SPECIAL REPORT: MANAGING CONSTIPATION AND FAECAL IMPACTION IN PRIMARY CARE
Encourage them to commit to at least 90 minutes per week of any exercise that gets their heart rate up, their breathing faster and makes them feel at least a bit tired
both soften the stool and encourage proper bowel function.
Keep Hydrated On the subject of hydration, too many fizzy drinks would dehydrate rather than hydrate. Ideally, your patients should think Oral Rehydration Salts5 (ORS) but, failing this, a volume of at least 2-3 litres per day is the advice that you can give. This might be as water, flavoured water, tea, coffee, milk, stew, soups or fruit juices with all the usual caveats of not too much of anything that has known negative health effects and, of course, it has to be palatable to the individual concerned. Another suggested approach is to introduce the concept of daily ‘servings’ of water to prevent the stool becoming dry and hard. A ‘serving’ is a full glass and your advice is for adults to have at least 6-8 of these per day.
Other Possible Causes of Constipation Other lifestyle factors that may lead to constipation include jet lag and travel and this may be because of combinations of changes of mealtimes, diet and lack of convenient access to toilets. A rarer cause of constipation perhaps similar to those rich ladies who simply must have a caesarean and are labelled ‘too posh to push’ are those who feel they are ‘too busy to poo’. This lifestyle trait ignores the fact that the reflex action is developed to encourage us to poo at appropriate times and those who ignore this too often blunt the reflex and, not surprisingly, get constipation as a result. Prescription and over the counter medicines can lead to constipation. Anticholinergics6, because
they affect the interaction between nerves and muscles of the bowel. Anticholinergics may be in muscle relaxants or used to treat the overactive bladder. Narcotics such as codeine and morphine. Laxative overuse or abuse interestingly can be a cause because, in a way, they teach the bowel to become ‘lazy’ and reliant on them and, in their absence, normal muscular and peristaltic action does not resume as it should. Iron and vitamins containing iron can lead to constipation as can calcium supplements and antacids that contain aluminum. Drugs used to treat seizure disorders, Parkinson’s disease, hypertension and schizophrenia may all exacerbate the problem. Systemic diseases such as multiple sclerosis, Parkinson’s disease (independent of medication), diabetes or thyroid disease may lead to constipation as may complications from pelvic or colorectal surgery. Local diseases or problems such as a spinal cord injury, irritable bowel syndrome, diverticultis or uterine prolapse may cause it as well. If the process of defaecation is painful, it is understandable that it will be held back and so those with local pain or discomfort around the anus caused by an anal fissure or haemorrhoids may become constipated.
Summary Preventing constipation and faecal impaction aligns with all the sensible advice you as a General Practitioner would want to give all your patients about lifestyle in terms of eating, exercising, drinking well and managing their life stressors, diseases, medications and their travel arrangements.
References: 1
https://www.drmcdougall.com/misc/2013nl/jan/burkitt.pdf Accessed 20/1/2017
2 3 4 5
12 | WWW.PRIMARYCAREREPORTS.CO.UK
https://www.drugs.com/health-guide/constipation-and-impaction.html Accessed 20/1/2017 http://lifehacker.com/what-it-means-to-eat-the-rainbow-1594799068 Accessed 20/1/2017 http://www.who.int/maternal_child_adolescent/documents/fch_cah_06_1/en/ Accessed 20/1/2017 https://www.parkinsons.org.uk/content/anticholinergics Accessed 20/1/2017