A condition characterised by a change in usual bowel habits and dry, hard stools. There is a decreased frequency of bowel action and patients should be assessed individually.

Constipation may have many causes:

» incorrect diet (fibre and fluid);                »  certain drugs;

» lack of exercise;                                    » metabolic;

» pregnancy;                                              » endocrine;

» old age;                                                  » neurogenic;

» psychogenic disorders;                            » lower bowel abnormalities;

» chronic use of enemas and


» ignoring the urge;

» cancer of the bowel;                              » behavioural problems in



Dietary advice preferably by dietician.

Dietary measures i.e. balanced diet with unprocessed foods, e.g. cereals,

legumes, fruit and vegetables.

Correct dehydration. Ensure adequate fluid intake.

Wheat bran: introduce slowly and take with sufficient fluid. Side-effects

include: bloating, cramps and flatulence.

Manual removal of impacted stools.

Encourage regular bowel habits.

Physical exercise.


Osmotic laxatives

• Lactulose, oral, 10–20 mL daily.

o Titrate to effect i.e. up to 60 mL daily.

Stimulant laxatives

For short term use only, except in the elderly where long-term treatment may

be indicated:

• Sennosides A and B, oral, 7.5–15 mg at night 2–3 times a week for up to 4


Polyethylene glycol-based purges

For acute bowel preparation or for chronic constipation on specialist advice.

Saline or phosphate enemas

May occasionally be indicated in acute constipation.


» For investigation for organic disease.

Reference and further reading

Standard Treatment Guidelines and Essential Medicines List for South Africa 2012 Edition

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