A condition characterised by a change in usual bowel habits and dry, hard stools. There is a decreased frequency of bowel action and patients should be assessed individually.
Constipation may have many causes:
» incorrect diet (fibre and fluid); » certain drugs;
» lack of exercise; » metabolic;
» pregnancy; » endocrine;
» old age; » neurogenic;
» psychogenic disorders; » lower bowel abnormalities;
» chronic use of enemas and
» ignoring the urge;
» cancer of the bowel; » behavioural problems in
Dietary advice preferably by dietician.
Dietary measures i.e. balanced diet with unprocessed foods, e.g. cereals,
legumes, fruit and vegetables.
Correct dehydration. Ensure adequate fluid intake.
Wheat bran: introduce slowly and take with sufficient fluid. Side-effects
include: bloating, cramps and flatulence.
Manual removal of impacted stools.
Encourage regular bowel habits.
Lactulose, oral, 10–20 mL daily.
o Titrate to effect i.e. up to 60 mL daily.
For short term use only, except in the elderly where long-term treatment may
Sennosides A and B, oral, 7.5–15 mg at night 2–3 times a week for up to 4
Polyethylene glycol-based purges
For acute bowel preparation or for chronic constipation on specialist advice.
Saline or phosphate enemas
May occasionally be indicated in acute constipation.
» For investigation for organic disease.
Reference and further reading
Standard Treatment Guidelines and Essential Medicines List for South Africa 2012 Edition