Everybody's normal bowel pattern is different; some people pass faeces or 'poo' two to three times a day, others only twice a week. Constipation can mean passing faeces less frequently than usual or straining to pass faeces.
How the digestive system works
The digestive system runs from your mouth to your rectum (back passage). It serves two main functions: the breakdown of food into small parts that the body can use and the disposal of unusable food. The muscles in the digestive system walls rhythmically contract and squeeze the food through the system (a process called peristalsis). The stomach acts as a reservoir for the food, mixing it with acids and enzymes to start its breakdown.
The food then moves into the bowel which has two distinct parts, the small intestine (duodenum) and the large intestine (colon). The small intestine absorbs the useful parts of the food into the blood stream. The remaining food waste now passes through into the large intestine where water is reabsorbed and the faeces are stored until they pass out of the body through the rectum.
What do the autonomic nerves do?
The movement of food through the digestive system is controlled mainly by the autonomic nervous system. The autonomic nerves keep food moving steadily through the bowel, from the gullet to the rectum. Normally you are unaware of this process. These nerves also eliminate faeces on a regular basis.
In conditions where the autonomic nerves are impaired, such as Multiple System Atrophy (MSA) and Pure autonomic Failure (PAF), the movement of food through the digestive system becomes disrupted. The whole process becomes slower, and can be uncomfortable and unpredictable. This slowing down results in more water than usual being reabsorbed by the colon, making faeces hard and difficult to pass. The slowing down can also cause bloating or cramping. There may be an urgent sensation of the need to go to the toilet.
While constipation is the most common disruption, there can also be episodes of loose watery faeces or diarrhoea.
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What are the effects of being constipated?
Constipation can make you feel unwell. It can also reduce how well your usual medication works. It can also lead to a temporary worsening of some of your other symptoms.
Some of the things you may experience are: headaches, abdominal pains, bloating, flatulence (wind), loss of appetite, nausea, lethargy, depression, and restlessness. In extreme cases people can become confused.
Preventing constipation from occurring is easier than treating these individual problems.
Severe constipation may cause diarrhoea (known as overflow diarrhoea) and if this happens it is important that you seek medical advice.
Constipation and your blood pressure
Postural hypotension or a fall in blood pressure is a common problem for many people with MSA or PAF. Postural hypotension can occur if you are straining to pass faeces. You may feel dizzy or light headed and you could be at risk of passing out, especially when you stand up to leave the toilet. If this is happening to you, you need to get advice about controlling blood pressure and preventing constipation from the Sarah Matheson Trust Nurses.
Some of the advice to prevent straining will also help control postural hypotension, for example drinking plenty of fluid (try for 2 litres or 3.5 pints) helps keep faeces soft and easy to pass, as well as helping to maintain blood pressure. There is more information about this in the Sarah Matheson Trust leaflet, Living with Postural Hypotension.
Other things that influence constipation
The type of food you eat will affect how efficiently your digestive system works. Although ready prepared meals or processed foods are useful for people who have difficulty cooking, they may not provide the best nutrients to prevent constipation.
Soft, moist food is recommended for people who have problems swallowing. This type of food often has very little fibre, which is needed to prevent constipation.
The amount of food you eat is also important. Loss of appetite, difficulty feeding yourself, or fatigue can reduce the amount of food you are able to eat which can contribute to constipation.
Access to a convenient toilet where you feel comfortable is important. Most people prefer their own bathroom at home to try to pass faeces. Delaying or avoiding the urge to go to the toilet is not recommended.
Some medication e.g. pain killers can be constipating. Read the information leaflet before starting any new medication and discuss alternatives with the doctor who prescribes them or your GP.
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What can I do to help myself?
Drink plenty of fluids – aim for at least 2 litres (3.5 pints) of fluid per day. This can be water, tea, coffee, juice. Bladder control problems can make you avoid drinking, if this is the case a continence advisor can help find ways to improve bladder control.
Increase the fibre content in your diet: wholemeal bread, wholegrain cereals, fruit and vegetables. Try to eat some of these at every meal. Some foods, e.g. prunes or figs, can be helpful. A dietician can offer advice on a variety of ways to do this. If you feel full quickly, then you may need to take smaller meals spread out through the day. Increasing your fibre intake without maintaining a good fluid intake may make things worse.
If you are able, being active and moving around helps to move food through the digestive system. Gentle clockwise massage can also help move food along and can ease some of the discomfort you may experience. Consider massaging your abdomen for 10 minutes a day in a clockwise direction.
Establish a toilet routine. Allow plenty of time to use the toilet, as feeling hurried or rushed can lead to constipation. A physiotherapist will give practical advice about getting to the bathroom and on and off the toilet. Sitting in an upright position will help. Avoid bending forward by using a support rail or a raised toilet seat. An occupational therapist can help organise this. They can also provide advice on clothing to make using the toilet easier, and equipment to help you wipe yourself.
If you need help in the bathroom, an alarm system will give you privacy by letting you call for help when you are ready. A social worker or social service care manager can help organise carers and an alarm system.
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Medications
Medication to prevent constipation is called a laxative. Many people with autonomic conditions need daily laxatives to prevent constipation. It is important to choose the laxative that will help your particular constipation problems. The type and frequency required will vary for each person and over time doses may well need increasing. You may also need to use a combination of types.
Laxatives should be used with the guidance of your GP or specialist. Laxatives work in three different ways;
- Bulk forming laxatives stimulate movement along the bowel. These may take several days to start working. These laxatives must be taken with lots of fluid. Examples are Fybogel and Normacol.
- Stimulant laxatives increase movement along the bowel. They usually work within 12 hours. Examples are Bisacodyl, Co-danthramer, and Senna.
- Osmotic laxatives keep fluid in the bowel for longer which soften faeces. Some osmotic laxatives can work very quickly. Examples are Lactulose and Movicol.
Where to get more help
Your GP and community nurses are good sources of information and advice. Continence advisors are nurses with specialist training in managing bladder and bowel problems. Most continence advisors will accept self-referrals.
For some people all these measures may not be enough to prevent constipation. In this case enemas and suppositories can be useful. The community nurses can teach you how to use these.
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The Continence Foundation
The Continence Foundation provides information, advice and expertise to anyone with bladder and bowel problems.
The Helpline Nurse
The Continence Foundation
307 Hatton Square
16 Baldwins Gardens
London ECIN 7RJ
0845 345 0165 Monday to Friday, 9:30am to 1:00pm
www.continence-foundation.org.uk
InContact
Incontact provide support and information and represent the interests of all people with all continence problems.
InContact
United House
North Road
London N7 9DP
0870 770 3246
www.incontact.org
Key Points
- Constipation in autonomic conditions is a common problem
- Preventing constipation is better than trying to cure it
- Drink plenty, at least 2 litres (3.5 pints) of fluid a day
- Establish a toilet routine - find the way that suits you and make the time to be comfortable on the toilet
- Don't worry about using laxatives regularly
- Severe or persistent diarrhoea needs medical attention
- Use the specialist knowledge and advice of the dietician, physiotherapist, occupational therapist and continence advisor