Faeces are waste materials that the body does not need. They are discharged from the body along with bacteria that live in the gut. Constipation is the infrequent and difficult passing of hard, dry faeces, often accompanied by bloating and abdominal pain.Toilet patterns vary: some people go several times a day whereas others may not need to go every day. Constipation is particularly common amongst the elderly and affects more women than men.

Causes

  • Poor diet. Fibre forms the basis of the waste which is lost from the body. Lack of fibre means that the muscles of the intestine will not be stimulated enough to force waste products through the bodyinsufficient fluid intakein a cool climate, drink at least two and a half litres (four pints) of fluid every day. Drinks containing caffeine such as tea and coffee have a mild diuretic effect which means that they make you lose fluid by increasing your urine output. However, as long as you drink them regularly and at normal strengths, these drinks will still contribute to your water intakemedicines. Constipation can be caused by indigestion remedies containing aluminium, certain antidepressants, iron supplements and some pain relief medicines and cough mixtures. If a particular medicine causes constipation, it should be listed as a side effect on the medicine label or information leafletpregnancy. Hormonal changes and the pressure of a baby on the bowel can lead to constipationchange in routine. Shift work, going on holiday and stress can all lead to a change in bowel habitslack of exercise. The muscles in the intestine help to move waste through the body. Regular exercise helps to keep these muscles toned and working properly
  • Resisting the urge. Poor toilet facilities or being in a strange place may put you off going to the toilet which can lead to constipation

Avoiding Constipation

  • eat a well balanced diet. This should consist of wholemeal bread, cereals, wholemeal pasta, pulses such as chickpeas, lentils and beans (including baked beans) and at least five portions of fruit and vegetables each day. One portion equates to one medium sized piece of fruit such as an apple or a banana, a slice of a large piece of fruit such as a melon or pineapple, two small pieces of fruit such as plums, a cupful of grapes or berries, 2-3 tablespoons of fruit salad, 2-3 tablespoons of stewed or tinned fruit, two tablespoons of vegetables, a dessert bowl of salad or a 150ml glass of fruit juice.Drink at least four pints of water or fruit juice every day.Take regular exercise
  • do not resist the urge to go to the toilet

Treatment

If preventative measures fail, there are various types of laxatives available which all work in different ways. Long-term use of laxatives is not recommended because your body can begin to depend on them. Only use them if straining will make an existing condition such as angina worse or if straining will increase the chance of rectal bleeding in the case of someone with haemorrhoids (piles). Only take laxatives until your normal routine returns.Bulk-forming laxatives absorb water as they pass through the body. This increases the volume of the faeces and makes it softer and easier to pass. Bran, ispaghula and methylcellulose are examples of bulk-forming laxatives. If you take these, make sure you take them with plenty of fluid.Stimulant laxatives encourage the muscles of the bowel to contract. This moves waste products through the body. Bisacodyl and senna are examples of stimulant laxatives. Do not use senna pods and cascara because their action is unpredictable. Do not use phenolphthalein because it has too long a period of action and unpleasant side effects. Castor oil is also no longer recommended.Osmotic laxatives keep water in the bowel making the faeces softer and easier to pass. Examples include lactulose, Epsom's salts and Glauber's salts.Lubricants make the faeces softer and easier to pass. Liquid paraffin was used but is no longer recommended as it stops the absorption of vitamins, can leak from the back passage and has dangerous side effects. Arachis oil in an enema is sometimes used. An enema is a liquid which is delivered straight into the rectum.

When To See A Doctor

Consult your doctor if constipation lasts for more than two weeks or if you have tried a constipation treatment which has failed. Also tell your doctor if you experience: vomiting, severe pain in the lower stomach, blood in the faeces, weight loss and unexplained constipation especially in the over forties.

Additional Information

For more information about constipation, contact the Digestive Disorders Foundation, 3 St Andrews Place, London NW1 4LB. Telephone: 0171 486 0341. Fax: 0171 224 2012. Website address: www.digestivedisorders.org.uk.