Constipation

Constipation can be a hard nut to crack, so to speak. It is often an ongoing issue rather than a one-off situation. That means we need to find management options that can be easily continued over time. As the RCH (with reference to children) says “Treatment is usually required for several months and if stopped early, may lead to recurrence”.

I highly recommend looking at the Royal Children’s Hospital (RCH) guidelines because there is lots of useful information there, particularly for children, but for adults also. I will refer to it throughout the article. It can be found here.

Here I am going to discuss both recommendations and the practicalities of them, as some are easier said than done!

Behaviour modifications:

·      Drink more water/fluid, if not having at least 1L per day. This helps the poos not get too dry and hard to pass.

·      Keep active. This helps the guts keep moving everything along. Being sedentary can be a significant contributor to constipation.

·      Position on the toilet – this one is really important for both adults and children. For adults I highly recommend a poop stoop, to get your feet a bit up off the floor. I recommend using this even if thinking you are just sitting down for a wee. It primes your body to be more ready to poop if there is one almost ready. (This is the sort of thing I mean here: https://www.bigw.com.au/product/big-softies-infant-step-stool/p/487233, you can get these at lots of places including Kmart and Amazon).

Dietary modifications

·      Avoid having too much cow’s milk as this can exacerbate constipation.

·      More fibre! Obviously, fruit and vegetables are a great way to do this, but eating plenty of these is not enough for everyone. Some people need more. The 3 things I recommend are Metamucil (or psyllium husk), Chia Seeds and LSA.

o   Fruit and Vegetables – different things will have different effects on different people, but top choices for constipation are apple, kiwifruit, grapes, broccoli, prunes, plums and pears.

o   Metamucil is basically ground up psyllium husk with flavouring. Most of them are incredibly sweet, if you don’t love super sweet stuff you may like the Lemon-Lime one more than the Orange. I recommend mixing it with refrigerated water and drinking it quickly before it goes gluggy.

o   Psyllium husk, located in the health food section of your supermarket. This can be mixed with water like Metamucil but goes into gluggy stuff quite quickly. It is better added to a smoothie or to cereal for breakfast

o   Chia seeds, you can make delicious chia seed pudding with it. If you google Chia Seed pudding, you will find a million recipes. You can also add it to Bircher muesli (or overnight oats), and you will barely notice it is there.

o   LSA mix is linseed, Sunflower and Almond meal. Again, you get it from the health food area in the supermarket. This can be added to smoothies, muesli or overnight oats.

Medications

The 3 points from the RCH website are key:

·      Osmotic and lubricant laxatives are usually required on a long-term basis (months to years). Reassure parents that this is safe and doesn’t produce a ‘lazy bowel’

·      Titrate medication aiming for one soft, easy to pass bowel action per day

·      A common cause of recurrence is stopping laxatives too early

Osmotic laxatives: include Osmolax, Movicol and Lactulose.

Osmolax and Movicol

For basically everyone over 1 month of age iso-osmotic laxatives such as Movicol or Osmolax are the first line option. The reason these are first line is because they work the best. Movicol and Osmolax contain the same active ingredient, Macrogol. Movicol just has the addition of electrolytes, which make it salty, and it has the options of flavours. Osmolax is relatively flavourless. For this reason, I think regular Osmolax is much more sustainable to achieve on a longer-term basis, because you can add it to any drink you enjoy drinking (juice, milk, tea, coffee, or just squeeze a lemon into water and have it with that). It can be difficult to have Movicol, when every time you think of having it you think “eurgh, I don’t feel like it right now”.

Lactulose

An excellent option for children because it tastes like sugar syrup, so not at all hard to get most kids to drink it. It is reported to make some people feel a bit gassy and/or bloated. You can mix this with water, juice or milk.

Stool softeners

Stool softeners make it easier and more comfortable to pass poos. This can be especially worthwhile for kids who are avoiding pooing due to fear of pain on passing the bowel motion. They include Coloxyl drops and paraffin oil.

Paraffin oil

One popular brand is Parachoc, and it tastes pretty delicious, so like lactulose, it is easy to give to children. In our household we call it “ice-cream medicine”, which is a little shot of 10ml of lactulose and 10ml of Parachoc. If you then combine that combination with milk, it tastes like a delicious milk shake! I have tried both Parachoc and Aragol (which is the other brand of paraffin oil) and Parachoc is far nicer.

Coloxyl

The coloxyl drops are useful for babies, and can be mixed with formula or milk. Coloxyl also comes as a combination with senna (in a tablet for adults). Senna is a stimulant, so is not ideal for long term use. It is also not recommended by obstetricians during pregnancy. Coloxyl on its own, is just not as effective as other options, so I don’t often recommend this.

However, when only used occasionally, Coloxyl and Senna can be very helpful to help get things moving.

Stimulants

Stimulants include medications with Senna in them, Ducolax or Bisacodyl. I do not routinely recommend stimulants as there are so many other options that work well and stimulants can cause gut pain if you are impacted (built up stools in the colon) and if used regularly can cause a ‘lazy gut’ once stopped.

Key Messages

·      Stay hydrated, keep moving and get into a good position on the toilet

·      Eat more fibre

·      Osmotic laxitives (like osmolax) work best and are safest long term

·      The easiest medications to give children are osmolax (in milk or watered down juice), lactulose or Parachoc.

Disclaimer: Please see your doctor for individualised advice or if you have any further concerns.