Now Beware of constipation

Now Beware of constipation

The Constipation is a very common problem, especially in India. Today’s lifestyle and eating habits are mostly to blame. It must be prevented as constipation can lead to many diseases.

The causes: Low fibre (roughage); not drinking enough water

l Medicines: Pain-killers (particularly those with codeine), some antacids, some antidepressants, iron tablets, morphine, etc.
l Medical conditions: An under-active thyroid, irritable bowel syndrome(IBS), and conditions that cause poor mobility, particularly in the elderly.
l Pregnancy: About one in five pregnant women become constipated. It is due to the hormone changes during pregnancy that slow down the gut movements.
l Emotion: There is some evidence to suggest that "emotional problems and stress" can lead to constipation.
l Unknown cause (idiopathic): Some people have a good diet, drink a lot of fluid, do not have a disease which can cause constipation, yet they become constipated. Their bowels are said to be "underactive". This is quite common. Most cases occur in women. This condition tends to start in childhood or in early adulthood, and persist throughout life.

Prevention: Constipation is best avoided. It can be done in the following manner:

l Eat plenty of fibre: By eating plenty of fruit, vegetables, cereals, fruit juice, wholemeal bread, etc.
l Have plenty to drink: At least two litres (about 8-10 cups) of fluid per day. Most sorts of drink will do, but alcoholic drinks can be dehydrating and may not be so good.
l Exercise regularly if possible. Keeping your body active helps to keep your gut active.
l Toileting: Do not ignore the feeling of needing the toilet. Some people suppress this feeling if they are busy. It may result in hardening and backlog of faeces that may become difficult to pass later.

Treatment: Treatment with a laxative is needed only if the measures above (fibre, fluid, etc) do not work well. There are four main groups of laxatives that work in different ways:

l Bulk-forming laxatives (fibre supplements).
l Stimulant laxatives.
l Osmotic laxatives.
l Faecal (stool) softener laxatives.

As a rule, a laxative should be used only for a short time, when necessary, to get over a bout of constipation. Once the constipation eases, you should normally stop the laxative. Some people get into the habit of taking a laxative each day "to keep the bowels regular" or to "prevent constipation". This is not advised, except for bulk forming (fibre ) laxatives.

Bulk-forming laxatives (fibre supplements): These increase the "bulk" of your faeces similar to fibre. They can have some effect within 12-24 hours. However, their full effect may take some days to develop. Unprocessed bran is the cheapest. Alternatives are ispaghula husk (Isabgol), methylcellulose and sterculia.

Stimulant laxatives: These stimulate the nerves in the large bowel which causes the muscle in its wall to squeeze harder than usual. This pushes the faeces along and out. Stimulant laxatives include senna (Softovac), bisacodyl, phenolphthalein, castor oil, sodium picosulphate (cremalax) and dantron. Their effect is within 8-12 hours. Therefore, a bedtime dose is recommended so that you have the urge to go to the toilet the following morning.

Stimulant laxative suppositories act more quickly (within 20-60 minutes). Possible side-effects from stimulant laxatives include abdominal cramps, and a "weakened" bowel (lazy bowel) with long-term use.

Osmotic laxatives: These work by retaining fluid in the large bowel by osmosis (so less fluid is absorbed into the bloodstream from the large bowel). A commonly used one is called lactulose (Loose). However, this can take up to two days to have any effect, so it is not suitable for rapid relief in constipation. Possible side-effects of lactulose include abdominal pain, bloating and an unpleasant taste. Another osmotic laxative is called polyethylene glycol (Peglec). This usually has a rapid action.

When tests need to be done for constipation

l If regular constipation is a new symptom, especially in people above the age of 40 years and there is no apparent cause such as a change in diet, lifestyle or medication.