Normal bowel function ranges from one to two stools per day to one stool every 3-4 days. Constipation is normally defined as the infrequent passage of small or hard stools. Many individuals also use the term to cover such symptoms as straining at stool, hard or lumpy stools, incomplete evacuation, unproductive calls to stool, abdominal bloating and distension. Bloating is a common problem especially in women and usually consists of lower abdominal distension sometimes extending to the whole of the abdomen. It may or may not be associated with constipation. These problems are often aggravated by high fibre foods which generate gas.

Simple constipation is often the result of an inadequate intake of dietary fibre. Appropriate change to the diet with or without the addition of a bulking agent such as Metamucil whose usually sufficient treatment for simple constipation. When constipation does not respond to simple measures it is important to exclude complicating diseases such as bowel cancer. Investigation will usually require colonoscopy.

Constipation can also be associated with the irritable bowel syndrome, diverticular disease, disorders of the thyroid and a variety of medications. Patients with anal sphincter dysfunction, disturbance of the pelvic floor muscles or rectcoele (where there rectum protrudes into the vagina) often also suffer constipation.

Regular use of laxatives is required it is critical that a full investigation is undertaken to exclude any serious colonic disease. Some laxatives are safe to take long term some are not. Particular combinations of laxatives maybe useful for different types of constipation.

  For full details of investigation and treatment of constipation and bloating see: assets/documents/Constipation 2006.pdf

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