When’s the last time you have a smooth and consistent ‘pooping’ experience?
Constipation is a common issue that affects many people of all ages and for various reasons. While it may not seem like a big deal at first, long-term constipation has been associated with many discomforts and negative health issues.
Check if it’s constipation:
It's likely to be constipation if:
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you have not passed any motion at least 3 times during the last week
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your stool is often large and dry, hard or lumpy
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you are straining or in pain when you are passing motion
It is also common to feel bloated or stomach distension when having constipation.
A healthy and regular pass motion is important for your physical health, but not everyone shares a similar bowel movement habit. Therefore, it would be helpful to identify how your usual ‘pooping’ habit is and any deviation from that norm may require you to do something about it.
What causes constipation?
The majority of constipation cases is due to several lifestyle factors, such as not having enough fibres and fluids intake, lack of physical exercises and changes in diet or daily routine. Nonetheless, constipation can also be caused by other reasons, such as the side effects of certain medications and psychological stress or anxiety.
Managing constipation
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Make changes to your diet
The easiest and most ‘natural’ way to manage your constipation is to incorporate more fibres into your daily diet and drink more fluids. Fibre-rich foods include oats, whole grains, fruits and vegetables.
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The fibre in these foods promotes the movement of material through your digestive system and increases stool bulk, which makes it easier to be pushed out. This is, however, only works if you drink plenty of fluids each day! Fiber works best when it absorbs water, making your stool soft and bulky.
There are also many supplemental products sold in the pharmacy that you can buy to add more fibre to your daily diet. Examples include psyllium husk (a type of bulk agent) or products that combine oats with probiotics.
It is worth noting that adding too much fiber too quickly can promote intestinal gas, abdominal bloating and cramping. So you are encouraged to increase fiber in your diet gradually over a few weeks. This allows the natural bacteria in your digestive system to adjust to the change.
The U.S Institute of Medicine recommends that adult male who aged 50 years old or younger take 38g of fibre everyday and 30g for those aged 51 years old and above; women who aged 50 years old and younger should take 25g and 21g for those who aged 51 years old and older.
Individuals with certain medical conditions may not be suitable for a diet with high-fibre and lots of water, such as people who have a stoma and heart failure patients. It is important that you consult a healthcare professional for the most appropriate diet.
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Over-the-counter laxatives
Below are some of the common laxatives you can find in Malaysia. Consult a healthcare professional before trying any of the following laxatives because they may or may not be suitable for your medical status.
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Enema: Enema contains sodium chloride (saline) solution and some may contain glycerine as well. It is used by squeezing the liquid content through your rectum, and the urge to pass motion usually sets in within 15 to 30 minutes after using the enema.
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Osmotic laxatives: An osmotic laxative promotes pass motion by drawing fluids from your large intestines into your stool, so that it is softer and easier to pass out. They are usually available in liquid that you can ingest. The urge to pass motion generally sets in within 1-2 days.
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Stimulant laxatives: Examples of stimulant laxatives are bisacodyl and senna. They work by stimulating your large intestine to contract, which helps to expel your stool. They are available in pills for you to ingest, or as suppositories for you to insert into your rectum. Stimulant laxatives usually work within 8 to 12 hours after taking them.
You should not be dependent on stimulant laxatives, however, as it may lead to a “lazy” intestine that would only work when you take laxatives. Other consequences when you over-dependent on laxatives also include colon infection, irritable bowel syndrome, and increased risk of colon cancer.
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How to select the right laxatives?
If you are a healthy person who has constipation because of dietary factors, making changes to your diet should be the first thing to do. However, in some circumstances, a laxative can be helpful to resolve constipation temporarily. For example, in individuals who have to take opioid painkillers long-term and suffer from constipation as a result of side effects of opioids, increased fibres may not be helpful. A stimulant laxative may be a more appropriate selection for such individuals.
Laxatives may not be suitable for everyone. For instance, it is generally not encouraged for pregnant women to take stimulant laxatives due to concern of miscarriage. Children of younger ages are also not suitable to take some of the laxatives mentioned above.
The rule of thumb is, if you are pregnant or have any medical conditions, or unsure which laxative to take, consult a healthcare professional first before starting any treatment.
Laxative abuse
There are also individuals with eating disorders who may misuse laxatives to lose weight. Laxative abuse is serious and dangerous, often resulting in a variety of health complications and sometimes causing life-threatening conditions.
The belief that taking laxative can lose weight stems from a myth that has since been debunked by science. Although laxatives artificially stimulate the large intestine to empty, the “weight loss” caused by a laxative-induced bowel movement contains little actual food, fat, or calories. Instead, laxative abuse causes the loss of water, minerals, electrolytes, and indigestible fiber and wastes from the large intestine. This “water weight” returns as soon as the individual drinks any fluids and the body re-hydrates. If the chronic laxative abuser refuses to re-hydrate, they risk dehydration, which further taxes the organs and which may ultimately cause death.
When should you see a doctor for constipation?
Talk to a doctor if you:
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are not improving with treatment
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are regularly constipated and it lasts a long time
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are bloated and it lasts a long time
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have blood in your stool
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have unexpectedly lost weight
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feel very tired all the time
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are taking medicine that’s causing constipation – such as opioid painkillers
References:
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NHS - Constipation. https://www.nhs.uk/conditions/constipation/
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NHS - Constipation in children. https://www.nhs.uk/conditions/pregnancy-and-baby/constipation-and-soiling/
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NHS - How to get more fibre into your diet. https://www.nhs.uk/live-well/eat-well/how-to-get-more-fibre-into-your-diet/
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Mayo Clinic - Nutrition and healthy eating. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fiber/art-20043983
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BMJ Best Practice - Constipation.
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NEDA - Laxative Abuse. https://www.nationaleatingdisorders.org/learn/general-information/laxative-abuse
