Constipation: treatment options
There are several treatments available for the treatment of constipation. Your doctor will be able to advise you on the most suitable treatment for you, depending on how long you have been constipated, how severe your constipation is and the cause of your constipation.
Controlling your bowel activity through lifestyle measures such as diet and exercise can help prevent and treat constipation.
Diet is an important factor in constipation. Eating regular, balanced meals containing adequate fibre is recommended, as is drinking plenty of (non-caffeinated) fluids each day.
The National Health and Medical Research Council recommends at least 30 g of fibre per day for men and 25 g of fibre per day for women. Include wholegrain or wholemeal breads and cereals, legumes (e.g. chickpeas and kidney beans), fruit and plenty of vegetables in your diet each day. Seeds and nuts are also a good source of fibre.
Rather than just adding one or 2 very high-fibre foods, a variety of foods that contain soluble and insoluble fibre should be included in the diet. For example, a bowl of high-fibre breakfast cereal (10 g fibre), 2 slices of wholemeal or wholegrain bread (3–8 g), 2 pieces of fruit (6 g), a cup of cooked wholemeal pasta (9 g) and a large serve of cooked vegetables (5 g) will provide 30–40 g of fibre.
Increase fibre gradually into your diet or you may feel bloated and have problems with gas.
Exercise and physical activity help prevent constipation by increasing the muscle activity in your bowel. Being physically active and getting some exercise on most days can help treat constipation.
When you feel the urge to go, make sure you go. Ignoring the urge to go can result in constipation by stretching the lower bowel. Commonly, the urge to open your bowels occurs after a meal (this is called the gastro-colic reflex) and upon waking in the morning.
Laxatives are medicines used to treat constipation by making it easier to have a bowel movement. There are several different types of laxative, and they are available in different preparations, including tablets, powders, granules, syrups, solutions, suppositories and enemas.
You should only use laxatives if your constipation has not improved with diet and lifestyle measures. As different laxatives work in different ways, your doctor can advise you on which laxative may be suitable for you.
Laxatives are not usually needed long-term. However, some people may need to use regular laxatives to maintain bowel function. Overuse or inappropriate use of laxatives may cause electrolyte imbalances, which can be dangerous. In addition, people who have abused laxatives may have trouble maintaining a regular bowel habit after stopping the laxative use.
Bulk forming laxatives (fibre supplements)
Bulk forming laxatives (fibre supplements) are generally the first choice treatment for mild constipation that has not improved with lifestyle measures. They can also be used to help prevent constipation in people at risk of constipation.
Bulk-forming laxatives work by absorbing fluid in the bowel, increasing faecal bulk and moisture, which stimulates bowel movement. It is very important to drink plenty of water with these laxatives — inadequate fluid intake can result in worsening constipation. Results may be seen in 24 hours, but sometimes the full effect is not noticed for several days.
Bulk forming laxatives include:
- psyllium/ispaghula, which can be taken as husks or powder supplements (e.g. Metamucil, Fybogel); and
- sterculia (e.g. Normafibe).
Side effects can include flatulence and bloating.
Osmotic laxatives are often used in people who need regular, long-term laxatives to stay regular. Osmotic laxatives work by drawing fluid into the bowel, which softens and expands the faeces. These laxatives should be taken with plenty of fluids. Effects should be within 2 to 48 hours.
Osmotic laxatives include:
- lactulose (e.g. Actilax, Duphalac and Lac-Dol);
- sorbitol (e.g. Sorbilax);
- magnesium sulphate (e.g. Gold Cross Epsom Salts); and
- macrogol 3350 (e.g. OsmoLax).
Side effects can include flatulence, bloating, abdominal discomfort, abdominal cramps, nausea and diarrhoea.
Laxatives that contain magnesium are best avoided in pregnancy.
Stimulant laxatives may be required when constipation is severe. Stimulant laxatives work by stimulating the bowel to contract. The onset of action is about 6 to 12 hours.
Stimulant laxatives include:
- bisacodyl (e.g. Dulcolax, Bisalax);
- senna (e.g. Sennetabs);
- sodium picosulfate (e.g. Dulcolax SP Drops); and
- glycerol suppositories (which act as a stimulant in the rectum due to the irritant action of glycerol).
Stimulant laxatives should not be used during pregnancy.
Side effects can include abdominal cramps, abdominal pain and discomfort, nausea and vomiting. Excessive use can cause diarrhoea and salt imbalances.
Stimulant laxatives may be used in combination with stool softeners such as docusate (e.g.Coloxyl with Senna, Sennesoft). Stool softeners are generally not effective laxatives when used alone.
Suppositories or enemas
Suppositories and enemas can be used to stimulate a bowel movement in people who are very constipated, but there is no evidence that they have any long-term effect on constipation.
Suppositories and enemas are best used under the guidance of a health professional.
There is a prescription medicine available called prucalopride (brand name Resotrans) that can be used to treat people who have chronic (ongoing) functional constipation — constipation that is not secondary to another illness or medicine side effect. This medicine can only be prescribed if several laxatives have not been effective in treating constipation over a period of time.
Possible side effects include headache, abdominal pain, nausea and diarrhoea.
Biofeedback pelvic floor muscle retraining
Biofeedback training can be used to treat constipation when abdominal muscles and pelvic floor muscles are not working in coordination. This specialised treatment, which involves learning to relax and contract your pelvic floor muscles, is available in a number of centres in Australia.
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