By Dr Ananya Mandal, MD
Treatment for constipation is dependent on the cause of constipation, how long the condition has been present and the severity of the symptoms. However, basics of treatment are similar for most cases.
In a large majority of cases it is possible to relieve symptoms through dietary and lifestyle changes alone. Management of constipation involves the following steps and measures.
Lifestyle and dietary changes
Some of the major lifestyle changes advised are those suggested for prevention of constipation. These measures can prevent recurrence of constipation as well. They include:-
Including enough fibres in diet - Fibres are available in fruits, vegetables, whole grain rice, whole wheat bread, whole wheat pasta, seeds, nuts, oats, pulses etc. It is recommended that a person needs at least 18 to 30g of fibre a day. Some bulking agents like wheat bran may be added to the diet to increase the bulk of the stools and facilitate passage
Including enough fluids in diet - Fluids like water and fruit juices help prevent dehydration and help in softening the stools as well. Certain fluids like caffeine, alcohol and fizzy drinks are not good for bowel motions and excessive coffee or alcohol may precipitate constipation.
Being more physically active - Sedentary habits often precipitate constipation. Being active and mobile helps prevent constipation. Ideally around 150 minutes of moderate physical activity is recommended every week
Developing good toilet habits - The urge to go to the toilet should not be ignored. When delayed the urge usually passes away and this may raise the risk of constipation. The best time for passing stools is first thing in the morning or around half an hour after a full meal. The toilet should be used with adequate time and privacy.
These are medications that help pass stools more comfortably. They lead to formation of soft formed stools after a couple of days of use and ease the process of passing stools.
There are three major classes of laxatives. These include:-
Bulk-forming laxatives – These agents increase the bulk of the stools formed and soften them to ease passage. They soften the stools by retaining the fluids within the stools. Softening the stools help in their passage and prevents stool impaction or fecal impaction. Commonly prescribed bulk-forming laxatives include ispaghula husk or psyllium, polycarbophill, methylcellulose and sterculia. These should be taken with plenty of water. These agents take around two to three days to be effective.
Osmotic laxatives – Osmotic laxatives work by drawing the water into the intestines and thus make the stools soft. These are prescribed if the bulk laxatives fail to work. Commonly prescribed osmotic laxatives include lactulose.
Stimulant laxatives – These laxatives are used if the other two agents have failed to cause softening and passage of stools. These agents stimulate the muscles of the gut to contract and expel the feces. The most commonly prescribed stimulant laxatives are senna, bisacodyl and sodium picosulphate. These agents take around 6 to 12 hours to work and should be used on short term basis only. They are also useful for clearing the bowel in patients who are to undergo surgery (especially abdominal surgery) or radiological investigations and imaging of the abdomen.
Treatment of fecal or stool impaction in severe cases
Fecal impaction or stool impaction occurs when stools become hard and dry and get stuck in the rectum. This may lead to severe pain and a lump like sensation.
Initially osmotic laxatives are tried and if there are no results, a stimulant purgative may be added.
If these fail a suppository (capsule containing bisacodyl or glycerol) is inserted into the anus and this helps in softening of the lump and easy passage.
When this fails an enema may be tried to cleanse the rectum. Agents used include docusate and sodium citrate.
Treating infants and children
Infants who are not yet weaned may be given water in between feeds to ease constipation. Gentle movement of the baby’s legs in a bicycle motion also helps the baby pass stools.
Babies who have begun solids may be given plenty of fluids like water or diluted fruit juice to prevent and treat mild constipation. They may be given fibres in diet in the form of fruits like apples, apricots, pears, peaches, grapes, plums, bananas, raspberries, strawberries etc. that are pureed or chopped.
In severe cases osmotic laxatives are prescribed. However, if this does not work, they can be prescribed a stimulant laxative. Bulk forming laxatives are not suitable for babies.
Children with constipation are treated almost similarly as adults with the condition by making lifestyle and dietary changes. In severe cases osmotic laxatives are prescribed. However, if this does not work, they can be prescribed a stimulant laxative. Bulk forming laxatives are not suitable for children.
Good toilet habits and toilet training and removal of fears associated with passing stools is important to prevent constipation in preschoolers.
Treating pregnant and breastfeeding mothers
Pregnant women are at a greater risk of constipation. The first method is to change the diet and lifestyle. Increased fibres and fluids in diet and more physical activity is advised.
If dietary and lifestyle changes do not work, a laxative may be prescribed. Laxatives that are safe to use during pregnancy include the osmotic laxatives lactulose and macrogols. When this fails a small dose of bisacodyl or senna may be prescribed. Senna is not advisable after 27 weeks of pregnancy (third trimester).
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)