www.badgut Constipation • • include: time, transit by altering stool. the hardening absorbed, is much water too colon, then the slowly foodpasses through meaning time, transit colon’s along role remove has to is water. someone If the and body the into absorbed have been nutrients of colon, most Usually, the the before foodenters expect. to what never knowing pattern, irregular an have Someindividuals orfriends. members family of those from different very maybe for person one bowel movement pattern anormal unique; is person Each tract. digestive the through travel 12-72to hours finally waste leftover from anywhere take could when Ameal stool. out as passes and mouth the enters males. in than females in frequently more elderly, the and occurring children 15- young in affects found commonly is and ofCanadians, 30% constipation Chronic pass. to difficult is which stool, or lumpy hard has constipation experiencing Aperson pass. to comfortable and (fecal stool soft the is long as as matter) a week, times three to a day times three from anywhere have to a bowelIt movement normal is (defecate) .org Factors that can contribute to constipation, often often constipation, to contribute can that Factors food when between duration the is Transit time radiation therapy, inflammatory bowel disease, bowel disease, therapy, inflammatory radiation (e.g., of body the ororgan tissue some to change aphysiological is there which in diseases system), nervous the affect that medications and supplements, oriron calcium codeine, antidepressants, (e.g., side-effects medication narcotics, some
• • you need more information on this topic. this on information more you need prolapse). Hemorrhoids on pamphlet for Ask our (rectal anus the out through pushes wall rectal the on streaks which in acondition and bleeding), red (rectal stool the bright disease, diverticular fissures, anal hemorrhoids, include These stool. pass to needed malaise. general and pain, back appetite, poor cause also may tract slowdown digestive the The in of constipation. symptoms common are evacuation of incomplete asensation and pain, abdominal bloating, orfullness, pressure piece. Rectal shaped sausage- hard, solid, one or pellets small many either like looking stool, lumpy, dry hard, in resulting infrequently, Bowelbloating. movements occur may and cramping abdominal to bowels,the leading on pressure increased colon the causes in remains Symptoms/Complications Most complications result from the intense straining straining intense the from result Most complications stool which during of time length increased The suppositories, orenemas. suppositories, of use laxatives, chronic and physical activity, insufficient and fluid, low fibre too in a diet consuming as choices, such lifestyle and diet and surgery, from resulting strictures or obstructions intestinal syndrome, bowel irritable as such disorders, functional or Parkinson’s disease), hypothyroidism, stroke, colon diabetes, cancer, Crohn’s Disease , if , if GI Society
Photo © style-photographs | Bigstockphoto.com 1 Diagnosis Food Guide, available from Health Canada, A panel of experts developed the main diagnostic and maintaining an adequate fluid intake, is the criteria for functional constipation, and update them recommended approach to prevent and manage regularly. Below are the current, Rome III, diagnostic constipation. (For more information on fibre, contact criteria*. our office.) 1. Must include two or more of the following: b. Straining during at least 25% of defecations Exercise c. Lumpy or hard stools in at least 25% of Exercise helps to move food through the colon defecations more quickly. Aerobic exercise, such as brisk d. Sensation of incomplete evacuation for at walking, accelerates your heart and breathing rates, least 25% of defecations and helps to stimulate the natural contractions of e. Sensation of anorectal obstruction/blockage intestinal muscles. for at least 25% of defecations f. Manual manoeuvres to facilitate at least 25% Physiotherapy of defecations (e.g., digital evacuation, support Pelvic dysfunction physiotherapy may include of the pelvic floor) bowel retraining, electrical stimulation, and posture g. Fewer than three defecations per week correction. 8. Loose stools are rarely present without the use of laxatives 9. Insufficient criteria for irritable bowel syndrome Medication Therapy (IBS) *Criteria fulfilled for the last 3 months with symptom If constipation does not improve with diet and onset at least 6 months prior to diagnosis lifestyle changes, then there are supplements and medications available. A physician may order a number of tests, including blood analysis, to check for abnormal levels of Bulk Forming Agents such things as thyroid hormone, electrolytes, or These are made of indigestible fibre, which glucose, and a stool sample to examine for hidden absorbs and retains fluid and helps to form a soft, (occult) blood. Other tests include a sigmoidoscopy bulky stool (e.g., Metamucil®, Prodiem®). While or colonoscopy, which are examinations with an not quick-acting, they are safe for longterm use. Add instrument that allows a physician to see the inside these to your diet gradually and increase your fluid of the rectum and colon. Colorectal screening is intake at the same time. recommended in persons older than 50 years of age. It is important to differentiate between temporary Enemas (acute) constipation and chronic constipation, as the An enema involves insertion of a liquid, usually treatments and recommendations may differ. water, into the rectum via the anus. Typically, after holding the liquid in place for a few minutes, there is an intense urgency to move the bowels. Management Always check with your healthcare provider Stool Softeners before making major changes, to be sure these These products work by holding water in the stool actions won’t interfere with other conditions you (e.g., Colace®). They are safe for long-term use and might have. for pregnant women and the elderly.
Lubricants Dietary and Lifestyle Modifications Lubricant laxatives coat the colon and stool in a waterproof film, allowing it to remain soft and Diet slip easily through the intestine, usually within 6-8 Eating regular well-balanced meals and snacks hours. Don’t use these products for longer than a with high-fibre content, as outlined in Canada’s week, as some have been shown to cause vitamin
2 GI Society Crohn’s Disease www.badgut.org deficiencies and medication interactions. An Enterokinetics example of a lubricant laxative is mineral oil. Not Prucalopride succinate (Resotran®) works recommended for pregnant women or for persons by targeting the serotonin (5-HT4) receptors in who have difficulty swallowing. the digestive tract to stimulate motility (muscle movement) and has Health Canada approval for Stimulants the treatment of chronic idiopathic constipation in These laxatives increase muscle contractions to women for whom laxative treatment has failed to move food along the digestive tract more quickly provide relief. Resotran® usually produces a bowel (e.g., Ex-lax®, Dulcolax®, castor oil, senna tea, and movement within 2-3 hours and then spontaneous Senokot®). Use only for very short-term situations complete bowel movements typically begin and under the recommendation of a physician or occurring within 4-5 days of starting treatment. Side pharmacist, because repeated use could cause the effects may include nausea, diarrhea, abdominal digestive tract to become stimulant reliant. Not pain, and headache, mostly following the initial dose recommended for pregnant women. and then subsiding with ongoing treatment.
Hyperosmotics Guanylate cyclase-C agonist Osmotic laxatives encourage bowel movements Linaclotide (Constella®) works by increasing by drawing water into the bowel from nearby tissue intestinal fluid secretion, which helps ease the (intestinal lumen), thereby softening stool. Some passage of stool through the digestive tract, relieving of these laxatives can cause electrolyte imbalances associated symptoms, and has Health Canada if they draw out too many nutrients and other approval for the treatment of chronic idiopathic substances with the water. They can increase thirst constipation in men and women. In clinical trials, and dehydration. There are four main types of Constella® showed a statistically significant hyperosmotics: improvement compared with placebo for complete Saline laxatives are salts dissolved in liquid; spontaneous bowel movements. The results occurred they rapidly empty all contents of the bowel, usually within the first week, often on the first day, of dosing working within 30 minutes to 3 hours. Examples and were sustained over the 12-week treatment of saline laxatives are citrate salts (e.g., Royvac®), period. Diarrhea is the most commonly noted side magnesium preparations (e.g., Phillips’® Milk of effect. Magnesia), sulfate salts, and sodium phosphate. Not intended for long-term use or for pregnant women. Lactulose laxatives are sugar-like agents that Outlook work similarly to saline laxatives but at a much Constipation can occur for many reasons, so slower rate, and are sometimes used to treat chronic treatment often requires trial and error. An individual constipation. They take 6 hours to 2 days to produce may experience a short bout of constipation and results. return to a normal routine, or it may be an ongoing Polymer laxatives consist of large molecules that health issue. With diet and lifestyle changes, and the cause the stool to hold and retain water. They are proper use of supplements and medications, most usually non-gritty, tasteless, and are well tolerated forms of constipation are manageable. If your bowel for occasional constipation. Results can be expected habits change drastically for no apparent reason, be within 6 hours, but it can take longer depending sure to consult your physician. on the dose. An example of a polymer laxative is polyethylene glycol (e.g., PegaLAX®). Glycerine is available as a suppository and mainly has a hyperosmotic effect, but it may also have a stimulant effect from the sodium stearate used in the preparation. Glycerine is available through several manufacturers.
www.badgut.org Crohn’s Disease GI Society 3 Notes: About Us As the Canadian leader in providing trusted, evidence-based information on all areas of the gastrointestinal (GI) tract, the Gastrointestinal Society is committed to improving the lives of people with GI and liver conditions, supporting research, advocating for appropriate patient access to healthcare, and promoting gastrointestinal and liver health. The Inside Tract® newsletter provides the latest news on GI research, disease and disorder treatments (e.g., medications, nutrition), and a whole lot more. If you have any kind of digestive problem, then you’ll want this timely, informative publication.
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The GI Society, in partnership with the Canadian Society of Intestinal Research, produced this pamphlet under the guidance of affiliated healthcare professionals. This document is not intended to replace the knowledge, diagnosis, or care of your physician.
© Gastrointestinal Society 2014
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