CONSTIPATION

Normal bowel habit can vary between individuals, from twice daily to once every 2 or 3 days. Constipation may therefore mean different things to different people.

Points to take note of are:

Is there a change in bowel frequency from the norm?

Are hard stools passed , often with difficulty and straining?

There are often other symptoms present, such as a feeling of incomplete defecation and abdominal pain and bloating.

The causes of constipation range from simple changes in lifestyle and daily routine to major bowel or systemic disease. If it is persistent and inadequately treated, constipation can lead to some unpleasant complications, such as haemorrhoids, faecal impaction in the colon or rectum, intestinal obstruction or urinary tract complications.

Treatment

Treatment is not usually required unless symptoms persist for more than 4 days, provided no other symptoms are present. The actual timescale will obviously depend on the individual’s previous frequency of bowel movement. If constipation has persisted for up to 14 days then an over-the-counter laxative should be tried for 4 days. If there is no bowel movement within this period, then it is important to see your GP.

Accompanying Symptoms

General Malaise

If you feel ill or unable to work while having constipation this should be regarded as unusual and you should see your GP. The same applies to any fever or night sweats.

Blood in the Stools

In the vast majority of cases blood on the stools will have a perfectly innocent explanation. Blood noticed as specks or as a light smear on the toilet paper after a bowel movement is most likely to be due to a haemorrhoids or a fissure in the anal canal or skin surrounding it. Straining at a stool can cause or exacerbate haemorrhoids. Fresh blood present only on the surface of the stool has most likely come from the anus or the most distal part of the colon. Blood that is mixed with the faeces, giving a dark colour, often described as tarry, may have a more serious cause, such as diverticulitis, a bleeding peptic ulcer or, rarely, a carcinoma. Dark stools may also be due to taking iron tablets, this is of no consequence.

It is best that all patients experiencing rectal bleeding should see their GP, unless this is very minor and resolves in a few days.

Other Symptoms

Any patient experiencing continuous or severe abdominal pain accompanying constipation, which has been present for 2 days or more, should see their GP. Similarly the presence of nausea or vomiting should also be regarded as unusual and a medical opinion sought to eliminate the possibility of intestinal obstruction.

Sudden weight loss for no obvious reason should also be taken as a warning sign.

In young adults, alternating bouts of diarrhoea and constipation, together with abdominal pain, are typical symptoms of Irritable Bowel Syndrome. Failure to control these symptoms in any way requires medical attention.

Aggravating Factors

Various food intolerances have been shown to cause symptoms in some patients with irritable bowel syndrome; these include wheat, dairy products, coffee, potatoes and onions.

Age

Babies who are breastfed normally produce fewer stools than bottle-fed babies. This is perfectly normal and does not require any intervention. Constipation in bottle-fed babies may be caused by insufficient water being added to the milk powder. Babies or older children who become irritable, feverish or drowsy, or who scream, have pain, feed or eat less or vomit, should be seen by a GP.

Management

• There a various different treatments available from your pharmacy.
• Bulk-forming laxatives
• Stimulant laxatives
• Osmotic laxatives
• Stool softeners

Generally, the approach to simple, acute constipation should be to use a stimulant or bulk laxative. Bulk laxatives are particularly useful in the elderly but fluid intake should be adequate too.dry, hard faeces should be softened with a stool softener before using a stimulant laxative.

Your pharmacist will be in a position to help you decide which is best suited to your situation. As for the vast majority of conditions and symptoms treated with over the counter remedies, a failure to produce relief within 7-14 days should indicate the need to see a doctor.