Treatment
Treatment for chronic constipation relies on understanding the causes and types of constipation. By the time a patient comes to the doctor, most have been using OTC laxatives and have adjusted diet and lifestyle. A web-based survey showed 96 percent of patients have tried some form of traditional medication (bulking agents, stool softeners, or laxatives). Treatment for constipation includes a wide variety of options which must be individualized for each patient. Treatment includes patient education, exercise, dietary adjustments, medications (herbal preparations, laxatives, IBS-C medications, enemas and/or suppositories) bio-feedback, and surgical procedures. Several options may be needed to achieve relief for the chronic-constipation patient.
Patient education is an indispensable part of the treatment for chronic constipation and should be incorporated into the initial contact. This should include information about lifestyle, diet, and use of laxatives or enemas. It should consist of an explanation about what a normal bowel habit is (three or more bowel movements a week). Patients should be advised to attempt to establish a regular schedule.
Instruction to a patient to attempt to have a bowel movement after meals is often helpful since this makes use of normal after-eating-increases in colonic motility, particularly after breakfast when colonic motor activity is at its highest (two hours of eating). Patients also need to learn to properly position themselves for better results when using the toilet. They should have their knees higher than their hips by having a footrest if necessary. The spine should be straight but leaning slightly forward with elbows on the knees. The abdomen should be bulged slightly outward. All of this helps to increase the anorectal angle and further aid in the ease of defecation.
Epidemiologic studies suggest people with sedentary lifestyles are three times more probable to report constipation. But, effects of exercise on gut transit times are not consistent. Importance of continuing or starting an exercise program for overall health should be included. A nurse's health study followed more than 60,000 women. They observed that physical activity six times a week was associated with a 35.5 percent lower risk of constipation. Yet, a survey of the Veteran’s Administration employees suggested that the level of physical activity is unrelated to self-reported constipation, but is associated with over-all wellbeing and improved quality of life.
Education and training in proper dietary needs is important to the treatment of chronic constipation. The addition of fiber is a prominent part. Fiber is defined as a non-digestible carbohydrate that is basic in plants. Fiber adds bulk to the stool by binding to water and the water softens the stool. The most common sources of fiber are fresh fruits, vegetables, whole-grain wheat or oat bran, and legumes.
Fiber may also be added in a synthetic form such as methyl cellulose or Citrucel. Fibers differ in their effect on the stool weight and consistency. For example, 60 percent of wheat-bran fiber can be recovered in the stool compared with 10 percent of cabbage fiber. Some patients may get worse initially with added fiber but the amounts can be adjusted. Bloating and flatulence are side effects of the fiber. The recommendation is 20 grams to 35 grams of fiber a day, but higher amounts may be needed. Extra amounts of liquids must be taken in to prevent dehydration due to the uptake of extra colonic fluids related to the fiber.
It should be noted that a high-fiber diet does not help all patients with constipation. Patients with slow transit or disordered defecation do not respond as well. Because of concerns with obstruction, people with known strictures should not increase fiber unless directed by their physician. Diabetics may need to watch what they use due to sugar content.
Probiotics are also being investigated. They are living organisms thought to work by changing the flora of the intestinal lining. Milk and yogurt are two of the foods that they are being produced in. They may reduce transit time and increase the frequency of bowel movements. Studies have shown that the results are dependent on the strain of bacteria in the product. More studies are needed to further evaluate their true effectiveness. Studies have not been compared them to fiber supplements or traditional laxatives.
