How To Relieve Constipation

When the cause for the constipation is identified, it is treated with applicable medication. Any drugs known to have the side effect of causing constipation are stopped or substituted by more suitable ones.

Prevention is always better than cure and in the case of constipation; the best way to prevent it is by leading a healthy life style with adequate physical exercise, sufficient intake of water and other liquids and the inclusion of fiber-rich items in the diet. When bed rest is required due to any reason or when a person is taking a drug which precipitates constipation, laxatives, dietary supplements of fiber, and increased fluid intake, should be incorporated to preempt constipation.

 How To Relieve Constipation..The 3-prong approach to relieve constipation includes:

  • Lifestyle changes
  • Use of laxatives
  • Enemas

Life style changes:  they are mainly aimed at preventing constipation rather than curing it. Life style changes which help avoid constipation include changes in the diet, bowel habits and the level of physical activity.

Consumption of at least fifteen to twenty grams of dietary fiber and adequate quantity of water and other liquids help in the formation of bulky and soft stools. Fruits and vegetables are the most common sources of fiber but supplements of fiber taken along with food also may help. Sprinkling unrefined bran on other foods add to the fiber content. It is very important to drink plenty of water while taking extra fiber.

Moving about, as opposed to a sedentary lifestyle, helps avoid constipation. With reduced physical activity, the movements of the digestive tract also become sluggish. Regular exercise is not only good for health but also for avoiding constipation.

Developing the habit of having a bowel movement at the same time and at regular intervals helps in avoiding constipation. Many people have a natural urge to empty their bowels within an hour of breakfast because more food entering the digestive tract stimulates peristalsis. However, the bowels of different people work at different rates and it is not necessary to have motion every day. Frequent use of laxatives because of the obsession to have daily movements interferes with the natural rhythm of a person’s bowel cycle. Laxatives should not be used unless at least three days have passed since the previous defecation.

Laxatives: There are different types of laxatives for preventing constipation and for treating it. Some are safe for prolonged use while others are for occasional use only.

 The following are the different classes of laxatives:

  • Bulking agents
  • Stool softeners
  • Osmotic laxatives
  • Stimulant laxatives

Bulking agents add body and volume to stool by absorbing and retaining water. The bulk induces the intestines to contract and relax moving the stool down the tract. The improved open texture of the stool makes it soft and facilitates smooth movement. The fiber contained in vegetables and which is supplied by bran and psyllium husk act as bulking agents which facilitates regular bowel movements. The use of bulking agents is a safe way to avoid constipation. It is necessary to drink plenty of water while taking the bulking agents as they have the tendency to draw water from the body and retain it, to be eliminated with stool. There are a few side effects though, such as bloating and flatulence or passage of gas. Excess fiber prevents the absorption of certain micronutrients too.

Stool softeners include mineral oil and docusate which are used for softening stools, making them easy to pass. Bulk is also increased resulting in better peristaltic movements which help push the stool along the way. The softened stool, though easy to pass may be disagreeable to some people. However, stool softeners are especially beneficial to avoid straining, in those who have hemorrhoids and those who have undergone abdominal surgery recently.

Osmotic laxatives work by drawing water into the large intestine, softening and making the stool loose. The increased fluid content in the large intestine results in better peristalsis, accelerating the movement of stool along the way. The usual osmotic agents are poorly absorbed sugars and salts such as lactulose, magnesium salts and phosphates. Osmotic laxatives are comparatively safe for use for most people. However, it is contraindicated for people with kidney disease as it causes fluid retention. Those who have heart failure also should avoid them because the phosphate and magnesium content in them gets absorbed into the bloodstream, which is harmful to people who take heart failure drugs such as [ACE] inhibitors, angiotensin II blockers and diuretics which affect kidney function. Rarely, kidney failures have been caused by laxatives containing sodium phosphate, when orally administered prior to colonoscopy or x-rays.

Stimulant laxatives are those which cause irritation to the intestinal walls causing them to contract with force, pushing the contents faster along the way.  Bisacodyl, phenolphthalein and anthraquinones are stimulant laxatives. They may contain irritating substances like cascara and senna.  Stimulant laxatives are beneficial in avoiding constipation when people are taking drugs such as opioids which usually result in constipation. They are also used for quick emptying of the large intestine prior to tests and surgery.

Oral administration of stimulant laxatives become effective in about six to eight hours and often produce a semisolid bowel movement which is usually accompanied by cramping. When used as suppositories, these drugs work much faster, usually in fifteen minutes to an hour. A condition termed melanosis coli, characterized by the deposit of an abnormal dark-colored pigment on the walls of the large intestine, results from extensive use of stimulant laxatives. Excess loss of essential salts from the blood and allergic reactions are other side effects. Lazy bowel syndrome may develop due to the dependency of the large intestine on stimulant laxatives. Hence, they have to be used judiciously and for short periods. Bisacodyl is an effective drug for chronic constipation.

Natural substances which aid in easy bowel movements such as anthraquinones are found in aloe, senna, sagrada, rhubarb and cascara. They are usually incorporated into   many of the herbal laxatives available over-the-counter. The drug lubiprostone is a laxative which is safe for use for prolonged periods and its action is by inducing extra fluid secretion from the large intestine, resulting in smooth passage of stools.

Enemas: They are used to flush out the rectum and sometimes the lower part of the large intestine as well. Usually, slightly warmed plain water is used. It is pushed into the rectum via the anus using a squeeze ball. Ready- made squeeze bottles with a fixed volume, usually five to ten fluid ounces or 150 to 300ml, are available at pharmacies. But for older people with enlarged rectum, it may not be sufficient, in which case, an enema bag is used to administer larger volumes. Enemas should be administered gently and cautiously, as forceful pumping can be dangerous. The water flushes out the stool, in a bowel movement that would soon follow the enema.

Addition of certain substances to the enema water is a common practice but whether it increases the effectiveness of enema, is doubtful. Soapsuds enema contains soap which is supposed to have the effect of a stimulant laxative. Mineral oils, phosphates and other salts are often added to commercially available enemas.

Colonic enemas are rarely used when people have a condition called obstipation, which is a very severe form of constipation. A large volume of enema is administered to flush out the contents even from the last part of large intestine called colon. It is not a general medical practice but it is often used in alternative medicine. Additives such as tea or coffee are also included in the enema solution but whether it is dangerous or beneficial, is still not proven.

The use of laxatives and enema can cause cramps, dehydration, diarrhea and eventually an addiction to the laxatives. People with inflammatory bowel disorders, gastrointestinal bleeding and obstructions in the intestines should not use laxatives or enemas.

Fecal impaction: This condition does not improve with any of the general measures such as increasing the fiber content in the diet, administering oral laxatives or using suppositories. The initial treatment is with warm water enema; it may be followed by medicated enemas. If these measures do not give the desired results, the hard stool causing obstruction requires to be removed manually with a gloved finger. This is generally performed under local anesthesia or sedation. An enema afterwards helps to clear the rectum of all the accumulated waste.

Essentials for Older People

Enlargement of rectum is a common occurrence as the years go by, and the larger size of the rectum in older people result in greater volume of stool being collected there, before the urge to defecate is felt. This increased collection of stool becomes hard on compaction and makes bowel movements difficult. Many of the drugs used by older people for the common age-related ailments have the side effect of slowing down bowel movements. Reduction in physical activity, diets low in fiber content, greater incidence of diabetes and Parkinson’s disease, all contribute to increased constipation among older people. Misuse of laxatives is also rampant among the old because of the misconceptions regarding bowel movements.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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