One of the most common issues that women face (yet, perhaps rarely discuss) is the frustration associated with constipation. In the September issue of Retail Pharmacy Assistants we look at constipation in women: the causes, how to manage our bowels, and how to prevent them from becoming blocked in the first place. 
According to Melanie McGrice, Accredited Practising Dietitian and spokesperson for Dietitians Australia, “while women are at an increased risk of constipation as a result of hormonal fluctuations, anyone can experience constipation”.
“Both hormonal fluctuations and dietary changes can increase the risk of constipation prior to menstruation and during pregnancy,” she says, adding that other factors that may lead to constipation include “medications and supplements that reduce intestinal motility” and “medical conditions such as diverticular disease, irritable bowel syndrome or diabetes”.
Evidently, the causes of constipation are multifactorial.
However, what constitutes constipation? How can you tell if you’re truly constipated or if you’re simply having an off day?
Ms McGrice says constipation can be recognised through a range of symptoms, which may include:
- Lumpy or hard stools.
- The feeling of not having completely emptied the bowels.
- Straining to pass a bowel motion.
- Manipulating the body to try to pass a bowel motion.
- Having fewer than three bowel motions a week.
Community pharmacist and master herbalist Gerald Quigley adds that constipation is “either an infrequent passage of stools or excessively hard stools, or an inability to evacuate without prolonged strain”.
“People get very concerned about how many times a week they need to [use their bowels],” he says. “But … every single person is different.”
While there is this “expectation that you need to go every day”, which “does cause stress in a lot of people”, he says it’s important to remember that we’re all different and what may be normal for one may not be the same for another.
To help customers determine if they are, in fact, suffering constipation, Mr Quigley says it’s important for a pharmacy assistant to “get an idea of the problem”.
He suggests asking some questions around the customer’s bowel motions, such as:
- Are you finding it difficult to pass stools?
- Are your stools excessively hard or difficult to pass?
- Are you finding yourself straining?
“Straining, of course, can increase the risk of haemorrhoids,” he says. “It’s all about asking the questions [and] … gently steering someone [towards] a solution … [such as a] fibre supplement.”
Mr Quigley says several medications can also contribute to the likelihood of experiencing constipation, including antihistamines and medications used to manage anxiety. Vitamins, minerals and supplements, such as iron supplements, can also lead to constipation, he says, as can antacids.
“So, anything that’s designed to reduce acidity in the gut can potentially constipate,” he said.
“That’s more the role of a pharmacist,” he adds.
“But certainly, it’s a question that a pharmacy assistant can ask if they feel that any medications a person is taking might be contributing – and then get the pharmacist involved, which can often make a difference as well.”
Managing constipation
Ms McGrice points out that if constipation is left unmanaged, in the short term it may lead to feeling bloated and uncomfortable and perhaps to a reduced appetite.
“In more serious chronic cases, it can result in conditions such as incontinence and haemorrhoids,” she said.
According to Mr Quigley, constipation may also lead to the build-up of toxins in the body, which can produce a feeling of being “sluggish, and very tired and fatigued”. He says it can also lead to poor vitality, poor sleep, pain, and to “anal fissures”.
Clearly, managing and preventing constipation are important for overall health, but what are the best strategies for this?
According to Mr Quigley, among the several strategies that may help with managing constipation, “probiotics are certainly important”.
Ms McGrice adds: “Pre and probiotics help to achieve and maintain a healthy digestive system. [They] may help to improve constipation in some people. However, they may worsen it in others.”
Similarly, she adds, some vitamins, minerals and supplements may help with constipation, such as magnesium, although others, such as iron supplement, as Mr Quigley mentioned, may increase the risk of becoming constipated.
Mr Quigley points to the benefits of the herbal supplement, slippery elm, in the management of constipation.
“I find it very effective,” he says.
“What [it] does is it draws water into the bowel. That tends to act as a bit of a bulking agent, stimulating the bowel.”
Eating enough fibre is fundamental to a healthy bowel, he adds.
“Most Australians don’t get anywhere near the amount of fibre they need,” Mr Quigley says.
Ms McGrice says: “Fluid plays an important role in helping to prevent and relieve constipation, as it helps to keep stools soft, making them easier to pass.
“Fibre draws water into the bowel, and, without adequate fluids, a high-fibre diet won’t be as effective at achieving regular bowel motions.
“Staying well hydrated, especially in hot weather and when exercising, is crucial in making sure our bodies function at their best.”
The role of a pharmacy assistant
“It’s all about engaging and being aware that the person who is buying laxatives frequently may have a problem, and some gentle involvement is worthwhile,” Mr Quigley says, speaking about the role of a pharmacy assistant in this space.
“Be confident in the range of laxatives that you have [at your pharmacy] … learn to know which are gentle and which are not so gentle,” he added, recommending that, at every opportunity, if the assistant thinks the pharmacist should be involved, then they should facilitate this.
For more and to read the feature in full, as it appears in the September issue of Retail Pharmacy Assistants e-magazine, visit: rpassistants.com.au/magazines/retail-pharmacy-assistants-september-2021/
