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Treatment options

Treating common bowel problems depends on the symptoms that are being experienced.

Explaining the course of action

Increasing dietary fibre and fluid intake, as well as taking regular exercise can help to ease constipation. OTC laxatives can also be recommended, if appropriate. These work in different ways, depending on their active ingredients:

  • Stimulant laxatives (e.g., senna, bisacodyl, sodium picosulfate) trigger rhythmic contractions of the muscles that line the gut, helping to move the stools along. These may be used for the short-term relief of occasional constipation only. Examples include Senokot, Dulcolax
  • Bulk-forming laxatives (e.g., ispaghula husk) increase the “bulk” or weight of the stools, which in turn stimulates the bowel. Examples include Fybogel
  • Osmotic laxatives (e.g., lactulose) draw water from the rest of the body into the bowel to soften the stools and make them easier to pass
  • Stool softeners (e.g., docusate sodium) add moisture to the stools, allowing for an easier bowel movement. Examples include Dulcoease.

Glycerol suppositories for rectal use can also be used as a short-term treatment. They are licensed for occasional use only and should not be regarded as a standard therapy. 

Staying hydrated by drinking plenty of fluids or using oral rehydration salts (e.g., Dioralyte) is important for customers affected by diarrhoea. For those who want something to slow down their bowel movements for a few hours, loperamide is an anti-diarrhoeal treatment, but it cannot be sold over-the-counter for children under the age of 12. Examples include Imodium.

Treatment options include creams and ointments for external piles, and suppositories for internal piles. These contain ingredients such as astringents (e.g., bismuth salts) to help soothe and reduce swelling; antiseptics (e.g., balsam peru) to protect against infection; emollients to protect the skin; and local anaesthetics (e.g., lidocaine) to reduce itching and pain. Hydrocortisone is an anti-inflammatory agent that can help to reduce external redness, itching, and swelling and should not be used for more than seven days. Examples include Anusol, Germoloids. 

Some customers find ointments, which are greasier than creams, alleviate dry skin. Customers may also find that moist toilet wipes are more comfortable to use than toilet paper if the area is sore.

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Remember!

In August 2020, the Medicines and Healthcare products Regulatory Agency (MHRA) introduced a package of new measures to support the safer use of OTC stimulant laxatives due to concerns about their overuse.

The licensing changes include limiting the pack sizes available for general sale to 20 standard-strength tablets or 10 maximum-strength tablets, and larger pack sizes of stimulant laxatives being made pharmacy-only medicines. Warnings have also been added to packaging and patient information leaflets that laxatives do not aid weight loss and that long-term use may be harmful.

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