Constipation is a condition that can affect people of all ages. It is classified as having less than three bowel movements per week and stools that are dry, hard and difficult to pass. This condition can lead to painful bowel movements, bloating and overall discomfort.

It is important to note that constipation is not a disease itself, rather a symptom. Constipation is usually a temporary condition, which may be related to poor diet, lack of exercise or insufficient consumption of fluids. However, consultation with medical professionals may be required to rule out any underlying conditions. It is important to avoid over-treating symptoms with the use of laxatives which may cause dependence.

Non-Drug Treatment Options

When secondary causes of constipation have been ruled out or treated, simple education can be helpful. Following a few guidelines and understanding good bowel habits can be sufficient to relieve constipation, such as:

• Regular timing of bowel movements as often as possible – You should not unnecessarily postpone your bowel movements, but instead go as soon as you have the urge. It is important to note that colonic motility is best following a meal, which is a good time to attempt defecation. If possible, you should attempt a bowel movement at the same time every day to improve regularity.
   
• Improved fibre consumption – Your dietary history can be used to determine if you are eating enough fibre and drinking enough water to promote proper bowel function. The recommended daily amount of fibre is thirty grams, which you can get from eating vegetables, fruits and whole grains. Fibre supplements like psyllium can also help with a fibre deficiency. Keep in mind that consuming more than the required daily amount of fibre can lead to flatulence or bloating without any relief from constipation and can even make the symptoms worse.
   
• Adequate water consumption – Drinking plenty of fluids is important to get the most out of the fibre that you consume. However, simply increasing the amount of water and other fluids in your diet without an increase of fibre will not aid constipation.
   
• Increased physical activity – By maintaining an active lifestyle, you can promote healthy bowel activity. Depression and stress can make constipation worse. Therefore, such symptoms should be properly addressed when seeking treatment for constipation symptoms for the best results.

Pharmacological Treatment Options

Often times, patients will try a number of different non-drug treatments without experiencing any relief from constipation. 

Bulking Agents, or Bulk Forming Laxatives

The first approach to treating constipation is with bulking agents. 

However, this treatment should not be used if there is any impacted faecal matter or bowel obstruction present. 

Drinking plenty of water with this type of treatment is very important and you may not see any results for at least two days.

This treatment should only be used for the short-term and under the advice of a medical professional.

Osmotic Laxatives

Osmotic laxatives like lactulose needs to be taken on a regular basis to experience the maximum effect. Elderly patients with electrolyte imbalances should not use this method of treatment. Like with bulking agents, you may not experience any relief for up to two days.

Stimulant Laxatives

Stimulant laxatives like senna and bisacodyl are often used in severe cases of constipation where immediate relief is essential. This type of treatment should not be used frequently unless directed by a medical professional. Relief is usually experienced in as little as eight hours. Once the bowel has be completely evacuated, it can take up to three days to refill. Thus, you should avoid using this treatment daily and never during pregnancy.

In some cases, constipation can be a sign of a serious illness. Therefore, the condition should not be ignored. If you experience persistent symptoms without any relief, you should seek immediate medical advice.
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References

Dietitians Association of Australia, For the Public, Smart Eating for You, Nutrition Information A-Z, Fibre

Australian Government Department of Health, For Consumers, Aging, Publications, How A Palliative Approach Can Help Older People Being Cared For At Home: A Booklet For Older People And Their Families; Constipation

Warwick S; Australian Prescriber Managing Constipation in Adults; 2010

Better Health Channel, Conditions and Treatments, Digestive System – Large Intestine, Constipation; 2012

myDr for a healthy Australia, Gastrointestinal Health, Constipation: treatment options

Chemist Warehouse, Health Information: Constipation

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Wallis M, McKenzie S, Guyatt S, Rayner J, Ellem F, Gass E, St. John W, Hughes R; Help patients win the constipation battle

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