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NHS Choices Condition

Content supplied by NHS Choices

The first way that your GP will treat your constipation is by advising you about ways you can change your diet and lifestyle. Changing what you eat and drink may mean that your constipation passes without the use of medication.

Some of the ways that you can help treat your constipation are outlined below.

  • Increasing your daily intake of fibre. You should be eating at least 18-30g of fibre a day. High fibre foods include fruit, vegetables, and cereals.
  • Add some bulking agents, such as wheat bran, to your diet. These will help make your stools softer and easier to pass.
  • Increasing your fluid intake. It is best for you to drink water, and you should be drinking at least 1.2 litres (6-8 glasses) a day.
  • Getting more exercise by going for a daily walk or run.
  • If your constipation is causing you pain, or discomfort, you may want to take a painkilling medication, such as paracetamol. Make sure that you always follow the dosage instructions carefully. Children under 16 years of age should not take aspirin.

See the 'prevention' section for more information about ways to change your diet and lifestyle.

If these diet and lifestyle changes do not help, your GP may prescribe an oral laxative for you.

Laxatives

Laxatives are a type of medicine that help you to pass stools. There are several different types of laxative and each one has a different effect on your digestive system.

Bulk-forming laxatives

Your GP will normally start your laxative treatment by using a bulk-forming laxative. These types of laxative work by helping your stools to retain fluid. This means that they are less likely to dry out, which can lead to faecal impaction (see 'complications' section). Bulk-forming laxatives also make your stools denser and softer which means that they should be easier to pass.

Commonly prescribed bulk-forming laxatives include ispaghula husk, methylcellulose, and sterculia. When taking this type of laxative, you must make sure that you drink plenty of fluids. Also, you should not take them before going to bed. It will usually be 2-3 days before you feel the effects of a bulk-forming laxative.

Osmotic laxatives

If your stools remain hard after you have taken a bulk-forming laxative, your GP may prescribe you an osmotic laxative instead. Osmotic laxatives work by increasing the amount of fluid in your bowels. This helps to stimulate your body to pass stools. Osmotic laxatives can also help by softening your stools.

Commonly prescribed osmotic laxatives include lactulose and macrogols. As with bulk-forming laxatives, you should make sure that you are drinking enough fluids. It will usually be 2-3 days before you feel the effect of the laxative.

Stimulant laxatives

If your stools are soft, but you are still having difficulty passing them, your GP may prescribe you a stimulant laxative. This type of laxative works by stimulating the muscles which line your digestive tract, helping them to move stools and waste products along the large intestine (colon) to the anus.

The most commonly prescribed stimulant laxatives are senna, bisacodyl and sodium picosulphate. These types of laxative are usually only used on a short-term basis, and you will usually start to feel them working within 6-12 hours.

According to your individual preference, and the speed with which you require relief, your GP may decide to combine different laxatives.

How long will I take laxatives for?

If you have only experienced constipation for a short period of time, your GP will normally recommend that you can stop taking the laxative once your stools are soft and easily passed.

However, if you have constipation due to a constipating medicine, or an underlying medical condition, you may have to take laxatives for much longer. Sometimes, you will have to take them for many months, even years.

If you have been taking laxatives for some time, you may have to gradually reduce your dosage, rather than coming off them straight away. If you have been prescribed a combination of laxatives, you will 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 is best to stop taking your laxatives. You should never stop taking any form of medication unless your GP advises you to.

Faecal impaction

Faecal impaction occurs when stools become hard and dry and collect in your rectum. This obstructs the rectum, making it more difficult for stools to pass along.

If you have faecal impaction, you will initially be treated with a high dose of the osmotic laxative, macrogol. After a few days of using this laxative, you may also have to start taking a stimulant laxative.

If you do not respond to these laxatives, you may require one of the medications described below.

  • Suppository - this type of medicine is designed to be inserted into your anus. The suppository gradually dissolves at body temperature and is then absorbed into your bloodstream. Bisacodyl, or glycerol, are two medicines which can be given in suppository form.
  • Mini enema - this is when a medicine in fluid form is injected through your anus and into your colon. Docusate and sodium citrate are two types of medicine which can be given in this way.


Pregnancy or breastfeeding

If you are pregnant, there are ways for you to safely treat constipation without causing any harm to you or your baby. As with most adults who are constipated, your GP will first advise you to change your diet by increasing your fibre and fluid intake. You will also be advised to take gentle exercise.

If dietary and lifestyle changes fail to work, you may be prescribed a laxative to help you pass stools more regularly. There are lots of laxatives that are safe for pregnant women to use because most are not absorbed by the digestive system. This means that your baby will not feel the effects of the laxative.

Laxatives that are safe to use during pregnancy include the bulk-forming laxatives lactulose, and macrogols. If these laxatives do not work, your GP may advise a small dose of bisacodyl, or senna (stimulant laxatives).

However, senna may not be suitable if you are in your third trimester of pregnancy (27 weeks to birth) because this medicine is partially absorbed by your digestive system.

Babies who have not yet been weaned

If your baby is constipated but has not yet started to eat solid foods, the first way to treat them is to give them extra water between their normal feeds. If you are using formula milk, make sure that you still make the formula as directed by the manufacturer - do not dilute the mixture.

You might want to try gently moving your baby's legs in a bicycling motion, or carefully massaging their abdomen (tummy) to help stimulate their bowels.

Babies who are eating solids

If your baby is eating solid foods, make sure that you give them plenty of water, or diluted fruit juice. Try to encourage them to eat fruit which can be pureed, or chopped, depending on their ability to chew. The best fruits for babies to eat to treat constipation are:

  • apples,
  • apricots,
  • grapes,
  • peaches,
  • pears,
  • plums,
  • prunes,
  • raspberries, and
  • strawberries.


Never force your baby to eat food if they do not want to. If you do, it can turn mealtimes into a battle, and your child may start to think of eating as being a negative and stressful experience.

If your baby is still constipated after a change in diet, they may have to be prescribed a laxative. Bulk-forming laxatives are not suitable for babies, so they will usually be given an osmotic laxative. However, if this fails to work, they can be prescribed a stimulant laxative.

Children

As with babies and adults, children with constipation will first be advised to change their diet. If this fails to work, laxatives can be prescribed, usually an osmotic laxative followed, if necessary, by a stimulant laxative.

As well as eating fruit, older children should have a well balanced diet, which also contains vegetables and wholegrain foods, such as wholemeal bread and pasta.

Try to minimise any stress or conflict associated with using the toilet, and with meal times. It is important to be positive and encouraging when it comes to establishing a toilet routine. Your child should be allowed at least 10 minutes on the toilet, to make sure they have passed as many stools as possible.

To encourage a positive toilet routine, you might want to try making a diary of your child's bowel movements which is linked to a reward system. This can help them to focus on using the toilet successfully, rather than the more negative aspects, such as faecal incontinence (when you uncontrollably leak solid or liquid stools).

view information about Constipation on www.nhs.co.uk »

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The information provided on this website (including any NHS Choices medical information) is for use as information or for educational purposes only and is not a substitute for professional medical care by a qualified doctor or other qualified healthcare professional. We do not warrant that any information included within this site will meet your health or medical requirements. This Embarrassing Bodies site does not provide any medical or diagnostic services so you should always check with a health professional if you have any concerns about your health.


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