Geriatric Medicine. Advice on. Constipation and Laxatives

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1 Geriatric Medicine Advice on Constipation and Laxatives

2 1 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 Large intestine (colon) Stomach Water removed Small intestine Ileum Rectum Anus Sigmoid colon Liquid intestinal content enters colon from small intestine Excessive water removal causes hard stools

3 2 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.

4 3 4. Good bowel habits 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. 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.

5 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

6 5 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 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 Colon Rectum 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.

7 6 Bristol stool chart Type 1 Type 2 Separate, hard lumps, which are hard to pass Sausage-shaped but lumpy Constipation Type 3 Type 4 Type 5 Looks like sausage but with cracks on its surface Looks like sausage or snake, soft with smooth surface Soft blobs with clear-cut edges, can be passed out easily Normal stools Type 6 Fluffy pieces with ragged edges, a mushy stool Diarrhoea Type 7 Watery, no solid pieces The Bristol stool chart describes the size and consistency of stools.

8 2 Simei Street 3 Singapore Tel: Fax: Reg No R For appointments and enquiries, please call the CGH Appointment Centre at Tel: (65) CGH Appointment Centre operating hours: 8.30 am to 8.00 pm (Monday to Friday) 8.30 am to pm (Saturday & Sunday) Closed on Public Holidays For more information, please visit Organisation Accredited by Joint Commission International All information is valid at the time of printing (May 2012) and subject to revision without prior notice.

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