Constipation (adults)

Patient Information Leaflet

• Constipation is a common problem, and it affects people of all ages, although it is more common as we get older.
• When you were discharged from hospital, you may have been prescribed laxatives (medication to help soften your stool (poo) and relax your bowel) to help you manage and treat constipation.
• It is important that you understand that you need to slowly stop using these medications.
• We call this 'weaning off laxatives'. This leaflet will help explain how to do that step by step.

What is constipation?

• Constipation is when you have difficulties passing a stool or experience irregular bowel movements.
• Your stomach and intestines work to draw out nutrients and water from the food you eat.
• Anything left is passed out of your body as waste, forming solid masses known as stools (poo).
• The intestinal muscles push the stool along your digestive tract to the rectum, where it is stored until you pass it out of your body.

What causes constipation?

• There are many possible causes of constipation. Some of the most common causes include:

  • Inadequate intake of fibre, normally found in fruits, vegetables and cereals
  • Not drinking enough fluids
  • An inactive lifestyle with long periods of sitting or lying down
  • Lack of exercise/movement
  • Frequently ignoring the need to go to the toilet
  • Changes in diet or daily habits
  • Medicines, especially pain killers
  • Stress, anxiety or depression
  • Hormonal changes

What is used to treat constipation, and will I take them forever?

• Laxatives are medicines used to help bowel movements by helping stools move from the intestines.
• They are used when people have difficulty passing stools or they experience infrequent bowel movements.
• You may be on various laxative medications when you get discharged from hospital.
• They work by making the stool bigger, softer, or by helping the muscles in your stomach push the waste out more easily.
• This can help get rid of symptoms such as stomach pain, difficult to pass stools, bloating (stomach feels swollen) and nausea (feeling sick).

Weaning off laxatives

• You must not stop taking laxatives suddenly.
• Slowly stopping them (known as 'weaning') helps your body get back to working normally and lowers the chance of getting constipated again.
• Using laxatives for a long time can make your body depend on them.
• You must use laxatives the way your doctor tells you to, so that you do not run into problems or start needing them too much.
• Your doctors will prescribe the appropriate type and dosage of laxative according to your needs, clinical condition and medical history.
• When you are taking laxatives, it is important to pay attention to how your body reacts.
• If you notice anything strange or have any worries, tell your GP. This way, they can change your treatment if needed and help you feel better.
• Before you begin to 'wean' yourself off the laxatives, you must speak with your GP.
• They will assess you and recommend a weaning schedule that is based on your individual needs.
• Weaning off laxatives involves reducing their dose over a specific period of time.
• Your doctor might suggest taking a smaller amount of the medicine or waiting longer between doses. This helps your body get used to the changes slowly.
• If you feel any discomfort or notice big changes, you should tell your GP right away. - They can check it out and change how you are slowly stopping the medicine, if needed.
• Stopping laxatives slowly is something you do together with your doctor to help your body work well without needing medicine.
• If you follow the plan your doctor gives you and make some changes to your habits, you can make this change more easily and keep your bowels healthy.

If your bowel movements have improved speak to your GP if:

1. you are experiencing regular, pain-free bowel movements.
2. your healthcare provider advises that your underlying condition has improved.
3. you are no longer experiencing symptoms that initially required laxative use.

• Contact your GP if you have any questions or need further support regarding the weaning process.

Types of Laxatives

What does a weaning process look like?

• Your doctor might recommend either stopping laxatives suddenly or gradually reducing the dose.
• If you're using a combination of laxatives, your doctor may suggest stopping them one by one, starting with stimulant laxatives if possible.
• Sometimes, adjusting the dose of osmotic laxatives might also be needed.
• When you stop taking laxatives, you may experience short-term constipation and bloating as your bowel function returns to normal.
• Eating a balanced diet and staying hydrated can help relieve these symptoms.
• During laxative withdrawal, you might observe temporary weight gain, bloating, or swelling in your feet and ankles.
• This is a normal reaction as your body adjusts to the lack of laxatives.

How can I prevent constipation?

• Stay active with activities like walking or swimming.
• Drink plenty of fluids, aiming for 1.5-2 litres per day.
  • Note: If you have heart failure or advanced chronic kidney disease, talk to your doctor about your fluid intake.
• Eat food rich in fibre gradually by including foods like wholemeal bread, high-fibre cereals, brown rice, beans, fruits, and vegetables. Adults should aim for 30g of fibre per day.
• It may take a few weeks to notice the benefits of increased fibre intake.
• Some fruits high in sorbitol (a natural sugar) may also act as a natural laxative such as apples, apricots, grapes, pears, plums, raspberries, and strawberries.
• Create a regular toilet routine.
• Do not ignore the need to go to the toilet. Allow enough time for a relaxed bathroom visit so that you fully pass all the stool.

Further information

• https://sandwellandwestbhamccgformulary.nhs.uk/docs/Guidance9420for9%20stopping9620treatme

• https://www2.hse.ie/conditions/laxatives/

• https://www.nhs.uk/conditions/constipation/

• https://www.stgeorges.nhs.uk/wp-content/uploads/2022/12/THE_CON.pdf

• https://cks.nice.org.uk/topics/constipation/management/adults/