Written by Amy Ng
Pharmacist at Community Pharmacy Glen Huntly

No-one has the exact same bowel motions, it can range from once to three times a day or up to one motion every 3 days. You will work out what is ‘normal’ for you.

If it has been more than 3 days without a motion, you are most likely suffering from constipation. This describes the difficulty and discomfort in passing faecal stools that are hard and dry.

What’s a healthy bowel motion?

A healthy bowel motion should be without strain, discomfort or difficulty.

A healthy stool is made up of three quarters of water and the rest of it is the undigested fibre, waste, intestinal bacteria and dietary fats.

A healthy stool is one that looks like a thin long sausage. If it comes up dried and in little pellets, it means your stools are too dry and hard.

How the body creates faeces

Once the food from our bodies has been digested by the stomach, it passes through the small intestine that absorbs all the nutrients. The large intestine (colon) absorbs water from the contents and contracts to help move the contents down to the rectum for storage. When the rectum gets full, it sends a message to the brain that you need to go to the toilet. The anus will then open up to allow the evacuation of your faeces.

Symptoms of constipation
  • Needing to go to the toilet less frequently than usual
  • When passing a stool, it requires more straining and pushing
  • The stool itself is harder and drier than usual
  • Feeling that you haven’t fully evacuated your bowels
  • Abdominal cramping and bloating
Causes of constipations

Medications: some have side effects that can cause constipation. Some may have a drying effect on the body, others may slow gut movements down.

Medical conditions: Certain conditions can increase the likelihood of constipation such as irritable bowel syndrome, hernias, Parkinsons disease, stroke, anal tears, hemorrhoids increase the chances of constipation

Age: elderly are more prone to constipation due to less frequent gut movements

Low water intake: as faeces make up 75% of water. If we drink less water in our diet, the fibre in our stools won’t absorb as much water and are more likely to be drier and hard

Not enough exercise: movement helps the gut and bowels move much more easily.

If your body is telling you that you need to evacuate your bowels and you choose to ignore it: the stools that are waiting to be evacuated will have their water extracted and reabsorbed back into the gut.

Low fibre diet: fibre is not digested by the body and it adds bulk to stools. . Fibre is the indigestible parts of plant foods, such as vegetables, fruits, grains, beans and legumes. It is type of a carbohydrate that helps keep our digestive systems healthy.

The two most common types of fibre are

Insoluble fibre: has a strong water absorbing property, so it will soften the contents in the bowel, makes you feel full too. Insoluble fibre is found in wholegrains, nuts, seeds and the skin of fruit and vegetables.

Soluble fibre: found in fruits, vegetables, oats, barley and legumes. They help make you feel fuller for longer, absorbs dietary cholesterol and stabilise blood sugar levels

Problems that can develop from constipation

Haemorrhoids (or piles) - repetitive straining can cause swelling in the veins around the anus. The swelling may occur on the outside or inside of the anus. They can be painful, they can bleed and can make you feel like you have not fully completed your bowel motion.

Faecal impaction: the bowels and rectum become so full that the bowel can not push anything out. You will need to see the Dr for treatment.

Treatment for constipation

Best way to get advice is to see your local Community Pharmacy Pharmacist

Increase dietary fibre: it is recommended we have 30 grams of fibre per day from various sources such as fruit and vegetables (with skins on if possible), wholegrain cereals and legume

Avoid excessive consumption of foods that contribute to constipation: dairy, white rice, white flour and meat

Drink more water: aim for at least 1 litre (or 4 cups of water) per day unless you are on a fluid restriction diet

Exercise regularly- aim for 30 minutes each day to improve gut motility

Medications and supplements to treat and prevent constipation:

  1. Fibre supplement (eg. psyllium husk, bran, Metamucil) - if you aren’t getting enough fibre from your diet, you could consider a fibre supplement. But always start on a lower dose and slowly increase. Also must increase fluid intake as well, other this is will cause further constipation. Takes 2-3 days for a gentle effect. Can take long term if needed.
  2. Softener laxatives (eg- Coloxyl) – brings more water and fats into the stools. Takes 6-72 hours to have a gentle effect. Can take long term if needed.
  3. Stimulant laxatives (eg- Coloxyl & Senna, Dulcolax, Bisalax) – causes increased gut movement to make bowel contents travel to rectum. Can cause cramping and bloating. When taken orally, it takes 6-12 hours for effect. If inserted rectally, takes 15-60 minutes. Should be used short term if possible as it can cause lazy gut syndrome where you rely on stimulant laxatives for bowel motions.
  4. Osmotic laxatives (Lactulose, Movicol, Glycerol suppositories)- helps bring more water into the bowel to soften the stools. Can be taken long term and takes 12-72 days for a gentle effect.
  5. Lubricant laxatives (Liquid paraffin and castor oil)- lubricates the stools for easier evacuation of the bowel. Can cause flatulence, oily stools. Takes 6-8 hours.
Speak to your local Community Pharmacy Pharmacist for more advice on how to manage and prevent constipation



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