Constipation treatment for diarrhea. Have I gone mad? No, one of the causes of diarrhea is actually chronic constipation.
If you don't have a bowel movement for quite some time, as the feces sit there the bowel draws more and more fluid from them (which is its job) and they gradually become drier and drier.
This can cause a hard plug to form which is difficult to shift. This is called fecal impaction.
This plug of hard feces stretches the bowel which affects the nerves. This causes the signal to open the bowels to get weaker causing the constipation to get worse.
The blockage means that liquid stool from higher up in the bowel can't move along and eventually as the pressure builds up it leaks around the sides of the impacted plug of poop.
This type of diarrhea is called overflow diarrhea or bypass diarrhea. The medical term is encopresis, although this word is used mostly when referring to children.
This type of diarrhea is most common in children from aged 4 upwards, the severely disabled and in the elderly, especially if they have dementia but anybody with chronic constipation could suffer.
You may not have all these symptoms but long periods of constipation followed by diarrhea point to overflow diarrhea / bypass diarrhea with the need for constipation treatment.
You should seek medical attention if you have the above symptoms especially if they come on suddenly. If you feel well but have diarrhea following constipation see your family doctor. If you feel unwell with other symptoms then go to the emergency room.
Your doctor will take a history from you to find out what has been happening. They will feel your abdomen as sometimes constipation can be diagnosed in this way.
They will stick a lubricated gloved finger into your back passage (rectum) to see if they can feel a blockage. You may feel embarrassed by this test but don't worry the doctor is doing it all day long!
If there is any doubt they will send you for an abdominal x-ray as constipation will show up on the picture.
Your doctor may order other more sophisticated tests such as a barium enema or colonic transit studies.
As with most things prevention is better than cure and it is important to try and prevent constipation happening in the first place. This is especially important for children and the elderly.
If constipation does happen, do not leave it before seeking help because chronic constipation can lead to impaction. If this happens it can be difficult to sort out and if left too long the signals to the bowel will get weaker and weaker making the problem worse.
If you think that you may have constipation or fecal impaction with overflow diarrhea then it is important that you see your doctor to check that your diarrhea is not caused by something else. Depending how severe the constipation is there are many different constipation treatments that can be recommended.
If possible and after advice from your doctor it is best to start with the least invasive treatments.
It has been found in a number of studies that probiotics can be used as a constipation treatment. It is too early to recommend a specific strain, although bifidobacterium infantis looks to be a good contender but a good all round probiotic with a range of strains would be a good place to start.
It makes sense that if our friendly gut flora is well balanced then our bowels will work more efficiently. For more information see this blog post from Harvard Medical School.
Although the normal advice is to cut down on dairy products if you are constipated some live yoghurt can be beneficial as it contains friendly bacteria.
The first thing that many people think of when constipation treatment is mentioned is laxatives. There are different types. Although most laxatives can be bought over the counter they should not be used by people with bowel conditions or by children unless they are under medical supervision.
Be careful when using laxatives as overuse of some types can lead to dependency and chronic constipation.
This type of laxative should be the one to try first. They work as a constipation treatment in the same way as fiber in the diet by increasing the stools bulk and helping them to retain fluid and making them softer. This makes them easier to pass.
They should be taken with a large glass of extra water as they can cause blockages in the throat and bowel if they get too dry. It is also a good idea to take them early in the day so that you can have enough time to drink plenty of fluids before going to bed.
Examples to try include methylcellulose (Eg.Citrucel), sterculia granules (Eg.Normacol), polycarbophil (Eg.Equalactin and Konsyl Fiber) and ispaghula (Eg.Fybogel) or pysllium (Eg. Metamucil) husk.
You should start off with a low dose bulk forming laxative and build up gradually to avoid extra gas. You will see an effect in 2-3 days.
These laxatives pull water into your bowels from the body helping to make your stools softer and easier to pass.
Try lactulose (Eg. Kristalose) and sorbitol. Side effects can be extra gas and fecal incontinence if you overdo the dose so start off carefully with a low dose.
Both these and bulk forming laxatives can cause dehydration so be careful to drink plenty.
Macrogol (polyethylene glycol) is the generic name of a number of laxatives which use the main constituent macrogol 3350. Trade names include Movicol, MiraLAX, Softlax, Purelax, Cololyt, and Osmolax.
They can be bought over the counter in some countries such as America and Australia but in the U.K. for example they are prescription only.
The good thing about these laxatives is that they do not draw fluid from the body into the bowel like osmotic laxatives. Instead they bond with the water that they are mixed with and carry this to the stool which is stuck. The stool is then softened and re-hydrated. As it swells it stimulates the bowel's natural action and will start to move along.
The macrogol is expelled from the body virtually unchanged.
The pros: they do not cause dehydration and they work with the natural action of the body. As they do not stimulate the nerves in the bowel you should not end up with the problem of a lazy bowel. They are available for adults and children.
The cons: Some brands are mixed with electrolyte salts in the correct formulation for your system but this can give them a slightly salty taste which is not liked by some people. Osmolax is a brand without salts.
These laxatives are a good option for either chronic or acute constipation treatment and they are particularly recommended in cases of fecal impaction.
If you have inflammatory bowel disease, a heart condition, toxic megacolon, are pregnant or breastfeeding then you should talk to your doctor before taking this treatment.
Arachis oil will soften hard stools. This is also a secondary effect of docusate sodium mentioned below.
Mineral oil coats the outside of the stools preventing the absorption of water so stopping them from drying out and making their passage easier.
This should only be used short term as it can lead to vitamin deficiencies and interference with the absorption of some medications.
My stool softener of choice would be olive oil. In countries where they regularly consume olive oil, like in Spain for example, rates of constipation are much lower than in many other countries like the USA.
It is best to use extra virgin olive oil. This can be drizzled over vegetables and used in salad dressings. It is better to use it unheated. To use as a laxative rather than a preventative swallow one tablespoon of oil with a spritz of lemon juice 1-2 times per day.
Stimulant laxatives like senna, bisacodyl, docusate sodium, glycerol and sodium picosulphate work by stimulating the nerves that control the muscles of the intestines causing them to speed up.
Generally they are not recommended as a regular constipation treatment these days as it has been found that after long use people seem to have nerve damage. It is not clear how this is caused but if these laxatives are used they should only be used very short term.
Triphala is a sanskrit word meaning three fruits. It is a traditional ayurvedic remedy for constipation and colon cleansing which is used widely across India.
As the name suggests it is made from a mixture of three different fruits, Indian Gooseberry, Belleric Myrobalan and Chebulic Myrobalan. It has the advantage of having a gentle laxative action and is not habit forming.
These fruits are not really available in the west but formulations in powder and capsule form are available.
There are other laxatives which can be prescribed by your doctor if over the counter laxatives are not working. Ask your doctor about prucalopride (not approved in the USA, 2015) lubiprostone (Amitiza) and linaclotide (Linzess).
Peripheral opioid-receptor antagonists are useful for people who have constipation brought on by pain killers in the opioid group like morphine and codeine.
If other methods of constipation treatment have not worked then your doctor may prescribe a laxative to be given in suppository or enema form so that it gets right to the root of the problem.
A suppository like Bisacodyl is a bullet shaped medicine which you push into your back passage where it will gradually melt due to heat from the body and then it will enter the blood stream.
Enemas for home use usually come in a little bag with a nozzle on the end. You squeeze the liquid medicine like Docusate or sodium citrate into your back passage and try to hold it as long as possible. Lying down with cushions to elevate your behind can help with this.
Sometimes these methods can be enough to move a plug of hard feces but if not more drastic measures are needed.
In very difficult cases where other remedies for extreme constipation have not succeeded and where the doctor thinks you have impacted feces a manual removal may be necessary.
The doctor or a specially trained nurse will use one or two gloved fingers to locate the blockage and break it up and remove it.This is done in small steps so that the rectum is not damaged.
This constipation treatment may sound alarming but I have seen it done many times and the sense of relief afterwards is great. A sedative can be given if necessary
In extremely rare cases surgery can be required.
Following severe fecal impaction a nurse led bowel retraining program may be necessary.
Some people with certain conditions which affect the sacral nerves can have chronic constipation followed by diarrhea if it is not constantly managed. This puts a strain on everyday life.
In 2011 the FDA approved a new chronic constipation treatment for people with constipation caused by nerve problems.
The sacral nerves at the lower end of the spine supply the pelvic organs. This means that they convey information between the brain and the back passage and large intestine.
If the flow of information is interrupted because of damage or there is a gap as there is in spina bifida then the signals we rely on to open our bowels are weak or missing.
Sacral neuromodulation or sacral nerve stimulation is a system where a device a bit like a pacemaker, only smaller, is implanted under the skin usually just above the buttocks. Wires electrically stimulate the nerves replacing or boosting the normal signals.
This is a new and advanced constipation treatment and it may not be available in everywhere but it is definitely worth asking about if you have chronic constipation caused by nerve damage.
This also works for bladder problems such as overactive bladder syndrome.
Some people find that psychological factors play a part in causing their constipation. Many people find it difficult to open their bowels if they are in an unfamiliar place or if they are traveling. For example, some people can only have a bowel movement at home.
This can be a form of obsessive compulsive disorder and it is important that treatment of this primary problem forms part of the constipation treatment.
Sometimes it is just a cultural difference. In Japan for example some people have such a fear of anybody hearing them go to the toilet (called toilet shyness) that you can buy special portable key ring devices that play flushing sounds or white noise to cover the sounds you are making and some toilets come ready fitted with the 'Sound Princess'. Let's face it many of us would like to have one of these high tech Japanese gadgets!
In the absence of advanced Japanese technology, if this sort of thing worries you, then when in a public place put some folded toilet tissue into the bowl and this will provide a soft landing for your poop, thus muffling the sound.
If your child is aged 4 or over and is soiling their underwear during the day then they could be in need of some constipation treatment. They cannot help what is happening and may not even be aware.
The soiling is most likely to be caused by liquid feces leaking around the sides of a hard lump of stool which is stuck in their back passage. This is called encopresis and it is more common in boys than girls.
It has been found that many children with chronic constipation problems have spina bifida occulta. This is a type of mild spina bifida which is hidden (occult) and normally only shows up on x-ray.
It means that there is an interruption in the information coming from the brain to the sacral nerves which regulate bowel movements.
Some children become constipated when they are at the potty training stage. They can become anxious about moving on from wearing a diaper/nappy and some even refuse.
A friend's daughter learned to pass water into a potty or toilet but would only ever open her bowels if her mother produced a nappy. It became quite a problem.
Unfortunately it is a vicious circle as if the child holds on too long then when they do go it will be difficult and painful and this will put them off from going again.
Potty training can be quite an anxious time for both children and parents but the best advice is to wait until the child is showing signs that they are recognizing the signals that they need to go. Trying to train too early before the child is ready can lead to problems and making a big thing out of it can also lead to anxiety.
I let both my children choose when to move on. I showed them the potty and had it nearby but I did not ask or encourage them to use it. One day they just decided that they had had enough of wearing the nappy and would use the potty instead. Maybe I just got lucky, as some children do run into difficulties at this time.
Most health services will have a specialist constipation treatment service for this type of problem and it is best not to wait too long but contact your doctor if you have concerns.
Initial treatment is usually with an iso-osmotic laxative like Movicol (macgrocol) to soften the stools. A high dose is normally given initially to clear out the constipation and then a maintenance dose will be given for some time, even years in some cases.
The treatment often increases the soiling and tummy pain initially but it is important to continue as the symptoms will lessen as the build up of feces is evacuated. Patience is needed as it can take some time to sort out the problem.
Although it is important to pay attention to your child's diet and provide enough fluids and fiber this is not usually the cause of fecal impaction in children.
Sometimes children may need to have impacted feces removed under general anesthetic. Once they are cleaned out it is important not to let the blockage build up again but this can be easier said than done if the child is determined to hold on. This is why specialist help and treatment for constipation is important.
Children should never be given constipation treatment without advice from a trained doctor, nurse or pharmacist.
Constipation followed by diarrhea as we have said is often caused because the passage of stools along the intestinal tract is being blocked by a hard mass of feces usually in the back passage. This causes the more liquid feces behind to overflow or bypass the blockage and appear as diarrhea.
If you have diarrhea after constipation though do not automatically assume that this is the cause as it could be something else. A classic example would be IBS-A or alternating irritable bowel syndrome. So if you have these symptoms seek medical attention to get a proper diagnosis.
Constipation treatment is not always easy or straight forward but if you follow some of this advice about prevention and treatment you should have an easier time in the bathroom. Just something as simple as drinking more can have a very beneficial effect.
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