Lifestyle changes and counselling for constipation

[Durba]

Hello, my neighbor is an 84-year-old man who was brought to a pharmacy by his wife to ask advice on his constipation. On discussion with him they established that he has recently been experiencing back pain, which prevents him from getting about as much as he used to. The physician gave him some co-dydramol 10 days ago, and things are starting to improve. His wife says that she was given some little brown tablets when she was constipated, but they gave her stomach pains. She tried to get him to take them, but he won’t. He thinks he should perhaps have something gentle, like a herbal medicine. Is constipation common? What lifestyle changes he should take? What counselling would I suggest him?

[Trina]

@Durba
Constipation cannot solely be defined by bowel frequency, as this naturally varies in the population. Simply, constipation is defined as a decrease in the patient’s normal pattern of defecation, although for research purposes other criteria are often considered (e.g. straining, hard stools).
Constipation tends to be more common in women, and in the elderly.
Lifestyle measures may include increased dietary fiber, ensuring an adequate fluid intake, keeping as mobile as possible, etc.
■ A laxative would seem appropriate at this stage as your neighbor is elderly and it is likely that his constipation is drug-induced.
■ Discuss the adverse effects his wife has experienced and explain that senna is in fact a herbal medicine and that herbal remedies may not necessarily be gentle.
■ Discuss the benefits of senna. If he accepts this suggestion counsel him to take the tablets before bed (as they take 8–10 hours to work). If he is reluctant to try senna explain to him that lactulose is often insufficient alone in treating opioid-induced constipation, and may take 48 hours to work. Bulk laxatives are really a more long-term solution. Bisacodyl may be an alternative stimulant laxative, but is likely to have similar adverse effects.