Constipation and stool softeners


Nurse Director
Jun 8, 2007
The North
United Kingdom United Kingdom
What causes constipation
Just because you get constipation it doesn’t have to mean you are unhealthy or even that you have an unhealthy lifestyle. You can follow a high-fibre diet, exercise every day, drink lots of water yet still get constipation from time to time. Even from childhood some people just seem to be more susceptible than others. There's really no need to feel you've brought constipation on yourself.

However, certain things make constipation more likely:
  • Diet - Dietary fibre provides the bulk that helps to speed the passage of waste food through the bowel. Lack of fibre results in harder, more compact stools, which take longer to pass through.
  • Lack of fluids - Everyone is different but the body can need up to 2 litres a day to function efficiently. Without sufficient fluids, waste matter dries out, making it harder to move through the bowel.
  • Lack of exercise - if you don't exercise often, things can slow down including the muscle contractions that move waste matter through the bowel.
  • Stress - constipation can be caused by stress.
  • Ageing - a lot of bodily functions slow down with age and the digestive system is just one of them.
  • Medicines - whilst effective, some commonly used medicines are known to cause constipation, particularly certain painkillers, iron tablets and some antacids (e.g aluminium hydroxide).
  • Ignoring the urge to pass stool can also cause constipation
  • Irritable bowel syndrome (IBS) sufferers often have constipation, sometimes alternating with diarrhoea. In IBS, cramping pains and discomfort in the bowel and rectum are common.
  • Holiday constipation - is quite common. Any change of routine or diet can cause constipation.
The important thing is to treat constipation as soon as it occurs.

Why constipation should not be ignored
When constipation only occurs once in a while, many of us tend to wait for it to go away by itself. After all, what real harm can it do? In fact, there are several reasons to treat constipation:

Impact on quality of life
The effects of constipation are not just restricted to your digestive system, as many people feel generally uncomfortable and less able to enjoy their day fully when constipated.

Build-up of waste
When you think about it, constipation is essentially food waste, that could be days old, sitting around in your body for longer than it should - you've been eating all different kinds of food but none of the waste from this is coming out. It builds up, getting heavier and heavier and you're carrying that around with you day after day – so it's no wonder constipation can make you feel uncomfortable.

Sometimes certain changes in lifestyle can be very effective at relieving constipation. However, there may be times when you need a little help to get back to normal. What is essential is that we do not ignore our bodies - we need to recognise the symptoms and treat constipation accordingly.

A combination of healthy living and giving your system a hand when it needs it is the key to taking control of your digestive health.

The main medications are: (green - good - blue, so-so - red - avoid)

These two groups are pretty much the same- bulk-forming laxatives – such as ispaghula husk and methylcellulose (Fybogel), which work in the same way as dietary fibre; they increase the bulk of your stools (faeces) by helping them retain fluid, encouraging your bowels to push the stools out
- stool softener laxatives – such as arachis oil (peanut oil) and docusate sodium (Dioctyl, Docusol, DulcoEase, Norgalax), which increase the fluid content of hard, dry stools, making them easier to pass

- osmotic laxatives – such as lactulose and polyethylene glycol (Miralax, Glycolax) which soften your stools and make them easier to pass by increasing the amount of water in your bowels

- stimulant laxatives – such as bisacodyl (Dulcolax), senna and sodium picosulfate (Duloclax) , which speed up the movement of your bowels by stimulating the nerves that control the muscles lining your digestive tract. Wouldn't recommend these as they can cause quite a lot of cramps and other unpleasant discomfort.

If things get really bad, a suppository or enema could be used, both available over the counter

Enemas, such as the well-known Fleet enema, treat constipation by introducing fluid into the intestines through the rectum. The liquid softens impacted stool, while the enema nozzle loosens the rectal and anal muscles. That combination will stimulate a large bowel movement.

How to use an enema

fleet enema.JPG

The product is generally supplied in a ready to use container so all you need to do is take the cap off the nozzle, wet it and gently insert it into the anus as far as you can and gently squeeze the container until it is fully discharged. The effect might not be immediate but make sure you are fairly near to the bathroom!

To use the enema try one of these positions:
1. Crouching or bending over, getting to your bottom which ever way is easiest for you. You may find it helpful to have something to hold onto like the side of the bath
2. Sitting on the toilet
3. Laying with your hips on your side so you can get to your bottom with your upper hand
lying on side.jpg

Using Suppositories
There is an excellent explanatory site here - pictures and everything! It's so good there is absolutely no point in me trying to replicate it! How to Use Rectal Suppositories

Impacted faeces

This is a serious problem when constipation becomes long standing or chronic. Any constipation lasting longer than two weeks can be said to be chronic and at risk of becoming impacted.

The next stage to this can be Faecal impaction, a serious condition where the faecal material in the upper part of the bowel becomes liquefied and pass around the block of faeces and exit as what looks like diarrhoea but it is much more watery than normal diarrhoea. Sometimes a patient can have a small bowel movement and then after believe they have got diarrhoea and assume it's because of all the remedies they've been taking. This may be true but sometimes it is not, especially if the diarrhoea is in small quantities and very watery. In this case, the patient should be checked by a doctor to ensure their bowels are not still blocked up.

A lot of people suffer from constipation after surgery. This is one of my 'mini' lectures on the subject!

Activity of the bowel is dependent upon two things
1. muscular activity called peristalsis
2. bulk in the bowel


This rhythmic muscular activity, like ripples along the bowel wall, happening from the stomach all the way along the gut - duodenum, small bowel and large bowel - to the beginning of the rectum.

Peristalsis only starts up at the rectum when a quantity of stool begins to enter it and causes the urge that tells us we need to go to the bathroom. Unlike the rest of the gut which we are unaware of, this part is under our conscious control and can be delayed until it is convenient for us to cooperate with a little pushing!

Peristalsis depends to a very great degree on the right quantity and condition of bulk in the bowel which should be bulky and soft but not fluid.

If a body gets constipated, more fluid is absorbed from the bowel contents and the stool becomes harder and smaller and then extremely hard to expel.

Now when we have surgery, several unusual things happen to our gut.
1. we are starved before and after surgery
2. we have lots of drugs that make our entire bodies, including the gut, go into deep relaxation - true in both general and spinal anaesthesia
3. we start taking pain killers which have the side effect of inhibiting normal bowel movements
4. our appetite and dietary intake for the first few days will be very low​

All these things result in a period of subdued peristalsis and little or no bulk in the bowel.

Medications for constipations are:
Bulking agents or stool softeners - these are taken as pills or granules which swell up as they pass along the gut, thus providing the necessary stimulus to create peristalsis.
Laxatives - these stimulate the peristalsis.​

A properly filled bowel will rarely become constipated.

People with a properly full bowel are unlikely to be constipated purely because of muscular inactivity, although pain killers like Percocet, Tramadol and codeine can certainly contribute. Even then the inactivity is mostly caused by lack of bulk which is easily remedied by taking bulking agents.

Never ever take laxatives for this type of constipation - it will not achieve the desired ends and may cause gut ache and discomfort.

Bulking agents should be taken daily whilst taking those medications known to be a problem, though other natural products could be taken instead like prunes or prune juice, fruit and vegetables or bran. Some people also find things like nuts and liquorice help as well. It's very much a personal choice and what suits one person probably won't suit another.

One other important thing is to drink lots of fluids. This simply cannot emphasise enough.

Prolonged constipation can result in the following symptoms
excess gas
poor appetite
abdominal aches and pains
faecal impaction​


Constipation is when you are not passing stool as often or as easily as is normal for you. Your stool becomes hard and dry, and it is difficult to pass. This can result in a faecal impaction which is a large lump of very dry, hard stool that stays stuck in the rectum. It is most often seen in people who are constipated for a long time, maybe even weeks.

Faecal impaction can often occur in people who have had constipation for a long time and have been using laxatives. The problem is even more likely when the laxatives are stopped suddenly. The muscles of the intestines forget how to move stool or faeces on their own.

Common symptoms include:
Abdominal cramping and bloating
Leakage of liquid or sudden episodes of watery diarrhoea in someone who has
chronic constipation​
Rectal bleeding
Small, semi-formed stools (rabbit droppings!)
Straining when trying to pass stools, often unsuccessfully​
Other symptoms can include:
Bladder pressure or loss of bladder control
Lower back pain
Rapid heartbeat or light-headedness from straining to pass stool​

Haemorrhoids (piles):
Another point of interest: it is a well documented fact that constipation and straining at stool are the primary cause of haemorrhoids. Therefore, it's essential that good bowel management is seen as a priority during the post op period.

Moral of this story: "Be kind to your bowel and your bowel will be kind to you"
(Michael J Fox, "The Hard Way")
Wow, Jo....THIS is a subject that people so often shy away from discussing and I'm so glad you posted all this great information. I just love your no-nonsense explanations that tell how things really work! This now makes perfect sense to me why we need the stool softeners after surgery. Thanks!!
Blood in the stool may have different appearances or no appearance at all.

1. Gross obvious red blood...usually caused by haemorrhoids or small anal fissures (splits in the skin in or around the anus). Many times you will see this with constipation.

2. Blood mixed with mucous on the stool is sometimes indicative of some issues higher in the colon. Something to talk to the doctor about.

3. Stool that appears black and tarry is a symptom that needs to be brought immediately to the doctors attention. This can be indicative of bleeding high up in the large bowel.

Note two major exceptions here.
a) if you are taking something like peptobismol this contains bismuth which will turn the stool black
b) high dosages of iron will also cause a dark stool.​
In the group home I work at, we make a thing called "Power Pudding" The recipe isn't exact as it comes out different each time, so sometimes we add a little more or a little less, but here is the recipe.

Take a
18oz container of prunes
1 good cup of water

simmer together till almost all the water is absorbed.

add 12oz apple sauce
1 cup of prune juice

bring back to a simmer for a few minutes.

Remove from heat and add 1 cup all bran cereal.
Let cool and then blend in a blender and you will have Power Pudding, which should give you some good results!!!
Serving Size. Start with 1 TBSP and work up to 4 TBSP per day if needed.
4 C Raisins
1/3 to ½ Prunes-canned and pitted
2 T Honey
2T Vanilla
46 0z apple juice

Soak raisins in water overnight
Puree all together in blender or food processor
Store in refrigerator up to one month
May be used on toast, on cereal, on waffles, pancakes, etc
Being a nutritional therapist, I tend to think in terms of 'food as medicine'. To that end, I've been working at some healthy flapjacks that may assist with constipation in hospital - a problem most of us suffer from because of the pain meds.

Here is the recipe:

100g/ ½ cup coconut oil
90g / scant ½ cup blackstrap molasses
40g / ¼ cup dark muscovado sugar
200g / 1½ cups jumbo oats
40g / 6 tablespoons ground flax seed
100g / ½ cup prunes, pitted and chopped
45g / ½ ounces walnuts, roughly chopped

Preheat the oven to 180C/350F/gas 5. Lightly grease a 20cm square tin (I haven't got one, so I use an oblong baking sheet and a rolled up piece of foil to reduce the size to a square.
Over low heat, melt together the coconut oil, molasses and sugar, stirring, until the sugar is dissolved.
Combine the oats, prunes, walnuts and liquid mixture. Spoon into the tin, press into the corners and flatten the top.
Bake in the preheated oven for 20 minutes.
Remove from the oven and cut into 16 squares while still warm. Leave to cool completely before removing from the tin.
Store in an airtight container, or wrap individually in foil.

Drink one or two glasses of water or other fluid with one or two of these, as that helps to bulk up the ground flax seed.

Substitute honey for molasses if you prefer, and pecans for walnuts.

I take no responsibility for the US equivalent measures, which I got off a converter on the internet. When one of my cookbooks was published in the US, they had to employ a professional writer to 'Americanize' it! I couldn't do that myself, accurately.
6 Week Bran Muffins

5 cups flour (I found the best is 4 cups whole wheat and 1 cup regular)
3 cups sugar
3 tsp baking soda
2 tsp salt
1 15-20 oz box bran cereal (can be raisin bran) crushed

1 cup cooking oil
4 eggs
1 quart buttermilk

Optional other dried fruit, such as cranberries (my favorite)--chop up the larger fruits. I use two packages of dried cranberries for this recipe.

1) mix dry ingredients in one bowl and wet ingredients in another bowl
2) mix the two mixtures together in a very large, bowl with a cover
3) refrigerate overnight in a covered bowl
4) scoop batter into muffin tins to make as many muffins you want each time
5) bake at at 380 F degrees for 15 minutes (approximate--they are done when they are no longer mushy on the top when you press lightly)
6) remaining batter can be stored in the covered bowl in the fridge for up to 6 weeks!
Mix together:
1 cup apple sauce
1 cup coarse unprocessed bran
3/4 cup prune juice

"This mixture will be like a thick paste. Refrigerate in a covered container between use. Take one-two tablespoons of mixture every day with a glass of water. Take in evening for a morning bowel movement. Increase the bran mixture by two tablespoons each week until your bowel habits are regular. Always take one large glass of water with the mixture.

A diet high in fiber and drinking at least 6-8 cups of water daily can also help."

1 dose of Milk of Magnesia
5 ounces of prune juice
2 ounces of 7-up

Mix it all together in a glass and drink it right down, BUT if you really can't do that, just take the ingredients one after the other. Drink the milk of magnesia, down the prune juice, and finish up with the 7-up to take the taste out of your mouth.
I might add one more suggestion to the already excellent mix of anti constipation foods offered here. Pumpkin purée- a brand with nothing else in it. Most markets carry it in cans. You can add cinnamon for flavor if need be.

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