Constipation

• Constipation symptoms

  • difficulty passing stools
  • Hard, dry stools
  • Frequency less than normal compared to the individual's norm
  • Abdominal discomfort
• Causes of constipation

  • Not enough fibre in the diet
  • Not drinking enough fluids
  • Lack of exercise
  • Medication use: Codeine, Antacids (aluminium, antispasmodics), antidepressants, diuretics, iron supplements, anti-epileptic meds
• constipation REFER

  1. No improvement with treatment

  3. Constipation that lasts a long time (Adults >2 weeks, Children >1 week)

  4. Black, red, tarry or bloody stools can indicate underlying condition (e.g. gastric ulcer)

  5. Continuous feeling of tiredness (Anaemia suspect)

  6. Medication suspected induced (Opioids, Antidepressants (TCAs, SSRIs), Iron supplements)

  7. Laxative abuse

  8. Unexpected weight and appetite loss (carcinoma-suspect)

  9. Weight gain, coarse hair, lethargy, dry skin (hyperthyroidism-suspect)

  10. Failed treatment (Pregnant women-unless advised by GP/Nurse to purchase)
• Treatments for constipation


  • 1st Line-Lifestyle Advice, increase fibre, fruit, fluids & exercise 30-60mins on min 5 days per week
  • 2nd Line Bulk forming laxatives (e.g. ispaghula, methylcellulose, sterculia-swell up in the gut to increase faecal mass which stimulates peristalsis. Onset within 24hrs, full effect in 2-3 days. Safe in pregnancy)
  • 3rd Line-Osmotic laxatives (e.g. lactulose, macrogol-takes 2-3 days to work. Side effects: flatulence, cramps, abdominal discomfort on initiation)
  • 4th Line-Stimulant laxatives (e.g. senna, bisacodyl, sodium picosulfate, glycerol suppository)-work by directly stimulating peristalsis through increasing release of water & electrolytes by the intestinal mucosa. Onset within 6-12 hrs (overnight. Suppositories are immediate. Senna can colour the urine red/brown). Avoid stimulant laxatives in pregnancy
• Increase water intake to reduce constipation, increase dietary fibre (30g per day wholemeal cereals, bread, fresh fruit etc)
• Refuse supply if suspected laxative abuse
• Soluble fibre

  Retains water in the stools making them softer
• Insoluble fibre

  Adds bulk to the faeces, thus causing them to pass through the gut more quickly