Treatment of Constipation
As we have discussed earlier that constipation is just a symptom not a disease in itself so, treatment of constipation involves treatment of underlying cause. In earlier sections we have seen that there are so many causes of constipation.
It is extremely essential to get medical advice rather than gulping the over the counter laxatives and making the condition worse from bad. Treatment of constipation essentially involves taking good history of the condition and other associated complains with a good diet history and drug history followed by thorough physical examination and investigations if needed. The treatment is provided depending upon the findings in above all examinations and final diagnosis.
Treatment of the constipation involves many steps . The role of patients and guardian is very important in the process. The role of patients and guardians is as important as medical professional in the management of the constipation. The steps in treatment of constipation involves:
- Education about constipation.
- Softening of the retained faeces.
- Evacuation of the retained faeces.
- Prevention of further faecal retention.
- Supporting the patient and family throughout the process.
Let us see what these step mean one by one with their description:
Table of Contents
Education of the patients and guardians in case of children:
It becomes very essential to explain the patients and in case of children to the parents that how constipation occurs. Explaining them causes and mechanism of constipation helps to involve them actively in management of constipation. The management becomes easier with this step done. They may follow the medical advise better and with knowledge why to follow that they are happy to see the results. Educating importance of healthy diet including dietary fibers and daily exercise is very important in all forms of constipation. Teaching proper method of toilet training is utmost important in case of infants and toddlers. Teaching methods of prevention of constipation is important for adults and old age patients. Explaining the patients and parents that they may need long term follow up is utmost important. It is educated to parents and guardians that they should not become frustrated and shout at the patients as they are facing genuine problem which also hurts psychologically. Explaining importance of using toilets when needed and not holding stool is very important in the process. Stool holding habits should be strongly discouraged. Bristol stool chart should be given to parents and patients and they should be asked to keep the record of daily motion to assess the effectiveness of the treatment and whether to escalate the therapy. This charting method helps the patients and medical professional to assess the severity and also deciding the dosages of the medicines.
Softening of the retained faeces:
As patients with constipation usually come in frightened state with retained hard stool it is very essential to relieve their symptoms allay the anxiety. The softening of retained stool helps them to pass the retained stool with minimal efforts. This step reduces their immediate anxiety and they are more receptive to the advice given with proper counselling. During this stage patients and in case of children parents are advised to drink more amount of water. Stool softeners like lactulose can be given in dosages 1-3 ml/kg. Patients and parents are advised that stool softeners many increase the faecal soiling of clothes. These drugs may take at-least 2-3 weeks to show the effect in some cases. The dose is started with minimal and increased to maximum if it is needed. Along with medicines giving healthy diet containing dietary fibers is very essential. The amount of fruits and green leafy vegetables are increased in the diet. The amount of animal milk intake should be kept to minimal. Patients should avoid products from bakery and biscuits and cakes.
Evacuation of retained stool:
When stool is softened most of the patients pass the stool effortlessly. It is sometimes still not possible to pass the stool. In these patients further medications are needed to make the patients to pass the stool. Further steps include:
Senna is anthranoid stimulant laxative. It is used to evacuated impacted stool. Single dose is sufficient. This medicine may cause abdominal pain and soiling of the clothes. If stool is too hard and too impacted it may need more larger dose of the medicine.
It acts in similar fashion but can cause explosive diarrhea. These medicines should be used with caution and only with medical advice as these may lead to electrolyte imbalance in some patients.
Polyethylene glycol is a good choice of medicine for this purpose. It acts by osmolarity accumulating more water in stool softening it. Only drawback is bad test may cause vomiting. Polyethelene glycol is now a days available in good flavors and additionally it can be mixed with testy fruit juices to make it more palatable.
This process can help to evacuated hard stool low in rectum and the sigmoid colon. Hypertonic saline phosphate is used. This should be used with a great caution and with fluid 30ml/5kg body weight. This measures tend to aggravate the fear in some patients and this fear may reduce the compliance with the therapy.
Manual evacuation of the retained faeces:
Manual evacuation is indicated when retained faecal matter is causing respiratory difficulty because of stool pressing diaphragm from below, severely protracted cases of the constipation, acute obstructive signs of the faecal impaction.
Prevention of the further faecal retention
- After treating the acute problem it is very essential to treat the problem underlying and also preventing constipation in future. This may need medicines to be continued till a year. Long term follow up is very essential for the successful treatment and prevention. Prevention of constipation also prevents the complications occurring because of constipation.
- Regular bulk laxative like ispaghula or methylcellulose that helps to increease bulk of the stool and also makes the stool softer is given regularly. This will lead to regular arrival of the stool in colon and rectum inducing ano-rectal reflex giving sensation of stool.
- Regular stimulant laxative like bisacodyl, which is polyphenolic stimulant laxative or senna. In severe cases combination of sodium picosulphate on weekends may reduce the accumulation.
- Treatment may be needed for one year with cycles of increasing and reducing the doses.
Supporting the patient and family throughout the process:
As we know suffering from constipation is a painful thing for anyone the support is needed to the patients and families to handle this situation. Additional medical help is need to treat the underlying cause of constipation which may be improper diet or a real cause like hypothyroidism. The patient may have got mental trauma because of consequences of constipation which may be loss of workdays and isolation and depression in the process. This needs to be addressed with the professional psychiatrists’ help. The families should be counselled regarding the problem and its treatments. All inclusive therapy for the family helps to overcome this problem with a reasonably good success rate. Teamwork of doctor, patients and their guardians make the treatment of constipation successful.