Reviewed by Dr Dan Rutherford, GP
What are the complications of constipation?
Haemorrhoids. These are swollen veins at the anus, caused by straining at a stool over a long period of time. If large enough they will be visible from the outside. They can be painful or cause local bleeding.
Dependency on laxatives. The bowel in someone who has abused laxatives over a long period of time becomes sluggish and eventually dependent on the use of these drugs.
Hernia (bulging of the abdominal contents through a weak point in the abdominal wall). This is made worse by too much straining when trying to get rid of hard stools.
A prolapse of the womb or rectum. These complications result from excess straining and weakness of the muscles in this area.
What medicines are used to treat constipation?
Bulking agents such as bran and ispaghula husk. These work gently and are the most common type of laxatives (examples are Fybogel and Regulan). They don't need to be in the form of medicines – increasing the fibre content of your diet should be the main treatment. Bulking agents should always be taken with plenty of fluids.
Stimulant laxatives that cause the bowel muscles to contract such as senna or bisacodyl.
Osmotic laxatives (such as lactulose) that increase the amount of water in the stools by drawing water in from the bowel lining.
Detergents that break down surface layers in the stool, letting water penetrate and soften it (such as docusate sodium).
Macrogols (polyethylene glycols). These are administered along with extra fluids, so they don't draw more water into the bowel from the body. Examples are Idrolax and Movicol. Macrogols may be of long-term benefit to patients with persistent constipation and faecal impaction.
Which treatment is best?
Laxatives
Large amounts of laxatives are bought over the counter every day.
This is due in part to the belief that it's desirable to move the bowels daily.
Laxatives of all types are among the most commonly prescribed medicines.
Yet little detailed medical research has been done to work out the best ways of treating constipation.
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