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