A guide to managing constipation

[Pages:32]A guide to managing constipation

Information for patients Sheffield Teaching Hospitals

PROUD TO MAKE A DIFFERENCE

SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST

Purpose of this booklet

The purpose of this booklet is to help you prevent, manage or recover from constipation. You will discover:

? What constipation is (page 2) ? How it can be helped through eating the right foods and drinking

enough fluid (page 8) ? The best use of laxative medication to help manage and prevent

constipation (page 20) ? The benefit of exercise and movement (page 24) ? How to sit on the toilet in a way that will help most (page 26)

What is constipation?

To help understand constipation it is first useful to understand how the gut (also known as the gastrointestinal tract) works.

Everything you eat and drink travels from your mouth, through the digestive system to the anus. The gastrointestinal tract (GI) includes the mouth, oesophagus, stomach, small intestine and large intestine (or colon). The colon is about 1.5 metres long and forms the last part of the GI tract.

Food that has not been digested further up the tract is collected in the colon, water is removed from it and it forms `stools' or `faeces'. It is these stools that result in bowel movements or passing faeces out of the anus.

The movement of food through the whole digestive system happens through wave-like contractions called peristalsis. This happens naturally. Everyone will open their bowels at different times and at different amounts during a week. Some people will open their bowels 3 times a day whilst others will open them 3 times a week. Some people may only open their bowels once per week without feeling unwell in any way.

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Mouth Oesophagus

Stomach Pancreas

Large intestine (Colon)

Small intestine

Anus

Rectum

Constipation can occur when peristalsis is not working as quickly or as strongly as normal. This can result in you not passing a stool as often as you do normally, or having to strain hard to pass a stool, or not completely emptying your bowels.

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Constipation could be a short-term problem or can become a chronic, longer term problem, particularly if left untreated. A doctor would describe you having constipation if:

? You open your bowels less than three times a week ? Need to strain more than 25% of the time you go to the toilet ? Pass hard or pellet-like stools more than 25% of the time

Some people will feel bloated with constipation. This is when there is a general feeling of swelling around the abdomen area. This may cause clothes to feel tight.

It is important to see your GP if your constipation or bloating has not resolved in three weeks, or you are getting regularly constipated and it is lasting a long time. If you have blood in your stools, are unexpectedly losing weight or are feeling tired all the time then it is important to not ignore these symptoms and to discuss them with your GP.

Who is affected by constipation?

Constipation can affect people of any age. It is more common in women; about 40% of pregnant women will experience some form of constipation during pregnancy. Older people are also at a higher risk. This is usually due to a less active lifestyle and medication. Most of us will suffer from constipation at some time in our lives, and brief periods of constipation are not a concern.

Common causes of constipation include:

? Not eating enough fibre from fruit, vegetables and cereals ? Not drinking enough fluids ? Ignoring the urge to pass a stool ? Not having enough time to go to the toilet properly ? Lack of exercise ? A change in routine ? Being under or overweight

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? Depression ? Pregnancy and childbirth ? Certain medications such as pain killers, antidepressants, blood

pressure tablets, diuretics (water tablets), iron and calcium supplements and certain antacids (medicine to treat indigestion). Other less common causes can include: ? Previous surgery to, or trauma to, your anus (back passage) ? The muscles around your anus tightening or spasming rather than relaxing when you go to the toilet ? Growths or areas of narrowing in the bowel ? There are also some other more rare causes of constipation which your consultant will discuss with you if they affect you. Are there any complications from being constipated? When food remains in your bowels it will become drier and drier (becoming hard and lumpy) and becomes more difficult to pass.

Hard and lumpy Smooth and soft

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The consequences of constipation include:

? A great deal of pain and discomfort. It can make you feel sluggish, bloated and can affect your appetite.

? You may also notice blood after you have opened your bowels, especially if you have had to strain.

? If severe it can cause an impaction, which are hard and lumpy stools in the rectum. This can be seen in the diagram on page 5. `Overflow' can then happen, where newer stools have to squeeze and leak past the impaction. This can cause very watery stools and faecal incontinence. If this happens it is important not to think this is your constipation resolving. Overflow can be a particular problem if you are older or immobile and need to strain.

What is chronic constipation?

Chronic constipation is when constipation has been occurring for a long time. This can increase the risk of additional problems.

? Haemorrhoids or piles (swollen blood vessels in your rectum) ? In rare cases stools can block your bowels (faecal impaction) and

can cause abdominal pain, and very rarely lead to confusion. ? Urinary incontinence. If you have to strain to open your bowels it

can weaken your pelvic floor muscles. These muscles control the opening of the urethra (tube that takes urine out of your body from the bladder) and rectum. Because of the weakened pelvic floor muscles you may have less control of when you pass urine. ? If you have hard stools in your rectum there will be increased pressure on the urethra. This can make your bladder empty too early or prevent you from being able to pass urine.

Any constipation lasting longer than 3 weeks should prompt a visit to your GP. If blood appears in your stool you should see a GP straight away.

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What can I do if I am constipated? There are a number of changes you can make to your diet and lifestyle that can help reduce the symptoms of constipation and prevent them happening again. This is recommended as the first treatment for constipation. It is important to remember that everyone is different and some things work better for different people. In many cases, lifestyle changes will improve your constipation without the need for medication. The rest of this booklet will describe some self help changes you may be able to make.

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Diet and constipation

Eating regularly is the best natural stimulant for your bowels. Skipping meals, especially breakfast, can lead to a sluggish or irregular bowel habit. The body has a natural 'gastrocolic' reflex. This natural reflex often occurs after eating and will make you want to go to the toilet. It can be considered as the body making room for more food and fluid. This reflex is often stronger in the morning. By having breakfast with a warm drink, you can stimulate the body's natural response further and promote the movement of stools through the colon, called peristalsis, and stimulate a bowel movement.

Contrary to popular belief, a very high fibre diet is not always best for constipation. Regular meals containing adequate fibre and a good fluid intake is the aim.

Fibre

Fibre is food that comes from plants that your body cannot easily digest. It therefore passes through the gastrointestinal tract into the colon and forms the bulk of the stool. Foods that contain fibre are vital for the health of the colon. The presence of faeces in the colon will stimulate the peristalsis required to move it through to the rectum. There are two types of fibre that can affect the bowels. They are called soluble and insoluble fibre.

Soluble fibre

Soluble fibre dissolves in water within the bowel to form a soft gel-like substance. The natural bacteria in the bowel then breaks down the gel to produce gases such as hydrogen, methane and chemicals known as short chain fatty acids (SCFA). SCFA are essential for bowel health. Soluble fibre acts as a prebiotic, which supports the growth of so-called `good-bacteria' within the bowel.

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