Managing Constipation

Many people are under the impression that they need to open their bowels (have a poo) every day, however a ‘normal’ bowel pattern can be anything from three times a day to three times a week and it is only when this changes or becomes a problem you should seek help.

Constipation is a common problem at all ages. Women are twice as likely as men to become constipated and constipation is more common in the elderly. However, anyone can become constipated at some point in their life. It is diagnosed when bowel movements are unsatisfactory because of infrequent stools, difficult to pass stools, or a feeling that you are not emptying your bowels properly.

Constipation can be described as:

• Bowel movements which occur less than three times per week.
• Stools (poo) that is large and dry or lumpy and hard
• Difficulty passing your stools and needing to strain

There are several factors that are known to cause constipation:

• Low fibre diet or faddy eating
• Dehydration caused by poor fluid intake
• Difficulty in accessing a toilet or changes in your routine or lifestyle
• Frequently ignoring the need to go to the toilet
• Lack of exercise or reduced mobility
• Limited privacy when using the toilet
• Stress, anxiety and/or depression
• Psychological disorders surrounding body functions
• Eating disorders
• A high temperature, dehydration or immobility caused by illness
• The position you sit in to open your bowels
• Some medical conditions (such as diabetes and thyroid problems)
• Some medications

To help you manage your constipation, your Healthcare Professional may recommend a combination of approaches which may include:

• Adjusting any constipating medication
• Increasing the fibre in your diet
• Increasing your fluid intake
• Increasing your activity and exercise
• Taking laxatives and/or suppositories
• Adjusting the position you sit in on the toilet

Dietary fibre

Certain foods we eat contain more fibre than others. A diet that is high in fibre can help treat and prevent constipation. Fibre should be increased gradually in the diet to help minimise flatulence and bloating.  Some people find increasing the fibre in their diet has an effect within a few days, for others it can take as long as a month – it is important to stick with it! Fibre is found in wholegrains, fruit and vegetables. Try introducing the following foods into your diet:

• Bran/wholegrain breakfast cereals
• Porridge
• Rye crispbreads
• Wholemeal bread
• Beans and pulses (including baked beans)
• Vegetables – fresh, tinned, frozen or juiced
• Fruit – fresh, tinned, frozen or dried
• Fruit juice
• Drink at least 2 litres of fluid a day!

Toilet Position

Trying to maintain a good toilet position can be useful for people that find it difficult to pass a stool, who strain when trying to pass a stool or who suffer from constipation. The following suggestions may help making your bowels easier:

• Lean forward when you are sitting on the toilet with your hands resting on your thighs
• Make sure that you knees are bent and are higher than your hips (it may help to use a footstool if your toilet is high or you are not very tall)
• Make sure your feet are resting on the ground (or on a footstool)
• Try to breathe to the bottom of your lungs with your mouth open to prevent straining and contracting your pelvic floor (diaphragmatic breathing)
• Bulge your tummy muscles forward as you take a deep breath in and then ‘brace’ your tummy to prevent it from bulging further forwards. Do not tighten your tummy.
• Relax your anal sphincter to open your bottom and let the stool out
• Use your deep breath to increase the pressure in your abdomen and push down towards your anus.

Laxatives

 Your healthcare professional may suggest you take laxatives to relieve your constipation. There are different types of laxatives and you should ensure you carefully follow the instructions given by your healthcare professional and contained with the medication. If a particular laxative does not suit you or help your constipation, it is important to let your healthcare professional know, as they may be able to adjust your dose or suggest an alternative.

Toileting routines

Our bodies naturally want to evacuate stool when we wake up in the morning and eat our first meal of the day. Getting in to a good routine of rising at the same time and breakfasting within half an hour can really help. Try sitting on the toilet half an hour after your breakfast to see if a natural bowel movement is stimulated. After breakfast is also a good time to take any suppositories you have been prescribed, remember these can take up to half an hour to work and experiment with both walking around and lying down with them in place, to see which stimulates the best bowel movement for you. Some people find suppositories ‘pop out’ if they walk around, but they are better able to hold them if they lie down on their left-hand side. It is important to follow any instructions in the packet when taking suppositories as there are different types with different usage guidelines.