Constipation and Laxatives - Advice on - Geriatric Medicine
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Geriatric Medicine Advice on Constipation and Laxatives
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Constipation
Constipation is defined as having bowel movements less than three
times a week. Stools are usually hard, dry, small in size and difficult
to eliminate. Some may find it painful to clear their bowels and often
experience straining, bloating and the sensation of a full bowel.
Causes of constipation
• Lack of fibre in diet
• Insufficient liquid intake
• Lack of exercise
• Side effects of medications (e.g. pain killers)
• Long term result of ignoring the urge to clear bowel
• Changes in lifestyle or routine such as pregnancy, old age and travelling
• Problems with colon and rectum
Stomach Water removed
Large intestine
(colon)
Small Liquid intestinal
intestine content enters
colon from small
intestine
Ileum
Rectum
Sigmoid
Anus colon Excessive water removal
causes hard stools2 How to prevent constipation? 1. Increase fibre intake Fibre improves bowel function by adding bulk and softening the stool. It is found in many vegetables, fruits and grains. Fibre is the part of the plant that cannot be digested by the body. Thus, when fibre passes through the intestine undigested, it absorbs large amount of water, resulting in softer and bulkier stool. People who consume high fibre diets are less likely to become constipated. Be sure to add fibre to your diet slowly, so that your body can adapt. Foods rich in fibre include whole wheat, bran, fresh and dried fruits and vegetables. 2. Drink more water Drink plenty of water (unless advised by your doctor) and other liquids such as fruit juice. This will increase the fluid level in the colon and adds bulk to stools, making bowel movements easier. People with constipation should avoid drinking liquids that contain caffeine (e.g. coffee and cola) or alcohol which will worsen one’s condition due to dehydration.
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3. Exercise regularly
Exercise decreases the time it
takes for food to move through
the large intestine, thus limiting
the amount of fluid lost from stools.
A regular walking regime of 10 to 15
minutes several times a day can help your
digestive system stay active and healthy.
4. Good bowel habits
Always allow yourself enough time to clear your bowels. It is normal to take about
a minute to empty your bowels. Never strain or hold your breath. Develop a good
toilet position. Lean forward while sitting on the toilet, with a straight back and your
forearm on the thighs.
Sometimes we feel so hurried that we do not pay attention to our body’s needs.
Make sure you do not ignore the urge to clear your bowels.
• Knees should be higher than hips
• Lean forward and put elbows on knees
• Bulge abdomen
• Straighten spine
When to see a doctor?
See your family doctor if you have constipation and experience the following
conditions:
• Abdominal pain and cramp
• Nausea and vomiting
• Stools that are thin like pencils
• Involuntary weight loss
• Bleeding from the rectum
Your doctor may conduct some tests to ensure that constipation is not caused by
other illness.4 Laxatives Most people who are mildly constipated do not need laxatives. However, the doctor may recommend oral or rectal laxatives for those who do not see an improvement despite making diet and lifestyle changes. Common laxatives are available in pharmacies. Oral laxatives such as tablets and syrup increase intestinal muscle contractions and release water into the bowel, to form soft stool. Rectal laxatives (suppository and enema) are normally inserted into the rectum for relief of constipation. Administering rectal laxatives Suppository can be given when one fails to pass motion for more than 2 days. Items to prepare: • Suppository – a small, bullet shape, solid medication formulation designed to be inserted into the anus • Disposable gloves – to be used for hygienic purposes • Lubricant – to lubricate the suppository for easy insertion How to administer: • Lie on the left side with knees bent, arms at rest (left lateral position) • Put on your gloves; lubricate the tip of the suppository
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• Gently push the suppository into anal opening until
it is completely inserted into the anus
• Wash hands
• Observe for bowel movement
Enema can be given when one fails to pass motion for more than
3 days.
How to administer:
• Lie on the left side with knees bent, arms at rest
(left lateral position)
• Remove the protective cap from the applicator tip
Colon Rectum
• Gently insert the pre-lubricated tip into the anus
pointing towards the naval region; slowly squeeze
the bottle until nearly all the liquid is expelled into
the rectum.
• Lie on the bed until you feel the urge to evacuate
(usually after 2 - 5 minutes)
• Wash hands
After treatment, one should be able to regain normal bowel habits to maintain
passage of soft, formed stools (ideally, type 3 or 4, as shown in the Bristol stool
chart) at least 3 times a week, without straining.6
Bristol stool chart
Separate, hard lumps,
Type 1
which are hard to pass
Constipation
Sausage-shaped but
Type 2
lumpy
Looks like sausage but
Type 3
with cracks on its surface
Normal stools
Looks like sausage or
Type 4 snake, soft with smooth
surface
Soft blobs with clear-cut
Type 5 edges, can be passed out
easily
Fluffy pieces with ragged
Type 6 Diarrhoea
edges, a mushy stool
Type 7 Watery, no solid pieces
The Bristol stool chart describes the size and consistency of stools.2 Simei Street 3 Singapore 529889
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All information is valid at the time of printing (May 2012)
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