Friday, 25 November 2011

Battling Constipation: Treatments

I have battled constipation all my life.  That’s the reason that prompted me to come up with a blog entry that discusses all about constipation, what it is, its  symptoms, and causes (see Battling Constipation : Knowing About It)  Alternative medicines, natural home remedies, medical prescriptions, name it, I have used and taken a few of them.  I grab whatever I can get hold of that will relieve me from constipation.  I have been consulting doctors, yes, mostly general practitioners and some are specialist (gastroenterologist) about my constipation problem.  In fact I am now on laxative and some other medication because my constipation is worsening and I still need to undergo some tests so that my gastroenteroligst would be able to rule out the probable cause/s of my annoying constipation.

This entry aims to provide an overview and information on the possible treatments for constipation, both long term and short-term.  Most doctors would advise their patient to undergo dietary and lifestyle changes first before they prescribe any further medication or more radical treatment should it be needed.  This general dietary and lifestyle guidelines will help relieve the symptoms of constipation and prevent it from recurring. Please understand that treatments depends on the cause/s, severity, and duration of constipation.  These recommendations and treatments are based on the advices and recommendations of the doctors and specialist with whom  I/we have consulted and also based on our researches:

DIETARY & LIFESTYLE CHANGES

1. Drink water and stay hydrated –  Doctors advised me to drink at least 8 glasses of water or other liquids a day (1 glass = 250 ml) but others specially those having health conditions would be needing either less or more of liquid per day.

As per the Institute of Medicine’s Food and Nutrition Board, women consume 91 ounces (2.69 L) of water each day from beverages and foods; men need to consume 125 ounces (3.7 L)  daily (source : http://www.webmd.com/ )

Drinking water or other liquid does not really cure constipation but it will helps keep the feces soft and easier to pass

2. Load up on Fiber –  Eat food like cereals, grains, fruits and vegetables that are high in fibers.  By fiber, it means dietary fiber, the  edible parts of plants that  cannot be digested  Fiber adds bulk to the feces making them softer and easier to pass and It also speeds up the digestive process

For women at my age level (31-50) we need at least 25 g. of fiber a day, while our male counterpart needs 31 g. per day.  See my post on Recommended Dietary Allowance  for the amount of dietary fiber intake needed per day depending on the gender and age of an individual.

3. Slow down on the meat, milk, cheese, and also white rice specially those who have irritable bowel syndrome (IBS). These foods tend to contribute to constipation.

4. Exercise daily -  Sedentary lifestyle is one cause of constipation and other diseases. Dr. Kong San Choon Chris, the gastroenterologist at SGH, which I have consulted recently regarding my abdominal pain, recommended that we do regular exercises like aerobic exercise at least 30 minutes a day.  The best exercise he recommended is swimming (20 + lapse per hour).

Exercise helps constipation by decreasing the time it takes food to move through the large intestine, thus limiting the amount of water absorbed from the stool into your body. Hard, dry stools are harder to pass. In addition, aerobic exercise accelerates your breathing and heart rate. This helps to stimulate the natural contraction of intestinal muscles. Intestinal muscles that contract efficiently help move stools out quickly. (source : Exercise to ease constipation - webmd.com )

5. Visit the toilet regularly. Schedule a time in the day to do your bowel movement and allocate enough time to do it. Make this a routine on a daily basis.  Also, DO NOT suppress urges to defecate. When the urge comes, find a toilet.

6. Live a stressful life - one of the questions Dr. Kong asked me which at first I thought was ridiculously absurd is if I am pressured and stressed (physically and mentally) in my job or in any other aspect in my life.  He explained that stress most of the time causes constipation as well as diarrhea.  So he suggest that I have to relax and de-stress if possible.

7.  Check your current medications with the help of your doctor.  Some medications (painkillers, diuretics, anti-depressants, antacids, etc.) and treatments for other medical conditions may be causing you to be constipated.  Ask for alternatives.  If there are no alternatives, the doctor will give you something to relieve your constipation like laxatives.  Check your multivitamins. Calcium or iron supplements can cause constipation.

MEDICAL PRESCRIPTIONS & TREATMENTS

1. Laxatives – but it should be prescribed and under the supervision of your doctor.
Most people who are mildly constipated do not need laxatives. However, for those who have made diet and lifestyle changes and are still constipated, a doctor may recommend laxatives or enemas for a limited time. These treatments can help retrain a chronically sluggish bowel. For children, short-term treatment with laxatives, along with retraining to establish regular bowel habits, helps prevent constipation.

A doctor should determine when a patient needs a laxative and which form is best. Laxatives taken by mouth are available in liquid, tablet, gum powder, and granule forms. They work in various ways:
  • Bulk-forming laxatives generally are considered the safest, but they can interfere with absorption of some medicines. These laxatives, also known as fiber supplements, are taken with water. They absorb water in the intestine and make the stool softer. Brand names include Metamucil, Fiberall, Citrucel, Konsyl, and Serutan. These agents must be taken with water or they can cause obstruction. Many people also report no relief after taking bulking agents and suffer from a worsening in bloating and abdominal pain.
  • Stimulants cause rhythmic muscle contractions in the intestines. Brand names include Correctol, Dulcolax, Purge, and Senokot. Studies suggest that phenolphthalein, an ingredient in some stimulant laxatives, might increase a person’s risk for cancer. The Food and Drug Administration has proposed a ban on all over-the-counter products containing phenolphthalein. Most laxative makers have replaced, or plan to replace, phenolphthalein with a safer ingredient.
  • Osmotics cause fluids to flow in a special way through the colon, resulting in bowel distention. This class of drugs is useful for people with idiopathic constipation. Brand names include Cephulac, Sorbitol, and Miralax. People with diabetes should be monitored for electrolyte imbalances. 
  • Stool softeners moisten the stool and prevent dehydration. These laxatives are often recommended after childbirth or surgery. Brand names include Colace and Surfak. These products are suggested for people who should avoid straining in order to pass a bowel movement. The prolonged use of this class of drugs may result in an electrolyte imbalance.
  • Lubricants grease the stool, enabling it to move through the intestine more easily. Mineral oil is the most common example. Brand names include Fleet and Zymenol. Lubricants typically stimulate a bowel movement within 8 hours.
  • Saline laxatives act like a sponge to draw water into the colon for easier passage of stool. Brand names include Milk of Magnesia and Haley’s M-O. Saline laxatives are used to treat acute constipation if there is no indication of bowel obstruction. Electrolyte imbalances have been reported with extended use, especially in small children and people with renal deficiency.
  • Chloride channel activators increase intestinal fluid and motility to help stool pass, thereby reducing the symptoms of constipation. One such agent is Amitiza, which has been shown to be safely used for up to 6 to 12 months. Thereafter a doctor should assess the need for continued use.
People who are dependent on laxatives need to slowly stop using them. A doctor can assist in this process. For most people, stopping laxatives restores the colon’s natural ability to contract. (source : Constipation – article published by National Digestive Diseases Information Clearinghouse (NDDIC) )

2. Doctors usually treat the underlying medical condition/s of that is causing your constipation so better consult your doctor so that he/she can rule out the possible cause of your constipation.

3. suppositories - (like Bisacodyl and glycerol) inserted through the anus;

4. mini enema - this is when a medicine in fluid form is injected through your anus and into your large bowel. can be given in this way.

5. biofeedback - is advised for people with chronic constipation caused by anorectal dysfunction. This is to retrain the muscles that control bowel movements. Biofeedback involves using a sensor to monitor muscle activity, which is displayed on a computer screen, allowing for an accurate assessment of body functions. A health care professional uses this information to help the patient learn how to retrain these muscles.

6. Chloride channel activators - The agent lubiprostone (Amitiza) is available by prescription and increases fluid content of stool.

7. 5-HT-4 agonists - These agents stimulate release of compounds in your body that increase fluid secretion in the intestines and decrease colonic transit time. Prucalopride is one such 5-HT-4 agonist. These drugs are not available in theU.S., and there have been some concerns about the safety of their use.

8. Mineral Oils - is also effective to relieve constipation and also cheap. But it should not beuse in a long-term basis.  Excessive use of this may cause some discomforts and diarrhea.

9. Sodium docusate or calcium docusate- is used to treat constipation and is sometimes used to clear the bowel before medical examinations which require the bowel to be empty. It may also be taken by patients who must avoid straining for a short period of time, such as after a heart attack, during pregnancy, or after gastrointestinal surgery. However, it should only be taken for a short time. Its effectiveness, however, wears off after several days

10. Lubiprostone (Amitiza)   - is given to people with chronic constipation and irritable bowel syndrome. It stimulates the bowel to put more fluid into the stool and therefore makes it softer. It is typically taken twice daily and again should be taken routinely whether constipation has been present that day or not. It however causes nausea and headache.

11. Patient with irritable bowel syndrome (IBS) is advised to stop smoking, avoid coffee and milk-containing foods. He/she must also take record for his/her daily food intake to identify foods that aggravate the symptoms.

12. Thyroxin will be prescribed if the doctor determines through clinical and laboratory tests that the patient has an underactive thyroid gland (hypothyroidism).

13. Nonabsorbable sugars such as lactulose  and sorbitol may be useful. Furthermore, they are usually acceptable for long-term use. However, they usually produce crampy abdominal pain, diarrhea, and electrolyte imbalance

14. Procedures . If everything fails (changes in lifestyle and diet or medical treatments) doctors will perform manual and/or surgical procedures

 - Manual procedures in which your doctor will perform disimpaction by manually breaking your impacted stools (by the use of his fingers) after which laxatives or enemas are administered to soften the stools and lubricate the colons.
- Surgical Procedure  is best recommended for chronic, severe constipation cause by anorectal problems, such as rectal prolapse. Surgical removal of the colon is also recommended specially for people with severe symptoms caused by colonic inertia.


- foodformylove (25November2011)


Sources & References:
1. Constipation – article published by National Digestive Diseases
Information Clearinghouse (NDDIC)

2. What I need to know about constipation by NDDIC
3. Constipation by Medicinenet.com   
4. Constipation in Adults
5. Constipation
6. Treating Constipation - www.nhs.uk
7. Constipation:  Treatments and Drugs by Mayo Clinic
8. Exercise to ease constipation - webmd.com
9. Water: A Fluid Way to Manage Constipation 
10. Apples and Constipation 
11. Mineral oils for constipation:  Moving your stool with ease
12. Docusate Sodium (patient.co.uk)
13. Constipation – Better health channel (http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Constipation)
14. Constipation – kidshealth.org (http://kidshealth.org/teen/diseases_conditions/digestive/constipation.html#)
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