At any one time, around one in 10 people think they have constipation. Lower abdominal symptoms are common, and patients frequently come to the pharmacy complaining of unsatisfactory or uncomfortable bowel emptying, bloating and abdominal discomfort. It is important to find out what the patient means by constipation and to establish what, if any, change in bowel habit has occurred and over what period of time. 

Many people believe that a daily bowel movement is necessary for good health and thus laxatives are often taken and overused as a result. In fact, the normal range may vary from three movements in a day to three in a week. An important health education role for the pharmacy team is to reassure patients that their usual frequency of bowel movement is normal. Patients who are truly constipated will usually complain of hard stools that are uncomfortable and/or difficult to pass, and are less frequent than usual.

In terms of managing symptoms, often advice is all that is necessary, or simple treatments for short-term use. Rarely, “red flag” features may indicate a more serious cause and pharmacy teams need to stay vigilant. 

Often, the best way to manage constipation is through encouraging dietary changes and exercise. For many, taking laxatives is unnecessary, but patients often wish to buy
a laxative, perhaps seeking a quick result for acute symptoms and also because making permanent lifestyle changes is hard. They may know what they should be doing, yet be unwilling to change.  

Common causes of constipation

•  Insufficient dietary fibre 
•  Changes in diet and lifestyle
•  Lack of exercise or reduced mobility 
•  Inadequate fluid intake 
•  Medication (e.g. the codeine in co-codamol, antidepressants (both tricyclics and SSRIs), oxybutynin).