Usual treatment regimes for constipation revolve around daily or twice-daily use of laxatives. Initially, fibre supplements are almost routinely prescribed. If this fails to work or if the fibre supplements cause too much bloating and discomfort, stronger laxatives will be prescribed, again on a daily or twice-daily basis. All this is built upon the misconception that your bowels must work daily and that daily laxatives are the best way to achieve this.
My own philosophy is based upon two critical observations:
Whereas, for most people, on most occasions, a bowel action follows the urge to go without any conscious awareness of the critical connection between the two, in people who are constipated, the urge to evacuate is virtually always faulty. The urge might be weak, infrequent or even absent. Alternatively it might seem considerable but does not, after all, herald the arrival of a worthwhile result.
Whichever way there is, at the heart of the problem, either a disturbance of urge or a disturbance of the usual relationship between urge and response. Without the urge to evacuate being true and strong, bowel function can be a major source of discomfort and exasperation.
Thinking along these lines, then, the solution to constipation primarily revolves around the ability to re-establish - and then respond to - a true and strong urge to evacuate. This observation and solution represents a genuinely new paradigm for the management of constipation. Put simply, the successful management of constipation requires you to recreate an irresistible urge to empty your bowels – and this is achieved by taking large enough dose of a suitable laxative (I routinely use magnesium sulfate capsules) to insist upon such an urge.
A recurring observation I have made in my practice is that the very best way to achieve comfortable and spontaneous bowel activity is not to take laxatives every day but to ensure that the bowel is emptied completely on a weekly basis using a non- habit forming laxative such as magnesium sulfate. Cleaning the bowel out thoroughly with magnesium sulfate capsules actually allows the intestinal muscle to recover some of its ability to contract spontaneously. Waiting a period of time between doses allows that recovery to declare itself while freeing you up from the misplaced sense of having to have your bowels open every day.
So, if you are a patient newly referred to my practice and suffering from bloating, straining and constipation, I will set out the following broad strategy for your treatment:
Once-weekly magnesium sulfate capsules taken at sufficient dose to:
provoke a powerful urge to empty your bowels, and
thoroughly clean out the bowel
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