Combating Tiredness

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

 In a recent survey, 68% of Irish adults blame tiredness for not doing all what they want to do. Over half of women blame too much house work as the cause for their lack of energy while in the case of men; their work was cited as the main reason (over half of all cases) for lack of energy. Other major reasons cited for lack of energy in this survey included (in order of popularity) raring children, not participating in enough exercise, poor diet and lack of sleep.

 

Keeping yourself energised
Exercise will help shake off any cobwebs and make you feel more energised. It has been proven to improve mood by stimulating “good mood” hormones in the brain such as serotonin. If you find it hard to motivate yourself to exercise, find something you can do with a friend as you will be more inclined to exercise if you have someone to exercise with as you won’t want to let them down. Team exercises have the same “motivating” effect.

 

Eating a healthy balanced diet will help prevent tiredness. Aim to eat the recommended five portions of fruit and veg per day and plenty of water. Keep sugar and high sweet foods to a minimum as while these will give you a quick surge of energy, this always leads to a quick lull as your body experiences a fast energy crash as sugar is processed and excreted quickly by the body. Aim for slow releasing foods such as porridge, these will keep you feeling energised for longer.

 

Many people cannot get enough sleep for medical reasons, with about 40,000 Irish people suffering from chronic insomnia. But for many of us, not getting enough sleep is simply down to not going to bed in time. Sleep requirements vary from person to person, and it varies from 6 to 9 hours. Most people need up to 8 hours sleep. Therefore, if you find yourself having an afternoon slump or falling asleep on the chair in the evening, the first thing you should look at is how many hours sleep you get. For example, if you find yourself watching TV or DVDs late at night, you may need to discipline yourself and turn off technology by a certain time and get to bed.

 

Could a medical condition be causing tiredness?
If you experience overwhelming and persistent tiredness, blood tests may need to be done to rule out other conditions such as anaemia (low iron), or haemochromatosis (too much iron). Other possible reasons for tiredness include under active thyroid, fatigue syndrome (CFS) and liver and kidney problems.

 

Practical ways of giving yourself more personal time
Do not get frustrated if you do not get everything done. The nature of life is for us to get distracted and for new tasks to crop up unexpectantly throwing our plans off course. Allowing for distractions will mean you will be less frustrated when they occur. Be realistic with what you can achieve in a day and don’t be afraid to say no at times. Learn to delegate both at home and at work.

 

B Vitamins
Our body uses a variety of enzymes to break down food and convert it to energy. Many vitamins are needed for this process, particularly the B vitamins B1, B2, B3, B5 and B6. Therefore B vitamins are essential for energy release. Example of good sources of B vitamins include bananas, lentils, potatoes, beans, brewer’s yeast, egg yolk and yogurt. If you feel you need a pick me up, Whelehans Tonic can give you the energy boost you need. It contains B vitamins and iron. These vitamins can be lacking in people who are not fond of fruit and vegetables. Tonics and supplements are only for short term use.

 

Upcoming Rheumatoid Arthritis Talk
Lack of energy of is a common symptom of Rheumatoid Arthritis. Whelehans Pharmacy in conjunction with Arthritis Ireland (Westmeath Branch) is hosting a Rheumatoid Arthritis Information evening next Tuesday April 28^th at 7pm in the Greville Arms Hotel in Mullingar. Admission is free. Speakers on the night will include Aoife Weller from Mullingar who suffers from Rheumatoid Arthritis; Nutritionist Aisling Murray BSc (nutrition); Chartered Physiotherapist Sinead Brogan MISCP and pharmacist Eamonn Brady MPSI. Call the Whelehans Pharmacy at 04493 34591 for more information or to book a place.

 

This article is shortened. More detailed information and leaflets is available in Whelehans

Reducing Cholesterol Naturally

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. Check www.whelehans.ie for more information. If you have any health questions e-mail them to info@whelehans.ie

If you have been diagnosed with high cholesterol, the first method of treatment will usually involve making some changes to your diet (adopting a low fat diet), and ensuring that you take plenty of regular exercise.  After a few months, if your cholesterol level has not dropped, your GP will usually advise cholesterol lowering medication available on prescription. The problem with cholesterol is that so much of it is down to our genes. It is reckoned that 60% of cholesterol is due to your genes (meaning that it runs in families). This means that in some cases, eating healthily, maintaining an ideal weight and exercising regularly may not get it down sufficiently if you have a strong genetic link in your family.

Diet

Changing to a diet low in saturated fats can reduce your LDL (bad) cholesterol.  A healthy diet includes foods from all of the different food groups including carbohydrates (cereals, wholegrain bread, potato, rice, pasta), proteins (for example, from lean meat, such as chicken and oily fish, like mackerel or sardines), and fats (varieties that are unsaturated, such as low fat mono- or poly-unsaturated spreads, and vegetable or sunflower oil).  You should also eat at least five portions of a variety of different fruit and vegetables daily. Aim to reduce saturated fat (contained in lard, butter, hard margarine, cheese, whole milk and anything that contains these ingredients, such as cakes, chocolate, biscuits, pies and pastries)

Good fats

Including a small amount of unsaturated fats in your diet can be a healthy choice, as this type of fat can actually reduce cholesterol levels.  Current thinking is that the traditional Mediterranean diet, with its emphasis on raw olive oil in many foods, and low animal-fat content, is effective in ensuring a healthy heart. Foods high in unsaturated fats include:

• Oily fish
• Avocados
• Nuts and seeds
• Sunflower, rapeseed and olive oil
• Vegetable oils

Weight loss
Losing weight is an important first step in helping you lower cholesterol. The best way to lose weight is to reduce your calorie intake and increase exercise. There is no quick fix to weight loss; it will take time, perseverance and hard work. However the benefits to your physical and mental health are outstanding.

Whelehans Nutrition Service

Whelehans nutritional service is a private one to one advice service with our nutritionist Aisling Murray. Aisling’s areas of interest include weight loss management, nutrition education and food intolerance. Our nutrition service offers you the chance to change your life in a positive way by focusing on your overall wellbeing as well as the chance to follow up on your progress.

Disclaimer: Consult a healthcare professional before making any changes recommended

This article is shortened. For more detailed information, logon to www.whelehans.ie or contact Whelehans at 044 93 34591 or info@whelehans.ie and we will forward you a more detailed copy for free

Hair Loss due to cancer treatment

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

In this blog I discuss the temporary hair loss caused by medication used to treat cancer

(chemotherapy or radiation). The scientific name for this type of hair loss is anagen effluvium and the hair loss is usually sudden, and occurs between 1 to 3 weeks after the start of cancer treatment. Often the hair falls out in large clumps and in many cases it occurs overnight. Some doctors recommend cutting the hair short in advance of the hair falling out.

It occurs because while cancer treatment drugs attack rapidly growly cancer cells, they also attack other rapidly growing cells including those in hair roots. Chemotherapy and radiation can cause hair loss all over your body (not just the scalp). Sometimes eyelash, eyebrow, armpit, pubic and other body hair also falls out. Some chemotherapy drugs are more likely than others to cause hair loss, and different doses can cause anything from a mere thinning to complete baldness.

Up to 90% of hair is sometimes affected. This hair grows back once treatment is finished but it can take three to ten months for hair to grow back after the cancer drugs are complete. Hair may not grow back as thickly as it was prior to treatment. On the other hand, some people find it grows back thicker and healthier than before treatment. Some people find that when it grows back, it is a different texture, for example curly hair growing back straight or the hair changes colour. Not all chemotherapy drugs cause hair loss so the doctor will advise in advance if it will occur. Some patients decide to wear wigs while their hair is lost and nowadays there is a great selection of very natural looking wigs. The cancer team in hospital or pharmacist can advise on where wigs are available.

Where to get wigs in Westmeath
I sometimes get asked where wigs are available locally for the likes of people with severe alopecia or undergoing chemotherapy. Joli Hairdressers (04493 95921) offer a good range of quality wigs, headwear and scarfs. They have staff trained in this area and a private fitting area. Joli are a HSE registered wig supplier meaning that the HSE will give you an allowance towards your wig if you have a medical card. Some health insurance plans cover part of the cost.

Some quick tips on Cancer Prevention and Re-occurrence

Seeing as I’m on the subject of cancer treatment, here are some cancer prevention tips. Evidence suggests that women with high aerobic fitness levels have a 55% lower chance of dying from breast cancer than their less-fit peers; there are similar statistics for other cancers in men and women so get active! Having two or more alcoholic drinks a day increases cancer risk by about 25%. Embrace a diet high in vegetables and fruit and low in sugared drinks, refined carbohydrates and fatty foods. Stop smoking, smoking is associated with increased risk of many types of cancer (but mainly lung and throat). Being overweight means increased risk of many cancers. Even losing a few pounds can reduce your risk significantly.

Disclaimer: Consult a healthcare professional before making any changes recommended

This article is shortened. For more detailed information, logon to www.whelehans.ie or contact Whelehans at 044 93 34591 or info@whelehans.ie and we will forward you a more detailed copy for free

 

Obsessive Compulsive Disorder

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. Check www.whelehans.ie for more information. If you have any health questions e-mail them to info@whelehans.ie

This information piece gives a brief outline of Obsessive-compulsive disorder (OCD). Check out www.whelehans.ie or call into Whelehans Pharmacy for more detailed information on OCD. If you feel you suffer from OCD, I would advise discussing your concerns with your GP in confidence and he/she will advise you on the best course of action to take (if any). Obsessive-compulsive disorder (OCD) is a relatively common psychiatric disorder of varying degrees of severity and it is characterised by obsessions or compulsions but commonly both. Obsessions are unwanted intrusive thoughts, images or urges that occur repeatedly and the person cannot get out of their mind. Compulsions are repetitive behaviours or mental acts that the person feels driven to carry out.

How common is OCD?

1 to 2% of the population are thought to suffer from OCD, although some studies suggest it is as high as 2 to 3%. OCD appears to be more common in women than men. OCD is sometimes linked to depression and about 50% of people suffering from OCD may also have depression.

Symptoms

Obsessions

Examples of obsessions include fear of causing harm to someone else; fear of harm coming to self; fear of contamination; need for symmetry or exactness; sexual and religious obsessions; fear of behaving unacceptably and fear of making a mistake

Compulsions

Compulsions can include behaviours such as cleaning, hand washing, checking, ordering and arranging, hoarding and asking for reassurance. Compulsions can also include mental acts such as counting, repeating words silently and constant worries about past events.

Treatment

Psychological therapy such as counselling and Cognitive Behavioural Therapy appears to be the most effective treatment option for OCD. Check out www.whelehans.ie for more info on psychological treatment of OCD.

Medication may be needed in some cases. Antidepressants called Serotonin Selective Reuptake inhibitors (SSRIs) appear to be effective for OCD. SSRIs such as fluoxetine, sertraline or citalopram can be prescribed for OCD. There are no significant differences in efficacy between the different SSRIs for OCD. Higher doses of SSRIs than those used for depression may be needed to effectively treat OCD. For example, fluoxetine dose may be increased to up to 60mg for OCD. GPs often refer people to psychologists who specialise in OCD to ensure the best possible treatment options.

OCD Ireland is a national organisation for people with Obsessive Compulsive Disorder (OCD). Their website is www.ocdireland.org and it provides great information and advice on OCD. The website also lists psychiatrists in Ireland who provide treatment of OCD.

Disclaimer: Consult a healthcare professional before making any changes recommended

This article is shortened. For more detailed information, logon to www.whelehans.ie or contact Whelehans at 044 93 34591 or info@whelehans.ie and we will forward you a more detailed copy for free

Sleeping tablets

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. Check www.whelehans.ie for more information. If you have any health questions e-mail them to info@whelehans.ie

Sleeping medication should be absolute last resort. I discussed in a previous blog natural ways to help aid sleep; to read this click on: http://whelehans.blogspot.com/2015/01/insomnia-and-its-management.html

Quite often sleep disturbance is due to a medical condition. Examples include depression, asthma, ADHD or pain. Treating the medical condition is often the key to solving the sleep problem.

Natural Products

There are many natural products available. Their effectiveness is questionable and will only help mild insomnia (if at all). In Whelehans, we find that products containing Valerian (a natural sedative) aids sleep for some. Ask our staff for details of products we stock containing valerian.

Prescription medication

Prescription sleeping medication should only be used for short term use. It is easy to become dependent on them and they become less effective if used for more than 5 days. A doctor may consider the short term use of sleep medication if the symptoms are particularly severe, to ease short-term insomnia, or if the non-drug treatments failed. Doctors try to rule out other medical problems such as depression before prescribing sleeping tablets. Prescription sleeping tablets will temporarily relieve symptoms but do not tackle the cause. You should be given the lowest dose possible for the shortest length of time necessary (no longer than 5 days). The doctor may advise to only take the medication two or three nights a week, rather than every night.

Prescription hypnotic medicines cause side effects including a hungover feeling and drowsiness the next day. Sleeping medication are best taken half an hour before bedtime. In some, especially older people, the hangover effects may last well into the next day, so be cautious if driving or using machinery the next day. It is very easy to become dependent on these medicines, even in the short-term. If regularly taking sleeping tablets, you should consider reducing or stopping them. If you have been taking long term, do not stop them suddenly, as withdrawal symptoms can include panic attacks, shaking and rebound insomnia. Your doctor or pharmacist will give you advice safe withdrawal.

Types of prescription sleeping tablets

Benzodiazepines

Benzodiazepines are tranquillisers designed to reduce anxiety and promote calmness, relaxation and sleep. These medicines should only be considered if insomnia is severe or causing you extreme distress. All benzodiazepines make you feel sleepy and can lead to a dependency. If they are needed to treat insomnia, then only short-acting benzodiazepines (with short-lasting effects) should be prescribed, such as temazepam (Nortem^®, Insomniger^®), lormetazepam (Noctamid^®), flurazepam (Dalmane^®), triazolam (Halcion^®). As someone who has seen too often the terrible problems addiction to benzodiazepines cause, I advise they should be an absolute last resort.

Non benzodiazepines

The newer non benzodiazepine sleeping tablets such as zopiclone (Zimovane^®, Zimoclone^®) and zolpidem (Stilnoct^®, Zolnod^®) are less addictive than older varieties but it is still easy to become dependant on them. They tend to cause a metallic in the mouth. There is little difference (efficacy wise) between the non-benzodiazepines and older benzodiazepines, so if one does not work, it is unlikely that swapping to another will have a different effect. Sleeping tablets are best avoided in the elderly if possible as they cause confusion and increase the likelihood of falls.

Antidepressants
Some older antidepressants such as amitriptryline and trazodone are sometimes used to treat insomnia as they induce drowsiness. They should only be used in patients suffering from insomnia caused by depression. They are generally only prescribed under the supervision of a consultant psychologist. These older antidepressants can have more side effects than newer antidepressants such as dry eyes and mouth and constipation. Newer antidepressants that do not cause side effects such as drowsiness are more regularly used in depression. However in most cases, by treating the depression (combination of lifestyle changes, counselling, medication if need be), the sleeping pattern should then soon improve. 

Melatonin
Melatonin is a natural chemical produced by the pineal gland in the brain. Its key functions in the body are to induce sleep by causing drowsiness and lowering temperature. Melatonin has been available to purchase over the counter as a sleep aid in the US for over 15 years. However, it has only recently been launched on prescription in Ireland under the brand name Circadin^®. It can only be prescribed by a doctor and is only licensed for short term use in people over 55 and should not be taken for more than three weeks. It is not recommended for people with a history of kidney or liver disease. As Circadin^® can make you feel drowsy; you should not drive or operate heavy machinery after taking the medicine at night, or if you still feel drowsy the next morning. Side effects of Circadin are uncommon but include irritability, dizziness, migraines, constipation, stomach pain, and weight gain. Circadin^® does not have a GMS code meaning it is not allowed on the medical card or drug payment scheme.

Disclaimer: Consult a healthcare professional before making any changes recommended

Insomnia and its management

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. Check www.whelehans.ie for more information. If you have any health questions e-mail them to info@whelehans.ie

This is a quick summary of insomnia and how to prevent and ease it; for a more detailed article on insomnia and how to tackle it, ask a Whelehans Pharmacy staff member for a free copy or check www.whelehans.ie.  One in three people suffer from insomnia at some stage in their life while one in ten suffers from chronic insomnia. Half the elderly population complains of suffering from insomnia.

How much sleep do we need?
This varies greatly from person to person. The amount of sleep needed varies from four hours to over ten hours. It also depends on level of activity. A person who is retired may undertake less activity than when they were working and less sleep is needed. On the other hand, a person with a young family and constantly on the go will require more sleep to recuperate. The amount of sleep needed reduces as we get older. A baby needs 16 to 17 hours sleep; by the age of five, sleep requirement reduces to 8 to 9 hours and teenagers generally need less than 8 hours sleep. Even less sleep is needed as we enter adulthood.

Reasons for insomnia

The main reasons for sleep problems include ageing as we need less sleep as we get older (so for example an older people may wake up at something like 5am as the body has enough sleep but it is considered too early to actually get up). Medical conditions can be a reason. Pain is often a problem.  Needing to get up to go to the toilet can disturb sleep. It is estimated that over 60% of men and women over 60 need to get up at least once during the night to go to the toilet. However urinary frequency can easily be treated by your doctor. It could be a medical problem such as unstable bladder which can be rectified with medication. Not drinking tea or coffee late and not taking certain blood pressure tablets late at night can alleviate this. Emotional upset from bereavement can be a cause. Some prescription and over the counter medication including decongestants can disturb sleep. Anxiety, worry and stress can be a factor. Sleep disturbance is a common symptom of depression and low mood.  Change in sleep routine such a shift work can affect sleep. Surroundings can be a reason for poor sleep, for example, a room is too hot or cold, too bright or too noisy.

Recent research

In 2008, research by the German Institute for Quality and Efficiency in Health Care showed that good bedtime habits are more effective than sleeping pills to help insomnia.  The institute found that going to bed when tired, avoiding caffeinated drinks like tea and coffee at night, and not reading or watching television in bed can help people who suffer from sleeping problems. They showed that learning relaxation techniques can help people switch off and make it easier to get to sleep. Getting up at the same time each morning can help your sleep pattern.

Self Help

Avoiding cat naps during the day can help ensure a good night’s sleep. Nicotine can have a negative impact on sleep so stopping smoking can improve your sleep pattern. A warm bath before going to bed can relax you and help you sleep. Many people consider alcohol as an aid to sleep, however alcohol actually disturbs sleep so it should be avoided if you have difficulty sleeping. Regular exercise helps sleep but do not exercise in the late evening. You should avoid watching TV, eating and talking on the phone in bed. If you feel restless in bed you may try getting up and try reading or listening to relaxing music for a while until you get tired again. If you still feel you don’t get a sufficient night’s sleep, it is possible that you don’t need as much sleep as you think you need. We don’t need as much sleep when we were older. Many people in their seventies only need less than 6 hours sleep.

Treatment

Quite often sleep disturbance is due to a medical condition. Examples include depression, asthma, ADHD or pain. Treating the medical is often the key to solving the sleep problem. There are many natural products available on the market with varying degrees of success. Their effectiveness is questionable but they may help if suffering from mild insomnia. Sleeping tablets are only available on prescription and should be used for short term use only. It is easy to become dependent on them and they become less effective if used long term (more than 5 days). The newer non benzodiazepine sleeping tablets such as zopiclone are less addictive than older varieties but it is still easy to become dependant on them. They are best avoided in the elderly as they cause confusion and increase the likelihood of falls. Your GP will generally try to rule out other medical problems such as depression before prescribing sleeping tablets.

I’ll discuss sleeping tablets in this blog in the coming days.

 

Upcoming talk on depression and mental health

Whelehans Pharmacy Mullingar has organised an expert panel to discuss depression and mental health. The information evening is being held in The Greville Arms Hotel on Tuesday February 10^th at 7pm. Speakers will include Consultant Psychiatrist from St Lomans Mental Health Service, Dr Ciaran Corcoran; Specialist Psychiatric Nurse Colette Moriarty and Pharmacist Eamonn Brady.  This talk is open to all and is free of charge. You can turn up on the night or incase it is booked out you can put your name down in advance by calling Whelehans at 04493 34591.

Disclaimer: Consult a healthcare professional before making any changes recommended

 

 

 

 

Constipation in Children

Constipation is a common complaint in infants and children. There are many reasons but it is rarely caused by an actual medical condition. In many children, constipation is triggered by experience of painful bowel movements or caused by factors such as toilet training, change in routine or diet, stressful events, illness like viruses or delaying defaecation (delaying going to the toilet).

Constipation can present at three common stages of childhood:

·         in infancy at weaning

·         in toddlers learning toilet skills

·         at school age.

Signs of straining in infants less than one year do not usually suggest constipation because children only develop muscles to assist bowel movements gradually. Provided that they pass soft stools and are otherwise healthy there should be no major problem.

What is constipation?

Constipation describes infrequent bowel movement, often with hard, dry stool that is difficult to pass. It may be associated with bloating, straining and pain. It is caused by inadequate muscle contraction or under absorption of water. Constipation is thought to affect approximately 20 per cent of the population. It can be a symptom of a serious illness but this is rare. Once a serious illness is ruled out its management can involve dietary interventions and then only if this does not work, laxatives may be considered but only under medical supervision (ie) must be prescribed by a doctor

Diagnosing in children

The general diagnosis criteria for constipation in adults and children must include 2 or more of the following:

·         less than 3 bowel movements per week

·         a history of painful or hard bowel movements

·         at least 1 episode of faecal incontinence (diarrhoea) per week (this is due to an excess build-up of faeces which when suddenly released can cause diarrhoea

·         presence of large faecal mass in rectum

·         a history of stool so large that may obstruct the toilet

These symptoms must be present for 4 weeks in infants and children under 4 years and for 8 weeks in children over 4 years in order to enable diagnosis

What is ‘Normal’ bowel function in children?

The ‘normal’ frequency of bowel movements varies from child to child and varies widely

Examples of average bowel movements include:

Age	Average	Per Week
0-3 months	2.9/ day	5-40
3 years and over	1.0/day	3-14

 Bowel motions in breast fed babies can be very variable. It is not common, but some babies can have infrequent motions sometimes once in 7 or even 10 days

Risk factors for constipation in infants and children
 

·         Some drugs - Antihistamines/anticonvulsants/iron supplements and many more

·         Intolerance to cow’s milk

·         Inadequate fluid intake

·         Poor diet including excess milk

·         Low fibre diet

·         Lack of exercise

·         Obesity

Treatment

Constipation can be challenging to treat and often requires prolonged support, explanation, encouragement and medical treatment. Aim is restoration of bowel habit so stools are soft and passed without discomfort. Treatment starts with education of parents/carers and children (as appropriate for age).

Constipation may be Acute (short term) or Chronic (long term):

Treatment of acute constipation

Acute constipation refers to short term constipation that lasts only one to three weeks (generally brought on by short term illness eg. viral illness). In this case, ensure the child has adequate fluid intake and a good diet. You should see your GP if no improvement or it is causing distress to the child. If not improving, the GP may consider prescribing lactulose or Movicol^® for a short period of one week. Movicol^® is brand name for macrogol; the other brand is Molaxole^®, for the purpose of this article I will refer to as Movicol. Lactulose and Movicol are called osmotic laxatives, they work by drawing water into the stool and are considered to be the safest type of laxative as they do not stimulate the bowel muscle like laxatives such as senna. Laxatives if required are generally only required short term. If a child is prescribed laxatives, it is important a GP reviews progress even if it is only a short term use of laxatives.

Treatment of chronic constipation

Chronic constipation refers to constipation that lasts longer term, usually a period of weeks or months. In this section I discuss laxative use; however bear in mind laxatives are generally last resort and should be only used under medical supervision. However they are very beneficial if it is an ongoing problem

Age 1 to 6 months

 

If it is a problem from birth or meconium (sticky tar like faeces a baby passes for the first few days after birth) has not passed in first 24 hours then discuss with hospital staff as Hirschsprungs Disease or another complication is a possibility.

 Other things to look at are:

·         type of milk (If formula fed, maintain on first formula for his/her particular age and do not    overfed)

·         Ensure adequate fluid intake (150mls/kg)

Maintenance regime

If it is an ongoing problems and diet, fluid intake etc have be assessed and are adequate, laxatives may need to be prescribed and these should only be maintained under regular medical supervision

Options include:

·         Macrogol (Movicol): ½ to 1 sachet daily

Or

·         Lactulose: 2.5mls twice daily (adjust depending response)

Or

·         Lactulose and Senna*: 2.5mls once daily  

Senna should be last resort as stimulant laxatives tend to case more side effects like lazy bowel than osmotic laxatives like lactulose and Movicol.

Dis-impaction regime: if faecal impaction (ie. Blockage) has occurred

Movicol ½ - 1 sachet daily; if this is not tolerated then Lactulose and Senna are alternative options

Age 6 months to one year

·         Ensure adequate fluid intake

·         Ensure overfeeding is not a problem and there is not excess milk (check with dietician)

·         May benefit from dietician assessment if diet is thought to be poor

·         Refer to specialist if abdominal pain, stomach bloating or vomiting occurs

·         An anal fissure (tear in anal skin that is painful when passing stools) is a possibility; easily rectified by medical intervention if it occurs

Maintenance regime and dis-impaction regime

Please note, the regime for this age is the same as the regime described above for one to six months (see above)

Children over 1 year

 

·         Ensure adequate fluid intake

·         May benefit from dietician assessment if diet is thought to be poor

·         Adequate exercise? Ensure an active lifestyle as this can help bowel movement

·         Ensure regular toileting

·         Behaviour modification :- toilet training/rewarding/toilet diaries etc (this can done by specialists

Maintenance regime

Movicol:

·         1-6 years: 1 sachet daily (adjust to response to max of 4 sachets/day)

·         6-12 years: 2 sachets daily (to a max of 4 sachets/day)

·         Over 12 years: same as adult regime

Lactulose:

·         1-5 years: 2.5 to 10mls twice daily (adjust to response)

·         >5 years: 5 to 20mls twice daily (adjust to response)

Senna*:

·         1-4 years: 2.5 to 10mls once daily

·         Over 4 years: 2.5 to 20mls once daily

*only if lactulose or movicol do not work

Dis-impaction regime: if faecal impaction (ie. Blockage) has occurred

Movicol:

·         1-5 years: 2 sachets on day 1, then 4 sachets for 2 days, then 6 sachets for 2 days and 8 sachets daily thereafter

·         5-12 years: 4 sachets on day 1, then increase by 2 sachets daily until max of 12 sachets daily

·        Over 12 years: same as adult regime

If dis-impaction not achieved by 2 weeks, add a stimulant laxative like Senna. If Movicol is not tolerated, use Lactulose and Senna for dis-impaction

Enemas can be considered in cases undergoing dis-impaction that do not have the required result from the medicine regime, if they are on maximum medication, and have been compliant with treatment. Enemas should only be used under specialist supervision

References

References for this article are available on request. The article was written and researched by pharmacist Eamonn Brady and Eamonn will forward references upon request.

Disclaimer: Information given is general; please ensure you consult with your healthcare professional before making any changes recommended

For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591. Email queries to info@whelehans.ie. Find us on Facebook.