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Constipation - Management
What should I advise about toileting routines? (pregnancy)
- Defecation should be unhurried, with enough time to ensure that defecation is complete.
- Attempt defecation first thing in the morning, or about 30 minutes after a meal. This may require some planning and time management.
- Respond immediately to the sensation of needing to defecate.
- Inadequate (auditory or visual) privacy can also contribute to constipation.
Basis for recommendation
These recommendation are largely based on expert opinion [Hsieh, 2005; Wilson, 2005; Emly and Rochester, 2006; Ginsberg et al, 2007].
- Occasional 'mass movements' propel the contents of the bowel through the colon. Propulsion of colonic contents is significantly increased in the mornings and after meals — the gastro-colic reflex. Activity of the colon is at a minimum in the late afternoon and at night. In people who are resting, colonic intraluminal pressure activity rises markedly during and after food, but this increase is rarely associated with the propulsive activity found in physically active people.
- The optimal times to have a bowel movement are typically soon after waking and after meals, when colonic activity is greatest.
- Evidence that bowel movements are more likely after awakening in the morning and after meals, and that bowel movements are less likely at night and while at rest, was found in studies of colon activity in healthy volunteers [Bassotti and Gaburri, 1988] and in people with irritable colon syndrome [Holdstock et al, 1970].
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