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Constipation is a common problem. It refers to either increased hardness of stools or reduced frequency of motion.

Lifestyle advice

• Eat foods with a lot of fibre (e.g. fruits, vegetables, cereal)
• Prune juice appears to be helpful to some patients
• Drink lots of water and fluids
• Exercising has been shown to help
• Maintain a daily routine, make sure there is a “protected time” to pass motion daily

Why?

Our gut has specific timings daily that will “move”. If you miss the timing where you have the “feel”, it will be hard to try to pass motion.

Medications

The number of medications that are used for constipation can be quite bewildering, even for doctors!

When all the above fails, you might have to use some of these.

First line

• Bulking agents
• Hydrophilic colloids
• Stool softeners
• Osmotic laxatives
  • PEG
  • Lactulose
  • Sorbitol

Second line

• Stimulants (cause intestinal muscle contraction and secretion)
  • Prucalopride (Resolor), is a 5HT4 prokinetic agent, 1mg daily (>65 years old) or 2mg daily. But $$$. Possible side effects: diarrhea, headache, abdominal pain, nausea.
• Lubricants
  • Soften stool and make passage of faeces easier
• Irritant Suppositories
  • Stimulate defacatory muscles to promote defacation
• Enema
  • Injection of fluid into distal rectum via rectum) : elderly/immobile patients or neurological disorders

References

1. Lectures given by Dr Aileen Seah from Colorectal Associates on 14 November 2015.
2. Management of chronic constipation in adults. Uptodate.com. Topic 2636 Version 24.0. Accessed 6 March 2017.

Gastrointestinal Reflux Disease

This is an extremely common disease. Normally, a diagnosis is made after serious diseases are considered and ruled out by your doctor.

Unfortunately, if you are diagnosed with this disease, you must understand that it is a chronic disease (AKA long term). It tends to wax and wane with time, and will be triggered when the lifestyle factors are overlooked again.

Some of the information in this article is meant for family physicians. Patients can try to read the top portion only.

Main symptoms

• Burning sensation behind the chest. Can sometimes be a dull or even pulling sensation (heartburn)
• Perception or feeling of stomach contents in the throat (regurgitation)
• Painful or abnormal swallowing sensation (dysphagia)

Other possible symptoms

• Unusual chest pain sensation (make sure it’s not due to a heart problem first)
• Lump or the feeling of something in the throat (globus). Rather common symptom in the local setting
• Unexplained nausea
• Chronic persistent cough that cannot be explained by other symptoms

Red flags

The doctor must make sure that there is none of the following red flags that can be a sign of something more dangerous.

• Loss of weight
• Bleeding from stools, malena (black tarry stools) or hematochezia (red stools)
• Low blood count (anaemia)
• Painful swallowing (dysphagia)
• Chest pain (make sure it is not due to a lung or heart problem first)

Lifestyle factors

There are numerous lifestyle factors that are associated with this condition.

• Obesity
• Poor quality of sleep/insufficient sleep
• Irregular eating habits