How to counsel patients with constipation

Constipation is a common ailment that often prompts patients to stop by the pharmacy for a quick remedy. Although constipation can affect adults, it is especially prevalent among children, with around 30% experiencing constipation worldwide. As a pharmacist, you likely have countless opportunities to counsel patients on constipation, whether they’re seeking relief for themselves or their children. For example, you might offer guidance on proper dietary habits, lifestyle changes, and suitable medications. 

How to counsel patients with constipation

Pharmacists can help patients manage their constipation at home with the right strategies. In some cases, pharmacists can also be the guiding voice to advise patients to consult their healthcare provider for medical advice. Read on for some key points to remember when counseling patients on constipation.  

Identify the potential causes.

A patient may be experiencing constipation due to various factors, such as lifestyle, diet, medications, or medical conditions. A sedentary lifestyle and inadequate intake of fiber-rich foods may contribute to constipation. Dehydration also slows the digestive process, making it difficult for stools to pass through the colon. 

Certain medications can cause constipation, such as narcotic pain relievers, antacids with aluminum hydroxide, calcium channel blockers, diuretics, and some Parkinson’s medications. Medical conditions can also lead to constipation due to hormonal imbalances or other causes. Patients with the following might have a higher risk of constipation than others:

• Diabetes
• Underactive thyroid
• Chronic kidney disease
• Pregnancy

Conditions that cause blockages in the colon or rectum, such as tumors or scar tissue, can also lead to constipation. In addition, patients with slow transit problems, where stool doesn’t move through the digestive tract quickly enough, may experience constipation.

Consider the patient’s age.

Treatment options and recommendations can vary based on the patient’s age. Constipation in elderly patients over the age of 65 may often occur due to decreased mobility, dietary changes, and medications affecting bowel function. For these patients, you might consider recommending an increase in dietary fiber and physical activity.

Some medications used to treat constipation may not be appropriate for younger patients, particularly children. For example, while mineral oil may be an appropriate lubricant laxative for some children, it is not recommended in infants due to the risk of lipoid pneumonia. You can discuss age-specific treatment options and strategies with patients and their caregivers.

Reinforce dietary and lifestyle changes.

When counseling patients on constipation, you can help them find immediate relief and help prevent future issues. If constipation is a recurring problem for them, emphasize dietary and lifestyle changes, such as increasing fiber intake. Consuming fiber-rich foods such as fruits, vegetables, whole grains, and nuts can help improve bowel movements and relieve constipation. Encourage patients to swap out low-fiber options for high-fiber alternatives, like choosing whole wheat bread over white bread or incorporating more beans and legumes into their daily meals.

Adequate hydration is another factor in preventing constipation. Remind patients to drink plenty of fluids daily and limit their consumption of dehydrating beverages like coffee and alcohol. 

Regular physical activity can also help keep stool moving through the colon. You might recommend patients engage in a moderate exercise routine, such as walking, swimming, or yoga, to maintain consistent bowel movements.

It’s also a good idea to stress establishing a routine when it comes to bowel habits. Encourage patients to listen to their body’s natural signals and avoid delaying bowel movements when they feel the urge. Creating a consistent schedule and allotting enough time for bathroom visits can help patients better manage their constipation. 

Recommend over-the-counter treatments.

If lifestyle changes aren’t sufficient, you can recommend appropriate over-the-counter (OTC) treatments—such as fiber supplements, stool softeners, and laxatives—to alleviate constipation. When recommending the most suitable OTC treatment option, consider each patient’s specific needs and medical history.

• Fiber supplements: Metamucil (psyllium), methylcellulose, and Fibercon (calcium polycarbophil) are popular options that increase bulk in the stool, making it easier to pass. These supplements should be taken with plenty of water to prevent worsening constipation.
• Stool softeners: Colace (docusate sodium), an emollient laxative, allows water to penetrate the stool, making it softer and easier to pass. This treatment is generally considered gentle and safe for short-term use.
• Osmotic laxatives: Constulose (lactulose), polyethylene glycol, and magnesium hydroxide retain water in the intestines, soften the stool, and stimulate bowel movements. These agents can cause electrolyte imbalances if not properly monitored.
• Stimulant laxatives: Dulcolax (bisacodyl) and senna speed up bowel movements and are commonly used for short-term constipation relief. Long-term use is discouraged due to the adverse effects these laxatives have on the colon’s nerves and muscles.

Before dispensing an OTC treatment, be sure to counsel patients on the proper use, dosage, and possible side effects. You can also remind patients that OTC treatments are intended for short-term use, and they should consult their healthcare provider if constipation becomes chronic or worsens.

When to refer patients to a doctor

In some cases, you may need to refer patients to their healthcare provider for further evaluation and treatment. Pharmacists should be aware of the following situations that can warrant a referral:

• The patient has a serious underlying medical condition (e.g., Parkinson’s disease, diabetes, etc.).
• The patient is a possible laxative abuser or misuser.
• Constipation has lasted longer than seven days, even with OTC treatment.
• The patient also complains of abdominal pain.

Patients should seek immediate medical attention if they experience any of the following symptoms along with constipation:

• Altered level of consciousness, such as fainting
• Black, bloody, or very dark brown and viscous stool

As a pharmacist, you can play an important role in educating patients about the appropriate use of over-the-counter laxatives and other constipation treatments. It can also be critical to recognize when it’s necessary to refer your patient to a healthcare provider. Help ensure patients receive the proper care for their constipation by increasing your awareness of potentially serious situations and providing clear guidance on treatments and solutions.