Constipation
Constipation is when your stools (faeces) become small and hard, your visits to the toilet become less frequent and it takes more effort than usual to pass a stool. The process can often be painful.
It is important to realise that not everyone has a bowel motion every day – some people have one every second or third day, or sometimes longer. If your regular pattern changes, and the number of days between passing a stool increases, you may be constipated.
What causes constipation?
Common causes of constipation include:
Not eating enough fibre
Not drinking enough fluid
Lack of exercise
Pregnancy
Some medications
Not responding to the urge to go to the toilet or putting off going to the toilet.
Other possible symptoms
In addition to hard, small stools, other symptoms that may occur with constipation include:
Bloating
Headaches
Feeling generally unwell
Feeling a bit irritable or cross
Frequent passing of wind (flatulence)
Loss of appetite
Stomach cramps.
Some people who have been constipated for a long time may suddenly notice they have diarrhoea (very runny stools). This type of constipation can be harder to treat than normal so consult your pharmacist or doctor as soon as possible.
Haemorrhoids (piles) can also be a sign of constipation. These are when the blood vessels around your bottom become engorged with blood, usually as a result of straining too hard to pass a stool. If you notice bright red blood on your stools or toilet paper after going to the toilet, this may be a sign of haemorrhoids and you should speak to your pharmacist.
See Your Pharmacist or Medical Professional
If you have other medical conditions, take regular medication for any reason, are elderly or frail, or the person with constipation is a young child, you should always talk to a pharmacist. Also talk to a pharmacist if you:
Have constipation and vomiting together
Have lost weight for no apparent reason
Notice blood on your stools or after you wipe your bottom
Notice that your stools have changed colour or look black
Have an on-going problem with constipation or it gets worse
Have abdominal pain or constant bloating
Have tried laxatives (products for constipation) and they have not worked
Have diarrhoea and constipation either alternating or together
Have a fever (temperature above 38°C)
Have been constipated for more than seven days
Are pregnant or breastfeeding – some laxatives will not be suitable
Have allergies to any medicines.
Treatment Tips
You can reduce your chances of becoming constipated by:
Increasing the fibre content of your diet by eating lots of fresh fruit, vegetables, cereals and grains
Exercising regularly
Drinking at least six glasses of water a day
Not ignoring the "call to stool". Failing to respond to the urge to go to the toilet can result in constipation
Talking to your pharmacist if you need to take laxatives regularly. Some laxatives are safer than others when used on an on-going basis.
Treatment Options
Products used to treat constipation are called laxatives and are available as tablets, sachets, powders, granules, liquids, suppositories and enemas.
Most products need to be given regularly over a few days to work properly
It is important not to take more than the recommended dose of laxatives
If you are unsure about which product is best for you talk to your pharmacist.
To increase the bulk of stools
[GENERAL SALE]
e.g., Metamucil (sugar-free available), Mucilax (sugar-free available), Normacol (caution if you have diabetes), Normacol Plus (not suitable in pregnancy)
By bulking up the stool with fibre-like substances, water is drawn into the stool making it lighter and easier to pass
Safe to use long-term since they work like fibre, but may take 2-3 days to reach full effect
Drink plenty of water when taking these laxatives
Not suitable for people with bowel blockages or who are confined to bed.
To soften the stools
[PHARMACY ONLY]
e.g., Arrowcare Laxofast, Coloxyl, glycerin suppositories
Some softeners contain docusate which acts like a detergent, encouraging a mixture of dietary fat and water within the stool, allowing an easier passage through the bowel
Docusate takes effect after regular use of 1-3 days
Docusate can also be bought in combination with senna (a stimulant)
Glycerine suppositories lubricate the stools making them easier to pass.
To increase the fluid content of stools
[GENERAL SALE]
e.g., Movicol, Movicol-Half, Microlax microenema
[PHARMACY ONLY]
e.g., Duphalac, Lactulose, Laevolac
Movicol laxatives are powders, to be dissolved in water and drunk to increase fluid content of the stool. These usually work in 1-2 days
Microlax enemas and lactulose encourage water from the surrounding bowel to enter the rectal area
Duphalac, Lactulose or Laevolac can be mixed with water, fruit juice, lemonade or milk.
[PHARMACIST ONLY]
e.g., MoviPrep
MoviPrep is used for bowel cleansing prior to investigative colonoscopy
Not intended for routine relief of constipation
Use only under the direction of a doctor.
To stimulate the bowel to pass a stool
[PHARMACY ONLY]
e.g., Dulcolax, Senokot, senna plus softener (Coloxyl with Senna, Laxsol)
Directly stimulate the bowel to cause movement
Work quickly (usually within eight hours with suppositories working more quickly)
Usually recommended for short-term use only to return your bowel habit back to normal
Generally not recommended in young children and during pregnancy but please consult your doctor or pharmacist as some products like Coloxyl with Senna or Laxsol is considered safe in pregnancy (Category A).
Fibre supplements
[FOOD SUPPLEMENT]
e.g., Benefiber, Metamucil Fibersure
Useful as a fibre supplement for people with mild constipation or who are unable to eat fibrous foods
These products work after two to three days of regular use
Can be sprinkled on foods or in cooking without pre-mixing.
Natural/herbal products/supplements
e.g., psyllium husks, magnesium, chamomile
e.g., kiwifruit extracts (Phloe - capsules, chewable tablets, powder drink)
Psyllium hulls work like a bulk fibre laxative
Magnesium can help relax tension in the gut
Chamomile can aid in digestion and help relieve gas
Kiwifruit extracts contain prebiotics, enzymes and dietary fibre to aid bowel movement and function.
More Information
Availability of medicines
GENERAL SALE available through pharmacies and possibly other retail outlets.
PHARMACY ONLY available for sale through pharmacies only.
PHARMACIST ONLY may only be sold by a pharmacist.
Consumer Medicine Information on some medicines is available at the government website www.medsafe.govt.nz
