Preventing Constipation

Although many people suffer occasional constipation as a result of physical immobilisation or constipating medication, most people seeking the advice of their Doctor or their Pharmacist have – or are likely to progress towards – an ongoing (or, using medical terminology, chronic) problem.

Can people who are likely to progress in this way be identified and, if so, can this progression be prevented?

I have come to believe that the answer to both questions is “yes”. When I meet a new patient suffering from the symptoms of bloating, straining or constipation, it is generally possible to elicit a history of a tendency towards these difficulties stemming from adolescence or even childhood. And there is often an apparent aggravating event such as having experienced childbirth or having suffered an injury as a result of a motor vehicle accident or having undergone an operation, particularly one involving the pelvic organs (such as Gynaecological operations).

The persistent constipation triggered by these aggravating events usually came on top of a background of an already existing tendency towards constipation. For very many women (and the occasional man), early intervention using a rational treatment strategy will prevent a more serious episode from developing. And ongoing use of this strategy can prevent matters from deteriorating over the longer term as well.

If you have even a subtle tendency towards bloating, straining and constipation, you can anticipate deterioration in these symptoms in response to all sorts of seemingly unrelated events. For example, a longstanding but subtle problem with an occasionally sluggish bowel can turn into a major crisis with constipation after a period of immobilisation due to illness or surgery or even as a result of holidays involving travel. So if you suspect that there might be problems (and most people are all too aware of this possibility precisely because it has happened to them before) you should be prepared to act early along the following simple lines:

Let’s use the example of a woman who does have an occasional need for laxatives (and who regularly maintains a high dietary fibre intake to keep herself “regular”) and who has undergone a hysterectomy for non-serious pathology (say, fibroids of the uterus). Lying around in bed during post-operative recuperation, changes to the nerve supply of the rectum caused by surgical dissection in the pelvis and the constipating effects of pain-killing medication all serve to make her bowels even less responsive.

If her bowels have not worked for 48 hours, a strong and purging dose of magnesium sulfate capsules will reliably clear the bowel and should be taken then and there, rather than waiting in (possibly false) hope that things will correct themselves. The longer this first dose is delayed, the harder it will be to get things going again and the longer will be the period of recovery back to “normal”.

Thereafter, purging doses of capsules should be taken, if required, every 3 – 7 days to ensure that there is no build-up of bowel matter and no over-stretching of the bowel. In the longer term, as dose requirements reduce and as the bowel returns to its more usual and mild sluggishness, there will be improved response to fewer capsules. And it is reasonable and sensible to continue with a regular, weekly dose of magnesium sulfate capsules into the future.

In this manner, the immediate episode of constipation has been nipped in the bud and longer term deterioration will be prevented.

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