Getting to grips with Constipation

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When I was a lad growing up in the UK, each day after breakfast- like clockwork - Dad got up from the table with daily newspaper in hand and disappeared into the toilet .... for at least 20 minutes! And wherever he went in the world, the routine was exactly the same which cannot be said of about 15% of the western world who struggle with constipation and may visit the smallest room perhaps less than 3 times per week!

Constipation is a big problem and a big strain on those who suffer from it - if you'll excuse the pun! One of the problems when talking about constipation though is to determine exactly what the problem is because one patients story may not correspond with another Doctors diagnosis! Is it difficulty passing a motion? Is having to strain to pass a motion? Is it the size or consistency of the stool? Well the correct answer is "yes ... and no.." as there is no one definition of constipation, but the experts have come up with a delightful compromise with the Rome III Consensus which is states that:
"Symptoms should include ≥ 2 of the following during at least 25% of defecations":

• Straining
• Lumpy or hard stools
• Sensation of incomplete evacuation
• Sensation of anorectal obstruction or blockade
• Manual maneuvers to facilitate evacuation
• Fewer than 3 bowel movements per week

but even using this chart, patients ideas of constipation will often differ from their treating physicians in 50% of cases!

But forming and passing a bowel motion doesn't just rely on the proximity of a newspaper and a suitable "drop-off" point!  In fact the mechanism of defaecation is still to be fully elucidated because it's a very complex process. As well as having two types of squeezing mechanisms within the colon - one for gentle mixing of the contents and the other which is much stronger to propel the motion towards the outside world - these contractions need to be coordinated so that the bowel "behind" squeezes whilst the bowel "in front" relaxes. This is all under the influence of nerves, neuro-transmitters and various hormones, and any interference in either one or some of these can lead to reduced bowel activity and hence constipation.

When it comes to diagnosing constipation, the history is useful especially when it come to medications as certain drugs are renowned for causing constipation - codeine, certain blood pressure medications called Calcium Channel Blockers and some anti-depressants - but history is only a guide, so the experts have come up with some really Hi tech and Low tech investigations which help work out the why's and the wherefores. They will also flash out what is know in their trade as the "Bristol Stool Chart" (which I won't publish here to save the blushes of those of a tender disposition) which is a pictorial depiction of various species of Stool!

When it come to treatment there are some new medications entering the "market" and which seem to be a big step forward in managing this dispiriting condition and that's great news. Old fashioned things such as Prunes do work: soluble fibre such as psyllium does work although Bran doesn't: exercise is definitely a great idea not only for bowels but for general health too - so keep moving to keep moving -: and laxatives that contain Polyethylene Glycol PEG are also effective.

But like all things medical, if you've had a constipation problem for more than 3 months you must see your Doc first before starting to self medicate - especially if you're over 40 or have a strong family history of bowel cancer when you should see your Doc at the first sign of any change in your bowel habit.
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Tips for conquering Constipation

Tweet It's not a topic of polite conversation, but as the saying goes "Constipation Happens"!

In these days of bowel screening for Colon Cancer, any change in bowel habit is worthy of investigation, but for the majority of people with "sluggish" bowels, how to treat constipation is still more of an art than a science: so in order to help improve the situation, here are a few thoughts on the subject.

The body has a natural reflex to empty the bowel and this occurs usually about 15 to 20 minutes after a meal and is known as the Gastro-Colic reflex. In other words, if you put food in the top end of the gut tube, you will need to clear some space lower down, in order to make room for the waste material from this meal when it comes through. The problem is that in these modern, busy times with all the rush and "things to do", we often suppress this urge, and like most things, if not used properly, it gets a little "rusty"! But the reflex is always there, even when not used, and it can be reactivated. So, if constipation is a problem, then chose a meal that you might regularly have time after, and then about 15 minutes after eating, go to the little romm with a book or magazine and sit and wait to see if you can feel that reflex wanting to work. If after say 5 minutes, nothing has happened, then repeat after the next appropriate meal. With patience, you should be able to become aware of your bowel wanting to empty.

The next thing is to make sure that your bowel has enough residue in it for the gut to actually grip on: and the best foods for this are vegetables, wholemeal grains, nuts and fibrous fruits. Processed and packaged foods are often just "dissolve in your mouth and disappear in the bowel" materials that will not help in resolving constipation! A good suggestion is to keep a food diary in order to help you become aware of what you actually eat on a daily/weekly basis: once you know, then you can make appropriate, healthy changes.

Exercise is yet again a really good "get out of goal" card for most things that ail us: and yes, it does help with constipation too!

When it comes to things that help the bowel work more efficiently, the following treatments might be of help:

• Treatments that help soften the stool: Coloxyl tablets from the Pharmacy.
• Treatments that help make the gut contract more strongly: such as Senna, and Phenopthalein that is found in certain medications.
• Treatments that ferment in the bowel such as Lactulose.
• Treatments that lubricate the gut such as Liquid paraffin and Glycerin suppositories.

Needless to say, if you have any health condition such as Diabetes; or are on any medications, antibiotics or anything else for any acute or chronic illness; or you are pregnant, then you should consult a Doctor before taking any medication for constipation.