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10/25/2008 - by Dr. Mark Porte
  
Chronic Constipation

Just over half of visitors to the online treatment advisor report that they are troubled by constipation at least once a week, with just over a third of saying they suffer on a daily basis. Yet rather surprisingly most choose to do nothing about it other than take steps to increase the fibre in their diet, and even then only a minority even try that. The obvious conclusion being that the majority of people with ongoing constipation do little or nothing about it, and therefore continue to suffer unnecessarily.

While anyone of any age can be troubled by constipation, research 1 shows that there are two groups most likely to be affected - women and the middle-aged and elderly. Women are more prone to constipation because their bowels work at a slightly slower rate than men, a difference that is accentuated by the hormones associated with pregnancy (as many as 1 in 3 women have problems with constipation during pregnancy 2).

The middle-aged and elderly - both men and women - are more likely to suffer for a number of reasons. Our bowels tend to become more sluggish as we age; older people tend to be more sedentary (being active is thought to help the bowel work efficiently); and they are also more likely to be taking medication - such as codeine-containing painkillers and some drugs used to treat high blood pressure - that list constipation among their side effects.

Whatever the underlying cause, recurrent or ongoing constipation can be unpleasant and worrying. As well as making going to the loo difficult, sufferers report symptoms as diverse as pain, bloating and back ache, to feeling tired, irritable, depressed and unable to concentrate. Recognised medical complications including piles, diverticular disease, and anal fissures (tears of the delicate lining of the anus).
The key to managing recurrent constipation is to take a stepwise approach - doing nothing and hoping it will go away rarely works!

Step one. should be to try and increase your fibre intake to 30 grams a day (nearly twice the recommended daily intake). Your practice nurse should be able to provide you with a leaflet detailing the fibre content of common foods but as a rough rule of thumb you should increase your intake of fresh fruit and vegetables (leaving the skin on where possible), and eat a portion of high fibre cereal (bran based) every morning.

Step two. If you find it difficult to increase your intake of fibre-rich foods then consider a fibre-based drink or constipation remedy - ask your pharmacist. - but whichever approach you take remember to drink plenty of fluid. Fibre needs fluid to help the bowel work effectively and if you are not drinking enough your body will take fluid from the bowel making your stools firmer, harder and more difficult to pass. Aim for an intake of at least 2 litres a day - any type of nonalcoholic drink, including tea and coffee will count towards this total.

Step three. If increasing the amount of fibre and fluid in your diet doesn’t help then consider a gentle laxative (such as senna) to stimulate bowel movements This doesn’t have to be taken on a daily basis but should be kept to hand for use when you find it difficult to go to the loo - and remember it’s not so much how often you go that matters, as how easy it is to open your bowels when you do. Don’t become obsessed with having your bowels opened on a daily basis, it is quite normal for some people to only go 3 - 4 times a week, and that doesn’t matter as long as their stools are soft and easy to pass. Your pharmacist will be able to advise you on the different types of laxative available and recommend one that fits your particular needs.

Step four. If the above measures fail to control your constipation you should arrange to see your GP for more detailed advice, and an examination that may include blood tests to look for contributory causes such as an under-active thyroid.

Constipation is rarely a sign of any serious underlying problem, and it is perfectly alright for most people to self-medicate with over-the-counter remedies, but there are exceptions so check out Should I see my doctor? if you are uncertain about the significance of your symptoms.