Greater Knox Pharmacy
Monday | 8am - 7pm |
Tuesday | 8am - 7pm |
Wednesday | 8am - 7pm |
Thursday | 8am - 7pm |
Friday | 8am - 7pm |
Saturday | 8am - 2pm |
Sunday | Closed |
The colon’s main job is to absorb water from residual food as it’s passing through the digestive system.
The colon’s muscles eventually propel the waste out through the rectum to be eliminated. If stool remains in the colon too long, it can become hard and difficult to pass.
Although the normal frequency of bowel movements varies from person to person, about 95% of healthy adults have a pattern that ranges from three times a day to three times a week.
In constipation, bowel movements either occur less often than expected or the stool is hard, dry and difficult to pass.
Constipation may be considered chronic if you've experienced two or more of these symptoms for the last three months.
Signs and symptoms of chronic constipation include:
See your doctor if you have any of the following:
Diagnosis is generally made based on symptoms and duration. The doctor may also do a physical examination and order some tests to be able determine the cause of constipation. These tests may include:
The action of hormones, reduced activity and the pressure of the growing uterus against the intestines mean that constipation is common during pregnancy.
Constipation is more common in the elderly. This is due to a number of factors, including reduced intestinal muscle contractions and reliance on regular medications.
There isn’t enough data to compare effectiveness and tolerability between laxatives. Drug choice may be based on symptoms, required onset of action, hardness of stool, personal preference, adverse effects, effectiveness of previous treatments and cost.
Some simple measures that can alleviate and prevent constipation include:
A stepped approach can also be used. Start with a bulk forming laxative (with adequate fluid intake), then add or switch to an osmotic laxative if inadequate (especially if stools remain hard). Stimulant laxatives are used if colon motility is poor (e.g. from opioids), otherwise they are reserved as a second-line option (if stools are soft but difficult to pass). Adjust dose and choice of laxatives according to response.
Dietary and lifestyle changes are preferred. If inadequate, bulk forming laxatives may be given to supplement fibre intake. Docusate, lactulose and sorbitol are safe to use; consider if stools remain hard. If these are ineffective, use an occasional dose of macrogol laxative; avoid stimulant laxatives.
Start laxatives when beginning opioid analgesia. If a patient is already taking laxatives, monitor and adjust or add laxatives if needed. Agents of choice include either a stimulant laxative combined with a stool softener or an osmotic laxative
Do not use bulk-forming laxatives and be cautious if increasing dietary fibre (increasing bulk may worsen constipation, particularly if the patient is dehydrated or immobile).
For resistant cases or established opioid-induced constipation use:
Constipation can occur from a high-fibre diet if insufficient water is consumed.
There are two broad types of fibre; soluble and insoluble. Soluble fibre helps to soften the faeces. Good sources of soluble fibre include legumes, fruits and vegetables. Insoluble fibre adds bulk to the faeces, helping it to move more quickly through the bowel. Good sources of insoluble fibre are in wheat bran, wholegrain breads and cereals.
Aim for 18-30g per day, and make sure to get enough water (6-8 glasses per day for most people).
Other points to consider:
Brand | Ingredients | Form | Onset of action | Pregnancy | Breastfeeding |
---|---|---|---|---|---|
Metamucil | Psyllium | capsules, powder | 2-3 days | Safe | Safe |
Fybogel | Ispaghula | granules | 2-3 days | Safe | Safe |
Normacol Plus | Frangula bark, Sterculia | granules | 2-3 days | Not recommended | May be used |
Normafibe | Streculia | granules | 2-3 days | Safe | Safe |
Glycerol can be used for rapid relief of constipation when stool is present in the lower rectum.
Lactulose and sorbitol need to be taken regularly. They are not suitable for acute relief of constipation as they can take several days to have an effect.
Macrogol laxatives may contain electrolytes to minimise electrolyte and water loss. They may take several days to have an effect. Use with caution in people with heart Failure or Renal Impairment.
Saline laxatives contain poorly absorbed ions such as magnesium, phosphate, sulfate and citrate. They have a fast onset of action and are suitable for occasional use when rapid bowel evacuation is required. There is a risk of electrolyte disturbance, particularly in the elderly, children and patients with renal impairment or cardiovascular disease. Phosphate-containing laxatives should not be used in the elderly.
Brand | Ingredients | Form | Onset of action | Pregnancy | Breastfeeding |
---|---|---|---|---|---|
Actilax, Dulose, Duphalac | Lactulose | Oral Liquid | 1-3 days | Safe | Safe |
Movicol, Osmolax | Macrogol 3350 | Powder | 1-3 days | Limited data | Safe |
Epsom Salts | Magnesium Sulfate | Powder | 1-3 days | Limited data | Safe |
Microlax | Sorbitol, Sodium Citrate, Sodium Lauryl Sulfoacetate | Enema | 2-30 minutes | Safe | Safe |
Fleet | Sodium Phosphate | Enema | 2-5 minutes | Limited data | Safe |
Glycerol | Glycerol | Suppository | 5-30 minutes | Safe | Safe |
Stimulant laxatives tend to be reserved for opioid-induced constipation (below) or severe constipation unresponsive to bulk-forming laxatives or osmotic laxatives. They are usually given at night to help produce a bowel action the following morning. Short-term use is preferred, although they may be used long term in spinal damage, chronic neuromuscular disease and in people taking opioids.
Brand | Ingredients | Form | Onset of action | Pregnancy | Breastfeeding |
---|---|---|---|---|---|
Dulcolax, Bisalax, Lax-Tab | Bisacodyl | Tablets, suppositories, enema | 6-12 hours (oral), 15-60 minutes (supp), 5-15 minutes (enema) |
Avoid | May be used. Monitor infant |
Senokot, Laxettes | Senna | Tablet | 6-12 hours | Avoid | May be used. Monitor infant |
Coloxyl & Senna | Docusate + Senna | Tablet | 6-12 hours | Avoid | May be used. Monitor infant |
Dulcolax SP Drops | Sodium Picosulfate | Drops | 6-12 hours | Avoid | May be used. Monitor infant |
May be used to treat constipation (usually combined with a stimulant or osmotic laxative), prevent straining after rectal surgery and in patients with anal fissures or haemorrhoids.
Brand | Ingredients | Form | Onset of action | Pregnancy | Breastfeeding |
---|---|---|---|---|---|
Coloxyl | Docusate | Tablets | 1-3 days | Safe | Safe |
Parachoc | Liquid Paraffin | Liquid | 2-3 days | Limited data | Safe |
Coloxyl Drops | Poloxamer | Liquid | 2-3 days | Unknown | Unknown |