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There is no objective definition of constipation because of great individual variation in normal bowel habit. The term implies a diminished frequency of bowel motions and/or the passage of small hard stools. The normal frequency of bowel motions in Western countries varies from 3 times per day to twice per week. There is a large number of causes of constipation ranging from common dietary problems to mechanical obstruction, including the adverse effects of many commonly used drugs such as aluminium-containing antacids and opioids. Changing or stopping these drugs may be all that is required to restore normal bowel function.

There are a lot of ways to treat constipation. A number of the most frequently used methods of treatment are discussed to some level of detail below.

(A) DIET AND LIFESTYLE

Adults, especially if ambulant and otherwise healthy, should be encouraged to control their bowel activity by attention to diet and exercise. The diet should contain adequate amounts of fiber and adequate fluid to avoid dehydration.

Physical exercise has been shown to reduce intestinal transit time and is believed to stimulate regular bowel movements. Lack of privacy, reduced physical activity and confinement to bed may cause suppression of the urge to defecate.

Everyone should be encouraged to respond to an urge to defecate, especially after meals or upon awakening. Correct positioning when sitting on the toilet - leaning forward with a straight back and with feet supported, such that the hips are flexed more than 90 degrees - is important.

Constipation has not been conclusively associated with a low fiber intake; however, the general consensus is initially to trial an increased fiber and fluid intake, before added therapy for constipation. Dietary fiber consists of complex carbohydrates from plants that escape digestion in the small intestine and are only partly broken down by bacterial enzymes in the large intestine. The recommended amount of dietary fiber intake for adults is 30 grams per day. For children, the recommendation is for (age in years + 5) grams of dietary fiber intake per day. Types of dietary fiber include insoluble fiber, soluble fiber, resistant starch and fructans. Of these, insoluble fiber and soluble fiber are the most effective in preventing or improving constipation.

Insoluble fibers are commonly termed "roughage". They increase stool bulk and decrease gut transit time. Sources include vegetables, legumes, fruits, nuts, wholegrain wheat and oats, rye

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