Everybody Poops

Everybody poops. At least that is what the book says, and what is supposed to happen. However, sometimes that is not the case and the bowel needs a little bit of help.

There are a number of approaches we can take when dealing with constipation. They will differ depending on whether we are dealing with a chronic condition, a temporary condition, or in some cases a side effect of a medication.

The ends of the digestive tract play a role in the regulation of water/fluid balance in the body. The stomach absorbs water, as does the colon, but the colon will also give water back to the rest of the body if it is needed.

It is not uncommon for changes in lifestyle to affect the regularity of bowel movements; travel, dietary changes, sleep pattern changes, or other modifications to your usual daily routine. Usually, these issues will resolve themselves over a few days. Things you can do to help include ensuring you have adequate water intake, adding some extra fruits and vegetables to the diet and increasing your exercise and movement. It is important not to fight the urge when it calls.

If, after a day or two you are not getting relief from the water and increased natural fiber, then you can consider other measures.

Chronic constipation is harder to manage and requires a different approach, and may also require combinations of different products. This is something that is best handled in consultation with a healthcare professional. If you believe the problem to be the result of a side effect from another medication you should also consult a healthcare practitioner

BULK FORMING LAXATIVES

These are the psyllium products like Metamucil^R etc or other insoluble fiber products (Benefibre^r and other generic house brands). Getting the sugar free, smooth texture or flavoured kind is simply a matter of preference to make the product more palatable.  There is little to the formulations to change how effective the product is. The idea of these products is simple; absorb water , expand in size and stimulate the muscles of the bowel to work naturally to move material along. These products must be taken with at least 240ml (8 ounces)  of water per dose. Add the product to the water, stir and drink. The longer you let the powder sit in the water before  drinking it, the more water it will absorb (and the thicker it will become). This can be important if you are taking other medications close to the time you are scheduled to take the bulk former.  It is generally recommended  in the product information that you separate bulk forming agents from  other medications  by up to 2 hours. The reason is that the bulk former could potentially take some of your medications with it as it passes through the system, and slow the absorption of the  other medication.  If you have to take them close together, saturate the bulk former completely with water by letting it sit longer in the water (15 to 20 minutes) and stirring completely a few times before drinking .

OSMOTIC LAXATIVES (Oral and rectal)

Salt/electrolyte solutions  (Fleet^R PhosphoSoda^R) lactulose (Chronulac, others),  PEG-3350 (Restorlax, Option+, various others) fall into this category. The idea here is that these products draw water into the colon, and thin out what is there. The salt/electrolyte solutions have fallen out of regular use due to the potential for other health issues, so they are generally not recommended for laxative use.

Like the bulk formers, these laxatives need lots of water to be effective. Based on effectiveness, and safety, PEG is becoming the go to for regular use.

STIMULANTS

Bisacodyl  both oral and suppositories  (Dulcolax^{R ,} newer forms of Ex-Lax^R and other, others) stimulate the muscles of the bowel to contract. This is not the place to start for laxative therapy. They are effective for occasional use, after trying the gentler treatments for an appropriate treatment period.

Senna or sennosides as discussed previously can sometimes be grouped in with the stimulants. Some of the products you will see on the shelves in pharmacies or health food stores contain senna (Senokot^R or other house brands) in one form or another. The active portion of senna is called a sennoside. It works by irritating and stimulating the bowel, bringing water to the colon and causing the bowel movement. Sennosides themselves are available from  several manufacturers. These are concentrated forms of senna in smaller tablets. There are also forms of senna available in combination with docusate sodium, long considered a stool softener (Senokot S^R and generic brands). There is some debate now as to whether or not docusate is as effective as we once thought it was.

SOFTENERS, EMOLLIENTS

Docusate sodium (Colace^R and house brands) and Docusate calcium (Surfak^R, Softlax^R and generic house brands) are the most common of these. For years these were what we started with for laxative therapy. The evidence for their effectiveness is now being disputed and they have fallen out of favour.

Mineral oil was used orally, but again the effectiveness is in question. Also, mineral oil can potentially be aspirated (brought back up and inhaled into the lungs) when used orally especially in children or the elderly. It is still used rectally in enema form.

Usually the first thing we want to discuss is the  diet. How much fruit and vegetables do you eat ? Do they make up the majority of your food intake? This is the best way to get the natural bulk forming fiber that you need to maintain proper bowel function. How much water do you drink versus other fluids?

Sometimes the ability to get enough fruit and vegetables is hindered by social or physical limitations. A good natural alternative is to prepare a form of stewed fruit laxative that can  be incorporated into the daily intake. The British Columbia Cancer Society Recipe is below:

FRUIT LAX RECIPE (BC Cancer agency website)

-Pitted dates 125 mL (½ cup)

-Prune nectar 310 mL (1¼ cup)

-Figs 125 mL (½ cup)

-Raisins 200 mL (¾ cup)

Simmer dates and prune nectar until dates are very soft. Put date mixture in a food processor and add figs, raisins and prunes. Blend to a smooth paste. Store in the refrigerator. Use on toast, crackers, ice cream etc.

Yield = 2 cups 1 tbsp = 45 calories & 1.0 grams of fibre

*If a thinner product is desired, more prune nectar can be added