How can I relieve the symptoms of constipation?
The vast majority of patients with constipation are successfully treated by adding high fibre foods like bran, shredded wheat, whole grain breads and certain fruits and vegetables to the diet, along with increased fluids. Your physician may also recommend lifestyle changes. Fibre supplements containing indigestible vegetable fibre, such as bran, are often recommended and may provide many benefits in addition to relief of ¬constipation. They may help to lower cholesterol levels, reduce the risk of developing colon polyps and cancer, and help prevent symptomatic haemorrhoids.
Fibre supplements may take several weeks, possibly months, to reach full effectiveness, but they are neither harmful nor habit forming, as some stimulant laxatives may become with overuse or abuse. Other types of laxatives, enemas or suppositories should be used only when recommended and monitored by your colon and rectal surgeon.
1. Lifestyle changes
It is important to try to make time for your bowels each day. Most bowels respond best to a regular habit. About 30 minutes after eating is the most likely time for the bowel to work. This is because of the “gastro-colic response” which means that eating sets waves of activity in motion in the bowel. Try not to rush going to the toilet. If you have a tendency to be constipated, set aside about 10 minutes in the toilet. Preferably this should be at a time when you are not rushing to do other things. Find a toilet that you feel comfortable to use and where you do not feel inhibited by lack of privacy or time.
Sport and exercise improve bowel habits in some people. If you lead a very inactive lifestyle (driving to work at a desk job) even taking a regular walk at lunchtime can make a difference. You can also try your own toilet exercises if you want to avoid a formal retraining program supervised by a therapist.
2. Diet and fluids
Eating regularly is the best stimulant for your bowels. Skipping meals, especially breakfast, can lead to a sluggish or irregular bowel habit. Contrary to popular belief a high fibre diet is not always the best diet for the constipation sufferer. Regular meals and an adequate fluid intake are the main aims.
Too much fibre can lead to an increase in bloating and discomfort, especially for people with slow gut transit. If you do feel your diet is short on fibre try to use fruit and vegetables (soluble fibre) rather than cereals (insoluble fibre) as they are less bloating. Some foods can act as natural laxatives in some people .
Try to drink at least eight to 10 mugs of fluid a day. However, excessive fluid intake may make you feel more bloated and is unlikely to improve your bowel function further. Too much caffeine (coffee, tea and cola) can be dehydrating, as can too much alcohol.
3. Medications and remedies
If you are taking any medicines (prescribed or bought from the chemist) ask your doctor or chemist if they could be adding to your constipation. If possible, try to remove constipating medications.
If really necessary, try using a fibre supplement such as fybogel and possibly suppositories or mini-enemas to help regularise the bowels. It is best only to use these as an aid to getting into a regular routine, rather than relying on them long term.
The use of laxatives should usually be confined to people:
- Who have only very occasional episodes of constipation.
- Who need laxatives to counteract a short-term constipating medication.
- Who need to avoid straining (e.g. angina sufferers)
- Who are in hospital.
- With an anal condition which needs soft stools for the healing period.
- Undergoing a radiological or surgical procedure.
- Who are severely or terminally ill.
It is common for patients to come to clinic and say: “I tried this laxative and it worked well to start with but then it stopped working so well.” They try another and another and another and it’s the same story every time. The nature of long-term laxative use is that the bowel becomes progressively less responsive to all these agents, meaning that increasing doses are required.
There is no convincing evidence that the colon is permanently damaged by long term laxative use, and in particular there is no increased risk of bowel cancer caused by laxatives. Nevertheless, these are not drugs that should be considered harmless. Some laxatives such as Senna stain the insides of the bowel and this can be seen at colonoscopy (examination of the lining of the colon). The fact that a product is “natural” does not mean that it is necessarily “good for you”. Laxatives can cause significant loss of minerals from the bowel, and uncontrolled long-term use can result in changes in the body’s chemistry, especially in older people and those who are unwell. The more you take laxatives, the less likely it is that the bowel will work on its own. This does not mean that you cannot stop taking laxatives once you have started, but it can take a while for the bowel to start working on its own again.
Suppositories or mini-enemas
Whilst the idea of inserting a suppository or enema may not appeal to all, it is important to bear in mind a number of advantages.
- Their action is more predictable than that of laxatives, without the tendency to cause diarrhoea.
- They can encourage a more regular bowel action especially if taken at the same time of day, every day, every other day or once every three days.
- There are generally well-tolerated - they are acting locally just like a nasal spray taken for hay fever or inhalers for asthma. Since there is minimal absorption into the body, there is low potential for side-effects.
- They must be inserted into the rectum for maximum effect. You can get a supply of gloves from your chemist. Suppositories and enemas work by causing contraction of the rectum, softening the stool in the rectum and by causing the bowel higher up to contract.
This is a bowel retraining programme run by therapists who are usually nurses or physiotherapists. Advice on diet, toileting habits and access to acceptable facilities is reviewed. Patients are shown how the muscles and nerves can be retrained to co-ordinate and produce a satisfactory effort to empty the bowel. The therapy may involve four to five one-to-one sessions between the patient and therapist.
This is needed in only a very small minority of people. There are women who benefit from a repair of a rectocoele. Rectal prolapse may also require an operation.
The results of removal of all or part of the colon to improve bowel function are often poor. About a tenth of patients return quickly to their previous levels of constipation, and a third have incapacitating diarrhoea, some with a degree of incontinence. Approximately one in ten who have part of the colon removed will end up with a stoma (bowel brought out to the skin to discharge bowel contents into bag) either because of severe symptoms that cannot be controlled, or as a result of the failure of previous surgery.