Constipation Checklist - symptoms and suggestions

Marlene Powell, Continence Advisor at St Martin’s Hospital, Bath, points the way

What is constipation?

• Having your bowels open less than three times a week
• Pain, discomfort and straining on passing a motion
• Stools are hard and dry, may be large or small in size
• There may be a bad taste in the mouth, bad breath, abdominal bloating, decreased appetite, lethargy and, for some, the inability to function normally
• It may be a lifelong problem or in response to pregnancy, childbirth, an operation or an emotional upheaval in your life

Some points about "straining"

• If the stool is hard and dry it will not easily be passed out of the rectum
• This is made worse if you get out of the "daily" bowel habit
• Some people strain although there is nothing in the rectum to come out
• You will weaken the pelvic floor muscle that support the bladder and bowel
• Women are particularly at risk as they can weaken the viginal walls

Bad habits

• Irregular meals, too much processed food
• Not enough fibre in the diet
• Too little fluid, less than 2-3 pints daily
• Taking regular laxatives over the years
• Ignoring the "call to stool"
• Not allowing time to have your bowels open each morning
• Not sitting in the correct position on the toilet

Diet

• Fibre in the diet helps regulate stool consistency
• Fibre is found in most of the fruits, vegetables, grains and seeds that we eat
• Try to take five portions of fruit and vegetables daily to keep healthy
• As people vary their diets, so their bowel habits vary

Toilet habits

• Many people have got into bad habits since childhood
• You may have had to use an outside loo as a child and put off the call to stool
• You may have had to sit on the loo before school until you performed
• You may have been given laxatives regularly as a child
• You may not like using public loos or other people’s toilets
• You may not sit in a good position with feet supported

How to avoid constipation

• Good fibre intake
• Mix fruit, vegetables and whole-grain cereals
• Maintain fluid intake, around 2-3 pints daily
• Regular morning routine, allowing time for yourself
• Eat breakfast to simulate the first gastro-colic reflex of the day
• Hot caffeinated drinks aid peristalsis of the large bowel and get things moving
• Never ignore your bowel when you get the message to "pooh"
• Support your feet when sat on the toilet if the seat is too high
• Blow your nose to encourage a valsalva manouvre and get this started
• Regular fresh air and exercise promote regular habits

Laxatives

• Bulk-forming agents can help retain water in the stool and increase bulk. It is essential to maintain a good fluid intake or symptoms of constipation may worsen (eg Fybogel)
• Stimulants will induce a bowel action within 8-12 hours by increasing peristalsis in the colon. Not to be taken if there is risk of intestinal obstruction (eg Senokot)
• Osmotic laxatives help retain fluid in the stool and increase bulk by bacterial fermentation
• Faecal softeners are only used as a last resort as it is better to promote a soft, formed stool by natural methods
• Enemas and suppositories may be used in acute situations before or after surgery, or in chronic conditions where the mechanism of normal bowel emptying is disrupted
• Always ask your doctor or pharmacist for advice about taking laxatives

Whatever your problem, try and get help since there is a lot that can be done to help. Your GP or Continence Advisor should be your first port of call

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