Constipation Management
Authors: Vivian Ho (BASc, Nutrition and Food), Dr. Steven Shao (Pharm.D)
Constipation is when one experiences pain and hardness of stool, or having fewer than three bowel movements per week. Additional symptoms of constipation include bloating, abdominal pain, and a feeling of incomplete bowel evacuation after a movement. Everyone has different bowel movement pattern. Therefore, fewer bowel movements does not necessary mean you are constipated as long as they are soft, pain-free and follow your normal bowel movement routine. If you notice there is a change in your bowel routine, for instance fewer bowel movements than usual, you may be constipated. Constipation exists when there is change in frequency, consistency, size, and ease of stool passage.
What Causes Constipation?
• Low fibre intake
• Low fluids intake
• Not getting enough daily physical activity
• Delaying or Ignore the urge to have a bowel movement
• Changes in your daily routines such as diet and travelling
• Side effects from iron or calcium supplements and some medications*
• Certain health conditions
* Many of the medications and supplements you take may induce constipation. Check with your pharmacist to find out. Common ones you may be using are opioid pain relievers, iron supplements, and some of the blood pressure medications. Opioids should always be paired with either a stimulant or osmotic laxative.
The symptoms of constipation can often be eased by increasing the fibre and fluid consumption in your diet and being physically active. Laxatives should be held in reserve for constipation that is not relieved by dietary and lifestyle changes.
Dietary Fibre:
Dietary fibre is the complex carbohydrates in plant foods that the body cannot digest. Dietary fibre adds bulk to stool, keeping them soft which in turn makes bowel movements easier to pass. Increase your dietary fibre intake slowly to prevent gas, cramps, bloating and diarrhea.
How much fibre do you need per day? Adults from 19 years old are recommended to have at least 21 to 38 grams of total dietary fibre each day.
Fluid
It is important to stay hydrated; fluids help with digestion by getting rid of waste and keeping your bowels regular. Drink plenty of fluid as you increase your fibre intake. This will help the fibre to work better.
How much fluid do you need? The recommended amount of fluid intake depends on your age, sex, activity level, and the weather. Adults who are 19 years old and above need 9 to 12 cups of fluid per day. Fluid includes water and liquids such as beverages, milk, tea, broth and soup.
Tips to stay hydrated:
• Don’t ignore thirst. Quiche your thirst with water or other healthy drinks
• Drink throughout the day
• Drink more water in hot and humid weather, and when physically active
• Add berries, lime, lemon, mint or cucumber slices in your water to make it more appetizing and refreshing
• Drink a glass of water in the morning when you wake up and have a glass a water with each meal
Physical Activity
Adults over 18 years old and seniors should aim for at least 150 minutes per week of moderate to vigorous physical activity, broken into sessions of 10 minutes or more.
Examples to stay active include:
• Brisk walking
• Bike riding
• Raking Leaves
• Dancing
• Swimming
Other tips to improve constipation
• Set a regular time for bowel movements.
• In general, no specific foods cause constipation. Removing cheese, milk or other dairy products is not necessary
• Prunes, apples, and pears contain natural ingredients with laxative effects (Prunes and prune juice should only be used moderately if adding more fibre and fluid to your diet does not help with your constipation.)
If dietary and lifestyle modifications do not provide satisfactory relief, medications could provide the result desired or it could even be the culprit of your constipation.
If dietary and lifestyle modifications do not provide satisfactory relief, medications could provide the result desired. There are many options. The best one for you is based on your specific need. Your doctor or pharmacist would happy to assist you.
Common Over-the-Counter Therapy
Bulk-forming Agent
Psyllium (Metamucil)
• Onset: 1-3 days
• Safe for chronic use. Contraindicated in fecal impaction
• Must take with 250ml of water if you don’t want to make the constipation worse
Osmotic Agents
Lactulose
• Faster onset of onset of 1-2 days but more side effects such as bloating
• Separate from other meds for at least 2 hours
PEG 3350 (e.g. Lax-A Day, Restoralax)
• Effective in opioid-induced constipation
• Onset 2-4 days
• Separate from other meds for at least 2 hours
Glycerin Suppositories
• Quickest onset (~15 mins - 1 hr)
• Only works locally
Stimulant Agents
Senna, Bisacodyl
• Used in opioid-induced constipation
• Nightly administration as it has delayed onset of 6-12 hours
• Not recommended in pregnancy
• Can become dependent on stimulant laxatives
Emollient, Lubricant, Stool Softening Agents
Docusate Sodium, Mineral Oil
• Limited efficacy data
• Onset: 1-3 days
• Avoid mineral oil in children and the elderly. Risk of aspiration and can also bind to fat-solution drugs
Prescription Therapy
There are several options available if over-the-counter options do not work for you. Drugs include prucalopride, methylnaltrexone, naloxegol, and linaclotide (Constella). Speak to your doctor or pharmacist for more details.
In general, do not rely on medications. They are only useful for the short-term. Focus on dietary and lifestyle modifications. Consult your trusted healthcare professionals for any questions or concerns.
Read more about health….
Legal Disclaimer
These presentations are intended for general information purposes only. Audiences are recommended to consult with a qualified healthcare provider and obtain professional advice and subsequent management for your particular conditions. The views and opinions expressed by the speakers do not necessarily reflect the policy or position of Assisting in Medical Expectations.
