Constipation advice

Constipation can be more likely to occur when you are following the Intensive Weight Management Programme (IWMP), especially in phase I if you are on the liquid only programme. This leaflet gives you advice on how to manage constipation.

What is constipation?

Constipation is a common condition that affects people of all ages. It can mean that you're not passing stools (poo) regularly, you strain while passing stools or you're unable to completely empty your bowel. Constipation can also cause your stools to be hard and lumpy, as well as unusually large or small.

Normal bowel habits vary from person to person. Some adults normally go to the toilet more than once a day while for others every three or four days is normal. If your bowel movements become less frequent than usual it could be a sign of constipation. Other symptoms of constipation include:

• stomach aches and cramps
• feeling bloated
• feeling sick
• loss of appetite

What is causing my constipation?

One or more of the factors below can increase your chances of constipation:

• Not eating enough fibre, such as fruit, vegetables and cereals
• A change in your routine or lifestyle, such as a change in your eating habits
• Not drinking enough fluids
• Immobility or lack of exercise
• Ignoring the urge to pass stools
• Having limited privacy when using the toilet
• Having a high temperature (fever)
• Anxiety or depression
• Certain medications including opiates (i.e.codeine and morphine), anti-depressants, antipsychotics, calcium or iron supplements

If you think constipation is caused by a medication prescribed by your GP, you should not stop taking it unless your GP advises you to. Speak to your GP who may be able to prescribe an alternative medication less likely to cause constipation. Please keep us informed of any changes your GP makes.

With certain medical conditions it is very important you don’t become constipated; you may have been advised of this already. If you feel that struggling to pass stools is impacting a medical condition, please inform a member of the team as soon as possible.

What can I do to help prevent/relieve constipation?

Take Fybogel regularly:

As part of the IWMP you are required to take at least one Fybogel a day during the liquid phase (phase I). It is important to take Fybogel from the beginning of the programme even though you may not feel you need it. Sometimes patients stop taking Fybogel as their stools become very loose; it’s a good idea to take it even if this happens as Fybogel can help to bind the stool and improve its consistency by absorbing fluid

Fybogel is one of a group of drugs called bulk forming laxatives. Fybogel is available in sachets or as chews. It is given to replace the bulk usually found in your diet from fibre that you are not getting while on a liquid diet. Fybogel is a source of natural fibre; it is a very important element of your daily dietary prescription on IWMP

You will have been told when you started the programme if there was any reason why you should not take Fybogel but please always read the patient information leaflet first

A starting dose of Fybogel will have been discussed with you at your first visit when you started the programme. We may need to alter the dose at subsequent clinic visits to optimise its effect

The requirement to continue taking Fybogel in phases II or III of IWMP will be discussed with you prior to moving onto those phases

If you experience any signs of constipation, please phone the obesity team for advice.

Advice for taking Fybogel:

• Open the sachet and pour the contents into a glass. Add approximately 150mls (¼ pint) of cold water. Stir well and drink straight away
• Fybogel sachets are available in three different flavours: orange, lemon and original. The original (flavourless) Fybogel can be mixed with a sugar free squash of your choice to make it more palatable
• 2 Fybogel chews are the equivalent to one sachet
• It is important to drink plenty of fluids when taking Fybogel
• Do not take Fybogel before going to bed. Your bowels slow down at night and this can prevent the normal transit of the stools through the bowel and can lead to a potential blockage in the large bowel
• Create a routine for taking Fybogel, try take at similar times each day
• It will usually be two to three days before you feel the effects of a bulk-forming laxative

Other management / treatment options

It is important to discuss any changes in your bowel habits with the clinical team at your follow-up appointments. We will ask you questions about your bowel movements, but it would be useful if you could think about the following prior to your appointment:

• How frequently are you having your bowels open?
• Are your stools hard and difficult to pass?
• Do you feel there are no stools to pass?
• Has anything else changed that might be impacting on your bowel habits?

The team will first review your Fybogel prescription and may alter the dose (for you to take less or more). We may also recommend additional laxatives; there are several different types and each one has a different effect on your digestive system. Any further laxatives recommended can be purchased from most supermarkets or from a pharmacist and we will explain how and when to take them.

What else can be done?

There are changes to your diet and lifestyle which can also help improve bowel habits. The following advice can be applied at any time during the programme:

• Increase the amount of fluid that you drink; six to eight glasses a day is recommended. Alcoholic drinks do not count. This not only ensures that your stools remain soft and easy to pass but some laxatives (including Fybogel) require you to drink plenty of fluid to help them work.
• Keeping your body active will help to keep your digestive system moving so gradually increasing your physical activity within your personal limits.
• Try not to ignore the need to go to the toilet. Often this is first thing in the morning or after a meal. When you feel the urge, do not delay.
• For some people it may help to have your bowels open at the same time each day. Work out a routine of a place and a time of day when you are comfortably able to spend time on the toilet and have privacy.
• Try resting your feet on a low stool while going to the toilet, so that your knees are above your hips, as this can make it easier to pass stools.

If you are on phase II or III of the programme, you will now be eating some solid food. Aim to eat higher fibre foods such as wholemeal bread, wholegrain rice and pasta, jacket potatoes, fruit, vegetables and high fibre breakfast cereals. Fibre is important because it helps food pass through your digestive system more easily. Current recommendations are to eat at least 18-30g of fibre a day. Higher fibre options are indicated on the meal plans by (HF) next to them. Eating meals at regular times can also help

Further information

If you have any further questions please do not hesitate to ask during your next clinic consultation or contact us.

Contact details:

Obesity Clinical Team office: 01223 348124 (with answerphone)