You and Constipation

What is it?

Constipation is characterized by infrequent, difficult passage of small hard stools, usually less than 3 times a week, although people may either pass several small hard stools each day, or not go at all for several days. Some people pass a normal soft stool every few days which is normal for them, and so it does not come under the umbrella of constipation.

Who gets it?

It is most common among young women and the elderly,but can affect anyone. It is also a feature of depression. as well as certain other metabolic disorders such as an underactive thyroid.

What are the causes?

A diet of refined foods, low in fibre, as seen in the typical ‘western’ diet. Rural Africans rarely have bowel problems.

Poor habits; resisting the urge to go, perhaps due to unwillingness to go in an unfamiliar or unpleasant environment, or perhaps just being too busy.

Change in diet or habits, e.g. travelling.

Lack of exercise, especially in the elderly.

Certain diseases such as an underactive thyroid, or rarely, excess calcium in the blood.

Medicines such as iron supplements, some blood pressure treatments, and pain killers containing codeine.

Neurological [nervous system] problems, either locally in the bowel, such as Hirschprung’s disease, or in spinal cord damage.

Chronic lead poisoning.

Local blockage from worms, poorly chewed food or a stricture due to tumour or adhesions may rarely present as constipation.

What problems does it lead to?

The problems associated with constipation are discomfort, bloating, hemorrhoids [piles] and anal fissure, a painful crack in the anal skin through passing a large hard stool.

Eventually there may even be rectal prolapse, when the rectum telescopes inside out and appears outside the anus.

If stimulant laxatives are used regularly, the bowel becomes ‘lazy’ and does not work without them.

Diverticulosis, a condition in which there are small pockets in the large colon, is a result of a long term low fibre diet.

Constipation does NOT cause poisoning of the blood stream, or ‘toxins’ to escape from the bowel causing headaches etc.

What is the usual treatment?

Most people will purchase a laxative. These come in different types such as ‘Senokot’, ‘Brooklax’, ‘Dulcolax’, which stimulate the bowel and may cause cramping, or Milk of Magnesia and Lactulose, which encourage more water to be retained and thus soften the stool.

Fibre supplements absorb fluid keeping it in the bowel.

Aloe products are also popular and act as bowel stimulants.

What treatments are recommended?

Please ensure that you are drinking 2 litres of water per day, as most people do not drink enough fluid. A glass of hot water helps some people.

Ensure that you listen to your tummy and answer the call to go to the toilet immediately. Try to establish a habit of going at the same time each day, and ensure that you have time to go!

Eat at least 5 portions of fruit and vegetables every day to provide fibre, and increase your fibre intake with wholemeal breads and pasta, nuts, beans and pulses. Prunes are especially useful.

Substitute breakfast oats for oat bran, as it has more fibre. If you eat other breakfast cereals choose one that is high in fibre and that contains as little sugar as possible. Wheat, oat or Quinoa bran may be added to cereals, yogurt, soups and stews.

Psillium husk is also a good source of fibre.

Use the seed mix below daily:

1 part sunflower seeds

1 part pumpkin seeds

1 part sesame seeds

2 parts Linseed

Start with 1 tsp, and increase slowly to 1 tbs. It is best ground in a coffee grinder and stored in the fridge, as this makes it less likely to cause cramping.

Linseed has the advantage of also providing Omega 3 oils, which are not only essential for good nutrition, but have a healing effect on the bowel. Start with 1/2 tablespoon soaked in plenty of water overnight, and work up to as much as you need, perhaps even taking it 3 times a day.

There are various commercial fibre supplements available and should be chosen according to price and palatability.

Use a probiotic, or eat plain yogurt regularly for healthy bowel flora.

Vitamin C in large enough doses is a very effective laxative. Many people do not take in enough Vitamin C, and it is especially necessary for smokers and during the cold winter season. Start with 1000mg of ascorbic acid, and increase by 1000mg daily until the desired result is achieved.

Milk of magnesia is a very safe remedy even for infants and pregnant mums. Start with a small dose of 5ml for adults and 2.5 ml for toddlers [1.25 ml for infants less than 1 year old] and keep increasing by the same amount morning and night until it works. Other forms of magnesium are also gently laxative and 4-800mg daily may be used. Epsom salts may be used the same way for adults.

Lactulose is very effective for some people, but should be used with caution in Diabetics. It is very useful to combine lactulose and Milk of magnesia for extra effect without cramping.

Dandelion root tea and other herbal teas are useful for some. There are various herbal teas that are laxative, but these should be used with care as they can be very powerful and cause diarrhea and dehydration.They should generally not be used in pregnancy.

Cascara sagrada 100mg is a powerful laxative and should not be used on a regular basis. This also applies to many commercial laxatives containing senna etc. The cramping that is caused by these laxatives can be reduced by taking a teaspoon of soaked fennel seeds.

If you are very stopped up and feeling sore, a glycerine suppository will help lubricate the anus while something else works from above.

If all else fails, an enema will move things, but you should see your GP if you are so badly stopped up.

A mixture of several different remedies such as Lactulose and Milk of Magnesia can be more effective than the individual items taken alone.

Commercial preparations containing phenolphthalein are popular, but may cause skin rashes and other reactions.

Tissue salts: silica, or ‘constipation combin’ may help.


Constipation is a common problem and usually responds to domestic remedies. Times to be concerned are:

  • A child who never manages to have a normal stool.
  • If there is pain or bleeding associated with bowel movement.
  • If the bowel habit has changed, or if there is constipation alternating with diarrhea, especially in the over 50s.
  • If the usual remedies do not work.
  • If there is severe pain or bloating, and especially if there is vomiting. Failure to pass even wind in this situation is an emergency.

Constipation is a common problem caused mainly by the busy lives that we live today. It should be viewed as a lifestyle disorder, and so it is an indication that we need to look carefully at our daily habits, and treat our body with the care it deserves.

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