Constipation

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Constipation is a common digestive issue characterised by infrequent bowel movements or difficulty in passing stools. 

It may be chronic or occasional and can lead to discomfort, abdominal pain, and bloating.

Around 15-20% of Australians may experience constipation at any one time. 

Constipation can be caused by a variety of factors including:

• Dietary Choices: Low fiber intake, inadequate hydration
• Physical Inactivity: Lack of exercise or mobility
• Medication Side Effects: Certain medications like opioids, antacids with calcium or aluminum
• Medical Conditions: IBS, diabetes, neurological conditions like Parkinson's
• Psychological Factors: Stress or depression
• Aging: Slower metabolism and muscle contractions in the digestive system

Symptoms of constipation include:

• Less than three bowel movements a week
• Hard, dry, or lumpy stools
• Straining to have bowel movements
• Feeling of incomplete evacuation
• Abdominal pain or bloating

In Australia and around the world:

• Bulk-Forming Laxatives: Psyllium (Metamucil), Methylcellulose (Citrucel)
• Stimulant Laxatives: Bisacodyl (Dulcolax), Senna (Senokot)
• Osmotic Laxatives: Lactulose (Duphalac), Polyethylene glycol (Movicol)
• Stool Softeners: Docusate (Colace)

• Bulk-Forming Laxatives: Bloating, gas
• Stimulant Laxatives: Cramping, diarrhea, dependency if overused
• Osmotic Laxatives: Gas, bloating, dehydration
• Stool Softeners: Throat irritation, mild cramps

Constipation affects around 16% of adults globally and 33% of adults over the age of 60. 

In Australia, around 15-20% of the population may experience constipation at any given time.

• High-Fiber Diet: Including whole grains, fruits, and vegetables
  • Reference: Christodoulides S, et al. Systematic review with meta-analysis: effect of fibre supplementation on chronic idiopathic constipation in adults. Aliment Pharmacol Ther. 2016.
• Adequate Fluid Intake: Particularly water and warm liquids
  • Reference: Arnaud MJ. Mild dehydration: a risk factor of constipation? European Journal of Clinical Nutrition. 2003.
• Regular Exercise: Helps stimulate intestinal activity
  • Reference: De Schryver AM, et al. Effects of regular physical activity on defecation pattern in middle-aged patients complaining of chronic constipation. Scandinavian Journal of Gastroenterology. 2005.
• Probiotics: Like Bifidobacterium and Lactobacillus strains
  • Reference: Dimidi E, et al. The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2014.

De-prescribing for constipation often revolves around encouraging non-pharmaceutical interventions, such as dietary and lifestyle changes.

• Dietary Interventions: Several studies show the positive effect of dietary changes in managing constipation without medications.
  • Reference: Müller-Lissner SA, et al. Myths and misconceptions about chronic constipation. The American Journal of Gastroenterology. 2005. Link
• Integrative Approaches: Tailoring treatment by integrating lifestyle and dietary interventions, as shown in various guidelines.
  • Reference: Leung L, et al. Chronic Constipation: An Evidence-Based Review. Journal of the American Board of Family Medicine. 2011. Link

Managing constipation often involves understanding the underlying causes and addressing them with both dietary and lifestyle changes. Effective de-prescribing programs can help patients transition away from reliance on medications, with appropriate guidance and personalized care.