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Clearing the Colon: A Guide to Constipation Management

Edited by Claire Butler


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Whether we like to admit it or not, constipation is a problem we all go through at some point in our lives. When your bowel movements are infrequent or difficult, it is not only uncomfortable but can lead to other issues such as hemorrhoids, anal fissures, and intestinal blockages. Luckily, there are many ways to treat constipation, some as simple as lifestyle changes, or for more stubborn cases, medications.



What causes constipation?


Constipation can be caused by many different factors including lifestyle, certain medications and medical conditions. Constipation tends to be more common in females and individuals over the age of 65. In terms of lifestyle, having a low-caloric intake, lack of fibre (fruits and vegetables) in your diet, travel and inactivity can contribute to developing constipation. Constipation is a common side effect of many medications, including opioids, antidepressants, and diuretics (“water pills”). Medical conditions such as pregnancy, Parkinson’s disease, thyroid disorders, and depression can also lead to constipation.



What are the symptoms?


Constipation is typically defined as having less than 3 bowel movements per week. Other symptoms that present with constipation include bloating, straining, abdominal discomfort, and the sensation of incomplete voiding and blockage. Stools that are hard and lumpy are a sign of constipation as they move more slowly than regular stools, making them more difficult to pass through the bowel. Constipation can either be acute, where the symptoms last less than 3 months, or chronic, where symptoms occur for more than 3 months.



How can I manage the constipation?


Constipation can be treated with simple lifestyle changes. Firstly, do not ignore the urge to defecate. If needed, placing a footstool in front of the toilet may help to position the pelvis to allow for easier defecation. Further, increasing your daily physical activity can stimulate the bowels, making stools easier to pass. Dietary adjustments to help with constipation include increasing your dietary fibre intake and fluid intake; this can add weight to the stools, decreasing the time it takes for them to pass through the bowels. Some examples of fibre-rich foods include beans, chickpeas, lentils, blackberries, avocados, raspberries, and nuts.


There are also medications which can be used to treat constipation. These include bulk-forming laxatives, emollients, osmotic laxatives, and stimulant laxatives.


Bulk forming laxatives such as psyllium (Metamucil) are fibre-based and add weight to the stools, putting stress on the bowel walls to stimulate motility. You can find these on the shelf at your pharmacy without a prescription. These should be taken with at least 1 cup of fluid. Effects can typically be seen within12-72 hours.


Emollients such as docusate sodium (Colace) may soften the stool by allowing watery and fatty substances to be mixed in with the stool. However, these agents do not have as much evidence compared to other options and are not typically recommended.


Osmotic laxatives such as polyethylene glycol (Restoralax, Lax-A-Day) and lactulose keep water inside the intestines. The increased pressure inside the intestinal wall helps to stimulate bowel movements. Osmotic laxatives take up to 24-72 hours for effects to be seen when taken orally, but more rapid results can be achieved when taken rectally. Glycerin suppositories are also considered osmotic laxatives, and when inserted rectally, work within 15-30 minutes. Osmotic laxatives can also be purchased without a doctor’s prescription. Talk to your pharmacist to see if these are the right option for you.


Stimulant laxatives such as senna (Senokot) and bisacodyl (Dulcolax) induce muscle contractions in the intestines to stimulate bowel movements. Their effects can be seen in 6-12 hours and are usually taken at bedtime to produce a bowel movement the morning after. Bisacodyl is also available as a suppository for more rapid results. Speak to your pharmacist to determine the best option for you.



When should I see a doctor?


You should consult your doctor if you have not had a bowel movement for 7 days or if your symptoms do not improve after 2 weeks of using over-the-counter medications or laxatives. Some signs that you should see a doctor earlier include constipation in children under 2 years of age, blood or mucus in the stool, severe pain when defecating, or constipation with vomiting and/or fever.



Constipation is a common ailment that is manageable with lifestyle changes and over-the-counter medications. For lifestyle tips on how to manage constipation or advice on which laxatives are safe for you to use, speak with your local community pharmacist!



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References

  1. Bowles-Jordan, J. Consitpation. In: Compendium of Therapeutics Choices. Canadian Pharmacists Association. Updated September 26, 2018. Accessed August 5, 2022. https://www.myrxtx.ca/

  2. Wald, A. Management of chronic constipation in adults. In: UpToDate. UpToDate. Updated June 3, 2022. Accessed August 5, 2022. www.uptodate.com

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