Constipation is generally treated with lifestyle changes and medication (laxatives).
Treating constipation at home
Follow these steps to find relief:
- Increase the fibre in your diet by eating more fruit, vegetables, legumes and whole-grain or bran products (see “Tricks to add more fibre to your meals” below).
- Eat more foods that have a natural laxative effect such as prunes and linseeds (flaxseeds).
- Add a bulking agent to your diet. Bulking agents such as bran and psyllium husk aren’t laxatives, but work by increasing the volume of stool and making it easier to pass. These products are safe to use and regular use makes them more effective. Always drink plenty of water when taking bulking agents.
- Drink plenty of fluids, especially water. Try to drink 6-8 glasses of water daily in addition to other beverages with meals. Try warm liquids, especially in the morning.
- Decrease your alcohol and caffeine intake. Caffeinated drinks include coffee, tea and colas. It’s a good idea to have an extra glass of water for every cup of coffee, tea or alcoholic drink.
- Exercise regularly. Aim for about half an hour every day. Exercise such as the knee-to-chest position may help activate bowel movements – spend about 10-15 minutes in this position, breathing in and out deeply. Increasing activity is especially important in the elderly.
- Don’t delay a bowel movement if you feel the urge to go, as this can worsen the constipation. Take your time in the bathroom, allowing yourself enough time to have a bowel movement without distractions and without feeling rushed.
- Try resting your feet on a low stool while going to the toilet, so that your knees are above your hips. This can make passing stools easier.
- If your child has rectal pain because he or she is unable to have a bowel movement, try adding 60ml of baking soda to a warm bath. The baking soda and the warmth may help relax the anal sphincter (the muscular valves that normally keep the stool inside the rectum) and thus help pass the stool.
Note: If you use any alternative remedies such as herbs, nutritional supplements, homeopathic remedies, acupressure or aromatherapy, you should keep your doctor informed. Always ask for medical advice before taking any over-the-counter medications or remedies.
A number of foods are a source of probiotics:
- Fermented milk (maas)
Probiotic supplements can also be used to alleviate constipation. In a meta-analysis of 14 studies, it was found that probiotics decreased “gut transit time” by 12.4 hours and increased the number of weekly bowel movements by 1.3. The probiotics seemed to soften stools, making them easier to pass. Probiotics that contained Bifidobacterium appeared to be the most effective.
Your doctor may recommend a laxative or stool softener if improvements in your diet, lifestyle and toilet habits don’t ease the constipation. These include:
- Bulk laxatives like Fybogel, which are usually the starting point for laxatives. They work by increasing the fibre content of the stool. When taking this type of laxative, you must drink plenty of fluids. It will usually be two to three days before you feel the effects.
- Osmotic laxatives such as Movicol help to increase the fluid content being drawn into the colon. This softens the stool, making it easier to pass them. Make sure you drink enough fluids. It usually takes two to three days before one feels the effect of the laxative.
- Stimulant or irritant laxatives (e.g. Senna) work by irritating the lining of the bowel, causing the intestines to contract and thereby speeding up the passage of faeces. Regular use isn’t recommended, as it damages the lining of the bowel and injures the nerve endings in the colon. This decreases tone and sensation in the large bowel, causing laxative dependence. Take these laxatives with water. They’re usually only used on a short-term basis, and they start to work within 6-12 hours.
- Stool softeners such as Dulcolax moisten the stool by drawing water into the intestines, thereby softening the stool. These softeners are often used in the long-term management of constipation. It may take a week or more for stool softeners to be effective. The dose should be increased after 1-2 weeks if no effect is seen.
- Lubricants such as mineral oils coat the stool, thereby preventing the removal of water from it. This results in a softer stool. These laxatives should only be used for short-term treatment as the oil can absorb fat-soluble vitamins from the intestine (which may lead to deficiencies). Mineral oils can also decrease the absorption of some medications such as warfarin and oral contraceptives, thereby compromising their effectiveness.
How long can you take laxatives for?
If you've had constipation for a short time, your GP will usually advise you to stop taking the laxative once your stools are soft and easily passed. However, if your constipation is caused by an underlying medical condition or a medicine you're taking, you may have to take laxatives for much longer, possibly many months or even years.
If you've been taking laxatives for some time, you may have to gradually reduce your dose, rather than coming off them straightaway. If you’ve been prescribed a combination of laxatives, you'll normally have to reduce the dosage of each laxative, one at a time, before you can stop taking them. This can take several months.
Your GP will advise you about when it's best to stop taking your laxatives. If you don't respond to laxatives, you may need a suppository or enema.
A suppository is inserted into the anus. It gradually dissolves at body temperature and is then absorbed into your bloodstream. Dulcolax is an example of a medication that can be given in suppository form.
Enemas are medicines in a fluid form that are injected through your anus and into your large bowel. Lenolax can be administered in this way.
Important: Don’t give laxatives or enemas to your child without talking to your health professional first. Children shouldn’t need an enema or a laxative to have a bowel movement.
Physical therapy can help if the muscles of your pelvic floor aren’t working properly. Physical therapy will help to strengthen and retrain the muscles. It will help the mind and body to connect, enabling the muscles to work properly when you’re having a bowel movement. Physical therapy can also help to decrease spasms.
Biofeedback therapy is often used for dyssynergic constipation. It’s used to restore the normal pattern of defecation through neuromuscular training using biofeedback techniques.
Biofeedback uses sensors and a computer to give you feedback about how your muscles and nerves are responding. Normally you’re not conscious or aware of this as it’s an automatic movement.
Biofeedback allows the individual with dyssynergic constipation to re-train their muscles to work more effectively and co-ordinated during a bowel movement.
Biofeedback teaches you:
- What is supposed to happen during the process of having a normal bowel movement.
- How to use diaphragmatic breathing to improve your ability to push out stool.
- How to relax the pelvic floor muscles during the process of defecation.
- How to improve the awareness of sensations regarding the need to have a bowel movement.
Botox (botulinum toxin) injections have been investigated as a treatment for dyssynergic defecation. However, studies have shown mixed results for its effectiveness, and faecal incontinence is a side effects that’s of concern. At this point, Botox isn’t a practical treatment option.
Surgery involving the puborectalis muscle (found within the pelvic floor) was used in the past as a way to resolve dyssynergic defecation. However, the risks of the procedure are quite high, and many patients experience ongoing post-operative problems of faecal incontinence. Therefore, surgery for dyssynergic defecation is no longer used as a form of treatment.
Talking to your child about constipation
Chronic constipation usually requires several months of treatment and co-operation among parents, the child, and the health professional. It’s important for you, as a parent, to talk openly to your child.
However, this can be difficult because children are often embarrassed about constipation and may avoid talking about the problem or even deny it. Children often refuse to use toilets at school and public places and tend to “keep it in”, which can cause further problems.
Don’t be discouraged if your child’s constipation recurs. As the rectum is a muscle, it becomes stretched in chronic constipation and might require several months to return to normal.
Diseases that affect the nervous system will not respond to the usual treatment for constipation and must be dealt with by specialists in these fields.
- A diet rich in fibre and with plenty of fluids will help, even if your child is being treated with laxatives.
- Children with long-term (chronic) constipation don’t usually have anything physically wrong with them. However, it can take time to correct the problem, so be patient.
- Encourage your child to have a regular toilet habit and allow them plenty of time.
- A reward chart for passing a stool can be useful if your child tends to “hold on”.
Tricks to add more fibre to meals (for children and adults):
- Add ground flaxseed to oats, smoothies, yoghurt and baked goods. You can use it to coat chicken or fish (2 tbsp contains 3.8g of fibre).
- Chia seeds have 5.5g of fibre per tablespoon. When they’re soaked in water, they form a gel that’s great for thickening smoothies, making healthy puddings, or replacing eggs when making cakes and biscuits.
- Spinach and carrots can easily be sliced or grated and “snuck” into many dishes without much hassle. Try adding these vegetables to banana bread, shakes, eggs or even homemade pizza bases.
- Purée some cooked vegetables and add them to sauces and stews.
Reviewed by Kim Hofmann, registered dietitian, BSc Medical (Honours) Nutrition and Dietetics, BSc (Honours) Psychology, December 2017.