Constipation is basically any change in bowel habits from what is usual for you. Having bowel movements anywhere from three times a day to once every three days is considered normal. However, bowel movements can become difficult or uncomfortable, or there may be fewer than usual. This is called constipation. Stool (waste) may be lumpy or hard. After a bowel movement, it may feel like there is still some stool left to come.

Causes

Constipation can develop for many reasons. Resisting the urge to have a bowel movement and not getting enough exercise are two of those. Many medications, including prescription pain medications, aluminium and calcium antacids, iron, and some high blood pressure medications, can also contribute to the problem. Several medical conditions, such as Parkinson's, multiple sclerosis (MS), and depression can lead to constipation.

Prevention and management of constipation

Many non-drug measures can help prevent and manage constipation. Start by increasing your fibre intake. Eat more fruits, vegetables, and bran cereals. Add fibre-rich foods to your diet slowly to avoid too much gas and bloating. Drink more fluids, aiming for at least six to eight glasses per day. Avoid beverages containing caffeine, as they can be constipating. Exercise also stimulates the bowels. Aim for at least 30 minutes of physical activity every day.

Develop a regular toilet routine. Pick a time of day to attempt a bowel movement. The best time is after meals, especially in the morning after breakfast. Allow time to sit for a few minutes, and avoid straining. If you do not have a bowel movement after a few minutes, get up. Try again when you feel the need to go, or at your next scheduled time. Avoid resisting the urge to pass stool.

If you are using a medication that contributes to constipation, talk with your doctor or pharmacist about preventive therapy or other available medication choices.

Treating constipation with medication

If non-drug measures do not work, talk to your doctor or pharmacist about whether a laxative may help. People who have irritable bowel syndrome or hemorrhoids may benefit from treatment. If you have any bleeding or pain in the rectum, diarrhea alternating with constipation, nausea, vomiting, or stools that are pencil thin, see your doctor before beginning treatment.

Bulk-forming laxatives, such as psyllium, polycarbophil, and methylcellulose, are safest. They work by absorbing water and increasing bulk, increasing the urge to have a bowel movement. Mix the laxative with at least one cup (250 mL) of water. Find a time of day when you can take it apart from any other medications. These products, especially psyllium, can cause gas and bloating. They take one to three days to start working, and can be used long-term to prevent constipation.

Lubricant laxatives such as mineral oil coat stool with a waterproof film, making it easier to pass. They act more quickly, within six to eight hours when taken orally. They work in about 15 minutes when used rectally. However, a risk of pneumonia exists when mineral oil is taken by mouth, since there is a chance of inhaling oil droplets into the lungs. These laxatives should be used for short periods of time only.

Hyper-osmotic laxatives include glycerine suppositories and lactulose. They cause fluid to be retained in the bowels. Glycerine suppositories are safe for almost anyone and work in 15 minutes to an hour. However, they can irritate the rectum. Get advice from a doctor before using a glycerine suppository for a child under six months of age.

Many people safely use lactulose, a syrup, to prevent constipation. It can cause gas, belching, and abdominal discomfort. Lactulose generally works within 24 to 48 hours.

Stimulant laxatives, such as sennosides and bisacodyl, can relieve constipation. They work within six to 12 hours and are often taken at bedtime to provide 'overnight relief.' These laxatives should only be used with more severe constipation lasting more than several days. They can cause cramps and abdominal discomfort. Using stimulant laxatives on a regular basis can make you dependent on them for bowel movements. Only use them for a short time, unless directed otherwise by your doctor.

Those undergoing diagnostic procedures or surgery may need a laxative to completely empty their bowels before the procedure. Again, talk to your doctor beforehand if you are experiencing any rectal pain or bleeding, diarrhea alternating with constipation, nausea or vomiting, or stools that are pencil thin.

Saline laxatives, such as magnesium citrate, magnesium hydroxide, sodium phosphate, and magnesium sulphate, completely empty the bowels. They are used to prepare the bowels before surgery or diagnostic procedures, and should not be used continually. They work quickly, within three hours if taken orally and 15 minutes if used rectally. These products can cause nausea, vomiting, and cramping. Be sure to drink the amount of fluid given in the instructions to prevent dehydration.

Hemorrhoids

Hemorrhoids are a normal part of the anal canal, which is at the very end of the intestines. They act as pads that cushion the canal during bowel movements. They also help control bowel function, and are found in two locations. Internal hemorrhoids are inside the rectum and cannot be seen or felt. External hemorrhoids are by the edge of the anus, which is the opening at the end of the canal (see diagram).

Cause and prevention

Hemorrhoids become a problem when these cushioning pads become displaced, leading to pain and irritation. Although the cause is not entirely known, many factors can contribute to developing hemorrhoids. Straining, usually as a result of constipation, commonly causes problems. Standing or sitting all day, lifting heavy objects, and sitting on the toilet for long periods of time can also increase the risk.

Pregnant women often have problems with hemorrhoids, due to increased abdominal pressure and greater chance of constipation.

Common signs and symptoms of hemorrhoids include itching, irritation, burning, swelling, and inflammation, especially after a bowel movement. Those with severe pain, bleeding, or leaking of bowel contents should be assessed by a doctor. As well, anyone diagnosed with gastrointestinal disease, a family history of colon cancer, or younger than age 12 should see a doctor before starting treatment.

Before using medications, try lifestyle changes. Get more fibre and fluid in your diet, and exercise regularly.

Avoiding constipation is key in preventing hemorrhoids. Do not strain during bowel movements or resist the urge to go. Try not to stay on the toilet for more than a few minutes.

Easing symptoms

Many measures can relieve problem hemorrhoids. Adding fibre to the diet and increasing fluid intake can help if constipation is a concern. Sitting on a pillow or donut cushion may help relieve pain. A sitz bath is a tub of warm water that fits over a toilet seat rim for you to sit in. Try using it three to four times per day for about 15 minutes to relieve itching and inflammation.

After bowel movements, cleanse the affected area with soap and water and wipe with a wet tissue. Any hemorrhoids that emerge should be put back in position with a moistened tissue or a clean finger.

Medication

Although several non-prescription medications may relieve symptoms of hemorrhoids, they are not a cure. Oral acetaminophen can help if you have a lot of pain.

Local anesthetics, such as benzocaine, dibucaine, and pramoxine, can temporarily relieve pain, irritation and itching. They are relatively safe to use for seven days or less, but should only be used externally.

Vasoconstrictors, such as phenylephrine, can be used both inside and out to reduce swelling and relieve itching and irritation. Anyone with very high blood pressure, diabetes, hyperthyroidism (overactive thyroid gland), BPH (enlarged prostate), or who is using MAOI medications (a type of medication for depression), should avoid vasoconstrictors.

Protectants, such as aluminium hydroxide, cocoa butter, mineral oil, white petrolatum, and cod or shark liver oil, are safe for most people to use. They form a physical barrier on the skin and help prevent water loss and irritation. They can be used both inside and outside the rectum.

Astringents include zinc oxide, zinc sulphate, and witch hazel (also known as hamamelis water). These form a protective layer and produce a drying effect to soothe the area and relieve burning and irritation. Zinc oxide and zinc sulphate can be used both externally and internally. Witch hazel is recommended for external use only.

Hydrocortisone can temporarily relieve itching and inflammation. Do not use it longer than a week.

Hemorrhoid medications come in a variety of forms. Creams, ointments, and gels are often the preferred choice. Suppositories are available, but may slip past where they are needed and go too high into the rectum. Pre-moistened wipes can clean and soothe irritated areas.

To use these medications, first wash your hands well. Clean the affected area and gently pat dry. For external application, apply a thin layer of ointment or cream with your fingertip. Use the applicator tip provided to apply a product internally.

If you have no relief after seven days of using these products, see your family doctor. Stronger prescription medications and other treatments are available.

Pregnancy

As mentioned, pregnancy increases the chance of developing constipation and hemorrhoids. Changes in hormones, calcium and iron supplements, and pressure from the unborn baby can result in constipation. Straining to have a bowel movement can form hemorrhoids.

Before using medications, try lifestyle changes. Get more fibre and fluid in your diet, and exercise regularly. Bulk-forming laxatives can be used safely. Using a sitz bath and sitting on cushions also help with hemorrhoids. Talk to your doctor before trying any other non-prescription medications.

Constipation and hemorrhoids affect many people. Fortunately, lifestyle changes can help deal with these unpleasant conditions. Medications are also available. Talk to your doctor or pharmacist about what might be right for you.

The Bottom Line Dealing with constipation and haemorrhoids

Although we may feel reluctant to discuss them, constipation and hemorrhoids trouble many of us. These common conditions range in severity and can affect quality of life. Fortunately, they are both preventable and treatable.

Constipation