Treating constipation

Educational measures. It is advisable to adopt a regular schedule for bowel movements, preferably after meals, and to make the most of the postprandial increase (blood glucose level after meals) of the movement of the colon. Having enough time to defecate and adopting a suitable position (preferably squatting) are also recommended. Regular physical exercise and weight loss can also contribute to regulating the intestinal rhythm. 

A diet rich in fibre. Soluble fibre is usually recommended as the first line of treatment due to its low cost, availability and safety profile. Daily consumption of 25-30 grams is recommended. Increasing the intake of foods with a high soluble fibre content (fruits, vegetables, pulses and nuts) may improve symptoms in patients with normal colonic transit. The main side effect is that it may cause abdominal distension and tympanites (gas in the intestines). To prevent this effect, start out with a low dose of fibre, then progressively increase the amount based on tolerance and response. 

Water intake. Sufficient water intake is recommended, whenever there is no contraindication (patients with certain serious heart, kidney or liver conditions). The daily recommended intake is at least 1.5-2 litres of water.  

It has been shown that physical exercise such as walking or running can encourage expulsion of faeces due to the increase in intestinal movement. On the other hand, a sedentary lifestyle tends to cause slow transit.  

Laxatives. Medical treatment with laxatives generally begins if dietary and lifestyle changes are not successful. There is currently a wide range of treatment options. The majority of laxatives cause side effects, mainly abdominal pain (cramps), watery diarrhoea and abdominal distension. When choosing the initial treatment, you should consider the efficacy, safety, suitability, cost and clinical response.  

Enemas. These are reserved for patients who do not respond to oral laxatives and who have not defecated for several days, normally in cases of low mobility (bed rest or hospitalisation).

Biofeedback is a specific treatment for patients with functional disorders in defecation, and consists of a learning or rehabilitation method with the aim of the patient learning to relax the pelvic floor muscles during defecation.