Constipation and over-the-counter remedies |20 May 2021

Constipation is described as a common gastrointestinal symptom which can affect people of all ages.

In the following interview with Zarine Udwadia-Durup, pharmacist at Behram’s Plaisance Pharmacy, we learn more about constipation and the role of pharmacists in helping patients to treat and manage constipation.

Seychelles NATION: Can you explain to us what constipation is?

Zarine Udwadia-Durup: There is no clear definition for constipation as patients may have different opinions of what their ‘normal’ is. Typical diagnosis of constipation is usually done by talking to the patient and getting their medical history.  

Generally speaking, a person may be constipated if they have not gone to the toilet at least 3 times during a week, have had to strain or are in pain when forcing a stool, or if the stool is very hard, dry and lumpy. In certain cases, they may also experience some abnormal cramping or pain.

Seychelles NATION: Who is most at risk of having constipation and what are some of the common causes?

Zarine Udwadia-Durup: Constipation is two to three times more common in women than in men and the incidence increases with age. Almost half of pregnant women will also experience a bout of constipation due to changes in hormones, particularly progesterone, which cause the muscles in the bowel to relax, which means it takes longer for food to digest and be excreted.

Further causes of constipation could be due to certain medicines or diseases, dehydration, lack of fibre and lack of physical activity.

Source: National Institute for Health and Care Excellence Nov. 2020

Seychelles NATION: You mentioned that constipation along with certain other symptoms need to be investigated. Tell us more about this. 

Zarine Udwadia-Durup: There are cases where constipation could be a symptom of an underlying condition and symptoms/family history such as the ones below have to be investigated further by a doctor:

•           Rectal bleeding
•           Mucus in stools
•           Unexplained or unintended weight loss
•           Severe or sudden abdominal pain
•           Feelings of a mass in the abdominal or rectal area
•           Fever
•           Family history of colon and/or ovarian cancer
•           Family history of inflammatory bowel disease
•           Medical history of taking certain antipsychotic medicines, namely clozapine

Seychelles NATION: What role can pharmacists play in the treatment and management of constipation in patients?

Zarine Udwadia-Durup: When treating constipation over the counter, we usually have two main aims: firstly, we want to treat the symptoms and secondly, prevent patients from getting it again.

Initially, symptoms of constipation are managed by advising the patient to make certain lifestyle and dietary changes such as:

•           increase fibre intake
•           drink plenty of fluids but avoid caffeine containing products
•           reduce alcohol intake
•           reduce stress
•           do not ignore the need to go to the toilet to pass stools
•           do some form of physical exercise.

If none of these interventions help, patients can proceed to try some over the counter (OTC) remedies. There is a whole plethora of products that are available for short term treatment of constipation in adults that can be purchased from pharmacies. We usually use a step wise approach when choosing which laxative to use. This can be seen in the flow chart below:

If OTC remedies don’t give any relief after 5 days, patients are advised to see a doctor but, in the meantime, continue with the lifestyle and dietary measures.

It is important to note that there are some patients who misuse, abuse or use laxatives excessively which can be very dangerous. Treatment with laxatives should stop once soft stools are produced without straining for at least three times a week. Regular use of laxatives, particularly stimulant ones, are not recommended as this could cause patients to develop what we call ‘lazy bowel syndrome’.

Lazy bowel syndrome is not an actual disease but a term used to describe when the bowel cannot fully function on its own to get rid of body waste. The bowel literally becomes slow and lazy and cannot move food fast enough to the colon, causing the constipation. The bowels would therefore need a laxative to ‘stimulate’ the movement again.

However, this can be a never-ending cycle and use of stimulant laxatives is not recommended. Instead, the patient should revert to dietary changes and if a laxative is really needed, then one with a high fibre content like Fybogel is preferred. If that still doesn’t help, referral to a doctor may be advised.

For more information, contact Behram’s Plaisance Pharmacy:

-               Telephone: 4 345 783

-               Email: plaisancepharmacy@seychelles.net

F. P.