Bowel habits vary among individuals. It can be normal to have bowel movement one to two times a day or once every other day. However, if the stools are dry and difficult to pass, or if bowel evacuation occurs only once ever y several days, it can be called constipation. On the other hand, frequent passage of loose or water y stools is diarrhoea.
Definition of constipation
Constipation is defecation that is unsatisfactory because of infrequent stools, difficult stool passage, or seemingly incomplete defecation. Stools are often dry and hard, and may be abnormally large or abnormally small.
Conditions which may cause or contribute to constipation
• Bowel obstruction
• Irritable bowel syndrome
• Diverticular disease
• Admission to hospital for any cause
• Neuromuscular disorders
• Stimulant laxative abuse
Commonly prescribed drugs which may cause constipation
• Opioid analgesics, including compound products e.g. co-codamol, co-dydramol.
• Drugs with antimuscarinic (anticholinergic) effects –Tricyclic/ SSRI/SNRI antidepressants; antipsychotics; antimuscarinic anti-parkinsonian drugs e.g. orphenadrine, benzatropine, trihexyphenidyl, procyclidine; antihistamines –especially older sedating antihistamines e.g. chlorphenamine, promethazine and cyclizine; antispasmodics e.g. propantheline, hyoscine.
• Calcium salts (note: contained in some antacids & phosphate binders).
• Aluminium salts (in many antacids).
• Iron salts.
• Calcium channel blockers (mainly verapamil).
• NSAIDs (more commonly cause diarrhoea).
• 5HT3antagonists e.g. Ondansetron
What are laxatives?
Laxatives are medicines that treat constipation, either by softening the stools or by stimulating the lower intestines to push out stool. They can do more harm than good if used improperly.
Types of laxatives
Stimulant laxatives such as bisacodyl (Dulcolax), castor oil, cascara sagrada, senna (Senokot), and phenolphthalein are dangerous, despite the fact that they are non-prescription medications. These are the most commonly abused laxatives. They stimulate the nerves in the walls of the large intestines and cause intestinal contractions as well as fluid and electrolyte changes, and can be habit-forming. In addition, tolerance develops, meaning that higher and higher doses are needed to obtain the same effect.
“Natural” stimulant laxatives usually contain senna. They are stimulant laxatives that happen to come from plant sources. Their dangers are the same as those of synthetic stimulant laxatives, listed previously.
Non-stimulant laxatives are safer if used correctly and in appropriate doses. They include the following:
• Osmotic laxatives include Milk of Magnesia, Epsom salts, Golytely, Colyte, lactulose, sorbitol and Miralax. These work by drawing fluid into the intestines and are less habit-forming, but can still cause fluid and electrolyte imbalances when used incorrectly. Some require a prescription.
• Lubricant and emollient laxatives, such as mineral oil or docusate (Colace), work by softening the stool. These are generally safe to use for a limited time.
• Bulk-forming laxatives, such as psyllium (Metamucil), Citracel, and FiberCon, are generally safe and also are a source of dietary fiber. When used in higher than recommended doses, bulk-forming laxatives can cause intestinal problems and block absorption of other nutrients.
Some people take large quantities of laxatives at one time. Others take small amounts of laxatives, perhaps not more than the “recommended dose,” but on a fairly regular basis. Most young, healthy people should rarely, if ever, require a stimulant laxative, and laxatives should never be used in higher than directed doses or over long periods of time. Once the pattern has started, however, people often find it very difficult to stop taking laxatives even if they want to. They can become physically and psychologically dependent on laxatives.
Some people use laxatives in the mistaken belief that it will help them with weight loss. Laxatives flush water and waste from the intestine, but they do not flush calories from the body.
• Constipation. With laxative abuse, the intestines lose muscle and nerve response. The intestines then become dilated and ineffective in moving s tool out. This results in dependency on the laxative, so that higher and higher doses are needed to produce stools.
• Alternating constipation, diarrhea, and gas. Laxative use can result in rebound constipation, which may include trapped gas in the intestines. This can cause the laxative user to constantly try to treat those symptoms with more laxatives, and a vicious cycle of laxative use may follow.
• Dehydration. Sub-normal body water content occurs when too much fluid is lost in the diarrhea caused by laxative abuse. Common symptoms include thirst, decreased urination, headache, light-headedness, diminished sweating, dry mouth and weakness.
• Electrolyte abnormalities. Electrolytes such as sodium, potassium, and chloride are lost at abnormally high rates in diarrhea. This can lead to weakness, irregular heartbeats and death.
Although such severe complications are infrequent, they are unpredictable and can happen to someone who abuses laxatives for the first time, or to someone who has abused laxatives for years.
• Blood in stool. Irritation of the colon can lead to blood in the stools, which in turn can cause anemia.
• Impaired function of the intestines. After long-term laxative abuse, the intestines lose normal tone and nerve response, and can no longer contract to evacuate stool normally. This is often reversible, but recovery may be a slow process.
• Rectal prolapse. Chronic severe diarrhea caused by laxative abuse can cause the inside of the intestines to protrude through the anal opening. This condition usually requires surgical treatment.
Steps to stop laxative abuse
• Stop now. It is generally better to stop completely and quickly rather than to try to cut down slowly.
• Dispose of any laxatives you have.
• Take steps to prevent possible constipation right away.
• Prepare to deal with the urge to use a laxative. Laxative withdrawal refers to symptoms people experience when they stop laxative use. Think ahead about the situations in which you might have the urge to use a laxative. For some people this occurs after a binge, or when they haven’t had a bowel movement in a few days. Come up with a few alternative plans of action in case you do have the urge (e.g., drink a large glass of water, take a walk, or call a friend for support).
• Seek support. Letting a friend or relative know about the problem can help.
• Get help. Your health care provider, nutritionist, and therapist can help you achieve health-related goals. Call to set up appointments now. Not everyone experiences laxative withdrawal, but it helps to be prepared for this possibility to guard against restarting the laxatives. Symptoms can last from 1 to 3 weeks, or occasionally longer, and include fluid retention, constipation, bloating, and temporary weight gain (from water and stool). Remember that in the long run your symptoms will improve, and you will be much healthier and feel better when you are not taking laxatives.
People suffering from constipation should drink plenty of fluid and eat high-fibre food such as vegetables, fruits or whole-wheat bread. Lead a regular life. Do moderate exercise regularly and stay happy. Do not smoke. Avoid stimulating beverages such as coffee and alcohol. Developing a regular bowel habit is most preferable.
Eating a small amount of food or drink a glass of cold water on an empty stomach when waking up in the morning, for example, could stimulate the urge for bowel movement and help the passage of stools. People with diarrhoea should take plenty of rest and avoid greasy food. Eat light food and drink plenty of fluid such as thin congee, clear soup or fruit juice to replenish the water and electrolytes lost.
A sudden change from normal bowel movements such as having frequent constipation, loose stools or stools with mucus or even blood, you should take caution as they could imply colon anomalies. Do not ignore these warnings and seek medical consultation immediately.