Following the subsequent 6 Step plan should assist in the prevention and treatment of constipation. It is important to give each step adequate time to work.

STEP 1
It is important to have a balanced diet, that is sufficient fibre, fluid (8 glasses of water per day; [tea and coffee should not be counted in the 8 glasses]), and most importantly a balanced lifestyle.

You should have regular exercise (walking, swimming etc). T his should be a comfortable level of exercise and take into account any other medical conditions.

Allow 2 to 4 weeks for this to work.
In the majority of patients this wi11 be stifficient to return bowel function o normal. If this fails then move to step 2.

STEP 2
Bulk Forming Agents
Like fibre, these agents increase the bulk in the bowel, which stimulates bowel muscle movement. Always drink a full glass of water with each dose. In most cases it is advisable to start at half to a third of the recommended dose and gradually increase the dose to the recommended level over three weeks. This is because the sudden introduction of recommended doses can cause abdominal discomfort in some people.

Allow 7 days for this to begin to work after the recommended dose has been reached.
Examples of bulking agents include: Physllium (Metamucil, Angiofibe, Apple fibre chewable complex) or Physllium husks; Stercullia (Granucol, Normacol Plus); Ispaghula husks (Fybogel); Crude fibre (Fibyrax Extra, Fibyrax Fibre Trim, Guarina); Methycellulose (Cellutone).

STEP 3
Stool Softeners
These agents soften bowel motions by increasing the amount of lubrication and fluid secreted into the bowel. These are best used when a hard stool mass is present or to prevent excessive straining.

Allow 7 days for these to work. Examples include: Docusate Sodium (Coloxyl)

STEP 4
Osmotic Laxatives
These agents draw fluid into the large bowel, with the resulting bulk stimulating bowel movement.

Allow 2-3 days for these to work. Examples include: Sorbilol 70% (sorbilax), lactulose (Duphalac, Actilax), Magnesium Salts (Epsom salts).

STEP 5
Stimulants
These agents stimulate gut movement via a direct irritant effect. Sometimes, they can cause abdominal cramps. Prolonged use is not recommended as it can lead to a permanent non-functioning colon (melanosis coli).

Stimulants then have a limited role in the treatment of chronic constipation.

Allow 12 hours for these to work. Avoid their use in children
Examples include: Biscody (Durolax, Bisalax); senna (Seokot, Coloxyl and Senna, Nulax, Bioglan, Prune and Senna, Laxettes with Senna, Bekunis, Agiolax and some laxatives teas): Phenolpthalien (Atophen, Agarol. Figsen, Laxettes, Ap-la-day): Liquid Paraffin (Parachoc): Castor oil.

STEP 6
Suppositories and Enemas
These agents act locally by various methods to promote evacuation.
Allow up to 1 hour for these to work.
NB these agents should not be used Routinely but Reserved for acute situations.

Examples include: Bisacodyl (durolax); coffibiflallor) producis (microlax. Travad); giycerirr. Vocu&ale sodiufti.

Dehydration or an inadequate fluid intake can cause constipation. Unless otherwise directed, you should drink 6-8 glasses of water per day to maintain kidney function and bowel regularity.

Caffeine has a diuretic effect, causing an increased urine output and a loss of body fluid. Cups of tea and coffee cannot be counted as part of your fluid intake.

A Stepwise Guide

Fibre: absorbs water like a sponge. This increases the bulk of the; faeces, making it softer and easier to pass. It is this bulk which stimulates the bowel muscle to work properly. Therefore you need to have plenty of water and fluid.

Caffeine has a diuretic effect, causing an increased urine output and a loss of body fluid. Cups of tea and coffee cannot be counted as part of your fluid intake.