels.
In older people, constipation can cause confusion, loss of appetite, or an inability to pass urine. Faecal impaction can lead to overflow diarrhoea.
Talking to your doctor
It’s natural to feel embarrassed talking about your bowels but try to get over this. The doctor will do their best to put you at their ease. Remember, doctors need to open their bowels too! The sort of questions they might ask are listed below.
Constipation can be caused by many different medical conditions. Your doctor will try to work out if there is an underlying cause and what can be done about it.
You should always see your GP if you have a change in your bowel habit over age 50, have acute constipation in an older person, have blood in your stools, iron-deficient anaemia, or unintentional weight loss.
Don’t suffer in silence – if constipation is bothering you, it’s time to go and get help.
What will the doctor ask me?
Your doctor or nurse might ask the following questions:
- When did you last have your bowels open?
- What does your poo look like?
- Is your poo very hard?
- Have you had any bleeding from your back passage, or in your stools?
- How often do you usually have your bowels open?
- Do you have any other symptoms – do you feel sick, feel bloated, or have a swollen tummy?
- What is your typical diet?
- How much exercise do you take?
- How much do you drink each day?
- What kind of drinks?
- Are you taking any medicines?
- Have you made any recent changes to your diet?
- Are you taking any medicines for constipation?
What to do about constipation
Here are some was you can help prevent constipation, and improve your symptoms.
- Drink plenty of water –Dehydration results in harder stools. Make sure you drink at least 2 Litres of water every day.
- Fibre – Fibre is a type of indigestible carbohydrate that passes through the gut unchanged. It has a vital role in gut health, as it bulks out the stool, and the pressure of the stool on the gut wall stimulates the transit of food. It also traps water in the stool, making it softer and easier to pass. Fibre is found in whole grains, fruits and vegetables. Foods such as lentils, peas, beans, and nuts are high in fibre. The current recommendation is that all UK adults should be eating 5 portions of fruit and vegetables per day. Psyllium is an Indian herb, high in fibre, that can be taken as a supplement, to reduce constipation. Some studies have shown it to have a superior effect on constipation to wheat bran.
- Exercise – Research studies confirm that increasing the amount of physical exercise improves constipation because exercise increases blood flow to the gut stimulates contractions in the gut wall. As a result, food passes through the intestines more quickly with less time for water to be absorbed from gut contents. The current recommendation is 150 minutes per week of moderate-intensity exercise, such as brisk walking. If you spread this out, it might mean exercising for example, for 30 minutes a day for 5 days, or perhaps 3 x 10-minute bursts of exercise in 24 hours, 5 days a week.
- Herbal tea – Many herbs have laxative properties – they contain chemical substances such as anthraquinones that stimulate the intestinal wall to propel the digested food along the GI tract. Try senna, peppermint, ginger, dandelion, liquorice root, chamomile or parsley.
- Probiotics – Several medical studies have confirmed the benefits of the use of probiotics on constipation. The microbiome has a profound effect on gut function. The best results have been from the bacteria Bifidobacterium lactis, which has been shown to significantly increase stool gut transit time, stool frequency, and improve stool consistency.
How to treat constipation
You can get advice about constipation and laxatives from your pharmacist. If things are not improving, see your GP.
Start by making the necessary lifestyle changes – drink more water, eat a healthy diet with a higher fibre content, and do more physical exercise.
If you need to take laxatives, start with a bulk-forming laxative such as Fybogel, which contains ispaghula husk. This is a stimulant laxative that will stimulate the bowel to work more effectively. It can take 3-4 days to work.
If the stool is still very hard, add a faecal softener. The best option is an osmotic laxative, such as lactulose, which draws water into the stool. Again, this can take 3-4 days to work.
If things are still not improving, try a stronger stimulant laxative such as bisacodyl or senna. Other faecal softening laxatives include those containing Arachis oil or docusate sodium.
Foods that can make constipation worse
Some foods can make constipation worse. Below are some typical examples –
- Underripe bananas
- Caffeine
- Gluten-containing products
- White rice
- White bread
- White pasta
- Red meat
- Ready meals
- Alcohol
- Chocolate
- Dairy milk
Final thoughts
Don’t let constipation get you down. Try and follow the above advice, but if it’s bothering you and not improving, go and see your GP. If constipation is not treated properly it can lead to haemorrhoids, faecal impaction, or even bowel obstruction.
Isn’t it time for you to get over your bowel embarrassment and take some action?
For more information
Constipation – NHS Inform Scotland