CONSTIPATION

CONSTIPATION

What is constipation?
Constipation is one of the most common medical complaints in Australia. People say they are constipated when they can’t empty their bowels as often or as easily as they would like to.
Any change in bowel habit should be discussed with your doctor. Further investigations may be required.
One in 10 children present to medical attention for problem constipation. One in 5 middle aged women suffers from constipation. Adult males have fewer problems but the incidence of constipation rises in both sexes with advancing age.
There is no rule about how frequently you need to go to the toilet. However, if there has been a change or if you are uncomfortable and find that you need to strain, you should talk to your general practitioner. Many healthy children have problems with constipation, particularly around the time of toilet training.
A desirable bowel habit is a once to twice daily evacuation of a softly formed stool passed without difficulty or pain, in a timely fashion. There is wide individual variation in the “normal” bowel habit.

What symptoms are associated with constipation?
Some people hold onto their motion for many days. The large bowel absorbs water from the stool which may become hard and dry and difficult to pass. Cramping abdominal pain is common, and is usually relieved with evacuation of a bowel motion.
The passage of hard, dry bowel motions may cause a small split in the internal lining of the back passage (causing an anal fissure) and subsequent bowel motions may cause an intense stinging pain, sometimes associated with passage of a small amount of bright red blood. Pain around the back passage causes a reflex contraction of the outlet muscles and exacerbates the constipation.
Occasionally the motion becomes so large that it stretches the back passage, which results in loss of sensation of the “need to toilet”. This can lead to faecal overflow and soiling on the underpants or pyjamas.

What can I do about this?
1. The first step is to relieve any pain around the back passage. Specific treatments are available from your general practitioner to treat anal fissures and other local causes of pain.
2. The second step is to ensure that medications or underlying medical conditions are not contributing to the problem. Drugs used to treat blood pressure, heart disease, depression and supplements of calcium and iron commonly cause constipation. Occasionally an underactive thyroid gland, calcium metabolism disorders, scleroderma or neurological disorders such as Parkinson’s Disease, stroke or paralysis will slow the bowel habit.
3. The third step is to evaluate “environmental” factors such as diet, fluid intake and toileting habits which may be contributing to constipation. A diet high in fibre is beneficial for most people with simple constipation. Fluid intake should be at least 1500mls daily. Allowing adequate time for toileting is important. This applies to both children racing to be ready for school, and to adults facing specific issues such as shift work, a busy schedule or difficulty accessing a toilet at work. Female hormones often affect the bowel habit, with constipation more common before the start of a menstrual period and in early pregnancy.

Dietary Guidelines
We should all aim to consume a varied, nutritious diet that will allow absorption of the correct amount of calories for energy, amino acids for building protein and essential micronutrients (vitamins and minerals) to sustain a healthy, active body. The food remnants that don’t get broken down and absorbed in the small bowel pass along to the large bowel and are generally known as “fibre”. By drawing water into the stool, this fibre will help form a bulky softly formed bowel motion. The recommended daily intake of fibre is 20-30 grams. See Food Fibre Content List below.

Food Fibre Content