Constipationin Adults

Laxative treatmentTreatment with a laxative is only needed if the measuresabove (fibre, fluid etc) do not work well. There are 4main groups of laxatives that work in different ways.

• Osmotic laxatives such as lactulose. This increases theamount of fluid that stays in the bowel. It takes atleast 2 days to start working and needs to be takenregularly. Another example is Movicol which has afaster onset of action. Side effects include abdominalpain and bloating.

• Stimulant laxatives such as senna and bisacodyl. Thesestimulate the nerves in the bowel and help it to workmore effectively. Their effect is within 8-12 hours so abedtime dose is recommended. Side effects includeabdominal cramps and a lazy bowel with long-termuse.

• Bulk forming laxatives and fibre supplements such asispaghula husks, methylcellulose, sterculia andunprocessed bran. These work in the same way asincreasing the fibre in your diet and you need to haveplenty to drink.

• Faecal softener laxatives such as docusate sodium(this also has a weak stimulant action).

You should only use a laxative for a short time, whennecessary, to get over a bout of constipation. Once theconstipation eases, you should normally stop the laxative.It is not advised to take a laxative each day just to 'keepthe bowels regular' or to prevent constipation.

If you feel you need a laxative regularly, talk to yourdoctor for advice on which is the best to use in yourcircumstances.

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A normal bowel habit can range from 2-3 times a day to2-3 times per week. Constipation causes the time betweentrips to the toilet to increase compared to what is usual foryou.

Causes of constipationKnown causes:Not eating enough fibre. The average person in the UK doesnot eat enough fibre. High fibre foods include fruit,vegetables and cereals

Not drinking much. Some people need more fluid and fibrethan others to avoid constipation

Some special slimming diets. These can be low in fibre andcan cause constipation

Some medicines. Pain killers (particularly those with codeinein such as co-codamol), some indigestion remedies,antidepressants, iron tablets and morphine. There are manyothers. Tell your doctor if you think your medicine may bemaking you constipated as a change of medication may bepossible.

Some medical conditions. For example an underactivethyroid, irritable bowel syndrome, some stomach disordersand poor mobility especially in the elderly.

Pregnancy. About 1 in 5 pregnant women becomeconstipated. It is due to hormone changes that slow the gutdown.

A common cause of

constipation is not

eating enough fibre.

Less common causes include a

side-effect from medicines,

and certain medical

conditions. In many cases the

cause is not clear. The

common treatment and

prevention of constipation is

to eat plenty of fibre, and to

drink plenty. Laxatives are

sometimes needed but, ideally

should only be used for short

periods of time until

symptoms ease.

How can you help prevent constipation?Eat plenty of fibre, such as:

• Wholemeal or whole-wheat bread, biscuits and flour

• Fruit and vegetables. Aim to eat at least five portionsof a variety of fruit and vegetables every day

• Whole-grain breakfast cereals such as All Bran, BranFlakes, Weetabix, Shredded Wheat, muesli orporridge

• Brown rice, wholemealspaghetti and otherwholemeal pasta

Increase your fibregradually to avoid bloating and wind. Even if you getthis at first, it will be temporary.

Drink plenty of fluid when you eat a high fibre diet toprevent blockage in the gut.

Have plenty to drink. At least two litres per day. Mostsorts of drink will do, but alcoholic drinks will bedehydrating and not so good. Perhaps as a start, justdrink a glass of water 3-4 times per day in addition towhat you normally drink.

Get regular exercise. Keeping your body active helpskeep your gut active.

Give yourself plenty of time to go to the toilet – thebest time is 20-30 minutes after a meal. Don’t ignorethe feeling of needing the toilet.

Unknown causes:Some people suffer constipation, even if they eat a gooddiet, drink a lot of fluid, and do not take any medicationthat can cause constipation. Their bowels are said to be'underactive'. Most cases occur in women and often startin childhood or early adulthood.

For more information please visit http://www.nhs.uk/Conditions/Constipation/Pages/Prevention.aspx