Dr Stephen John Middleton MA MD FRCP FAHE

Consultant Gastroenterologist

Constipation

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Constipation is a common and often troubling symptom which can lead to abdominal pain, bloating, haemorrhoids, anal fissures and can make people feel very nauseated and generally lethargic.  Initially a lifestyle assessment is helpful:

Dietary assessment to check fibre and fluid intake is adequate
Availability of toileting facilities (particularly in the work place) and time to use such facilities        
Current drug therapy which may cause constipation, for example pain killers such as codeine, but there are many other drugs present that cause constipation.

  If these points are not relevant, the next stage is to consider the type of constipation:  
 

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Hard infrequent motions
This is best treated with bulking agents, usually in the form of fibre bought as supplementary fibre from the chemist.  Along with the fibre, a faecal softener such as Magnesium Hydroxide based preparation is often useful.  It is important that  adequate fluids are taken with these.  It is best to avoid stimulant laxatives such as Senna or products such as Lactulose which can cause bloating and are therefore not ideal for long term use.  Liquid paraffin based preparations if taken long term can cause vitamin deficiency and anal leakage.  
Difficulty in passing soft stools
This may be due to a problem controlling pelvic muscles and is called an evacuatory disorder.  This condition can be improved greatly with specialist treatment and patients should be referred to a gastroenterologist with a particular interest in constipation and who has access to biofeedback which is a form of physiotherapy to improve the function of the muscles involved in evacuating a bowel motion.   It is obviously very important to exclude other conditions causing  constipation and your GP or Consultant will know which conditions need to be excluded and may undertake tests such as thyroid hormone measurements, colonoscopy to exclude polyps or other diseases in the large bowel.  It is important to understand the cause of symptoms and exclude any sinister underlying diseases before embarking on long term treatments.  
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