11/17/2003 - Questions and Answers

Constipation with a colostomy

By: Mark Castleden



Is constipation a normal occurrence after a colostomy? If it is normal, is it wise to take a stool softener?


Colostomy patients may suffer from constipation, and whenever possible this should be treated by increasing fluid intake or dietary fiber. Bulk-forming agents can also be tried. If they are insufficient, as small a dose as possible of senna should be used.

Bulk-forming laxatives relieve constipation by increasing fecal mass, which stimulates peristalsis; the full effect may take some days to develop and patients should be told this. Bulk-forming laxatives are of particular value in those with small hard stools, but they shouldn't be needed unless fiber cannot be increased in the diet. A balanced diet, including adequate fluid intake and fiber is of value in preventing constipation.

Bulk-forming laxatives are useful in the management of patients with colostomy, ileostomy, hemorrhoids, anal fissure, chronic diarrhea associated with diverticular disease, irritable bowel syndrome, and as adjuncts in ulcerative colitis. Adequate fluid intake must be maintained to avoid intestinal obstruction.

Unprocessed wheat bran, taken with food or fruit juice, is a most effective bulk-forming preparation. Finely ground bran, though more palatable, has poorer water-retaining properties, but can be taken as bran bread or biscuits in appropriately increased quantities. Oat bran is also used.

Methylcellulose, ispaghula, and sterculia are useful in patients who cannot tolerate bran. Methylcellulose also acts as a fecal softener. Magnesium hydroxide helps relieve constipation in colostomy patients. Ispaghula husk is useful in helping colostomy patients who suffer with constipation.

We would advise you to discuss your problem with your doctor before making too many changes in your dietary regimen.

Created on: 11/15/2003
Reviewed on: 11/17/2003

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