Constipation

Fibre (roughage) is the part of plant food that is not digested. Fibre adds bulk and some softness to the stools. Increasing the fibre in your diet may take a few days or even a few weeks to work. You may find that if you eat more fibre, you may have some bloating and wind at first. As your gut becomes used to extra fibre, the bloating or wind tends to settle. So if you are not used to a high-fibre diet, it is best to increase the amount of fibre gradually. Aim for 30 g of fibre per day. Remember to drink plenty when you increase the fibre in your diet. Rarely, the guts can develop a blockage if too much fibre is eaten without enough fluid.

Aim to drink at least two litres (about 8-10 cups) of fluid per day. You will pass much of the fluid as urine but some is passed out in the gut and softens the stools. Most sorts of drink will do, other than alcoholic drinks, which can lead to a lack of fluid in the body (dehydration). As a start, try just drinking a glass of water 3-4 times a day in addition to what you normally drink.

Sorbitol is a naturally occurring sugar. It is not digested very well and draws water into the gut, which has an effect of softening the stools. So, you may wish to include some foods that contain sorbitol in your diet. Fruits (and their juices) that have a high sorbitol content include apples, apricots, gooseberries, grapes (and raisins), peaches, pears, plums, prunes, raspberries and strawberries. The concentration of sorbitol is about 5-10 times higher in dried fruit. Dried or semi-dried fruits make good snacks and are easily packed for transport – for example, in a packed lunch.

Keeping your body active helps to keep your gut moving. It is well known that disabled people, and bed-bound people (even if just temporarily whilst admitted to hospital) are more likely to become constipated.

Do not ignore the feeling of needing the toilet. Some people suppress this feeling if they are busy. It may result in a backlog of stools which is difficult to pass later. When you go to the toilet, it should be unhurried, with enough time to ensure that you can empty your bowel.

When mobility is limited – for example, in people who are frail or who have dementia – it is important for carers to see that they have sufficient help to get to the toilet at the time they need to go; also, that they have a regular, unhurried toilet routine, with privacy. As a rule, it is best to try going to the toilet first thing in the morning or about 30 minutes after a meal. This is because the movement (propulsion) of stools through the lower bowel is greatest in the mornings and after meals (due to an effect called the gastrocolic reflex).

Positioning on the toilet is also important, especially for elderly people with constipation. Western-style toilets actually make things more difficult – squatting is probably the best position in which to pass stools. Putting a small footstool under your feet is a simple way to change your toilet position to aid the passage of stools. Relax, lean forward and rest your elbows on your thighs. You should not strain and hold your breath to pass stools.

Laxatives are the medicines most commonly used for constipation. Treatment with a laxative is needed only if the lifestyle measures above do not work well. It is still worth persisting with these methods, even if you end up needing to use laxatives.

For short-term uncomplicated constipation, you may even choose to treat yourself (without visiting the GP) by buying laxatives in the pharmacy or supermarket. In short-term constipation, laxatives can be stopped once the stools (faeces) become soft and easier to pass. You should probably visit your GP if you are struggling to manage short-term constipation yourself, or if you have longer-term (chronic, or persistent) constipation.

Chronic constipation can be more difficult to treat. Laxatives are usually needed for longer periods (sometimes even indefinitely) and they should not be stopped abruptly.

There are four main groups of laxatives that work in different ways. You can read about laxatives, the different types and when they are used, in the The laxative recommended by your doctor or pharmacist will depend on factors such as your own preference, the symptoms of constipation that you have, possible unwanted effects, your other medical conditions, and cost. You should use a laxative only for a short time, when necessary, to get over a bout of constipation. Once constipation eases, you should normally stop the laxative.