A 32-year-old woman comes to your pharmacy seeking advice for her wife’s constipation. What is the most suitable course of action?

• A. Advice on dietary and lifestyle measures
• B. Prescribe laxatives
• C. Refer to GP
• D. Start saline enemas

Answer: (A)

The main idea is to start with non-drug, lifestyle-based management for uncomplicated constipation. In an adult without alarming symptoms, dietary and lifestyle measures are the most appropriate first step in a pharmacy setting. This approach helps many people improve bowel habits without introducing medicines right away.

Advise on increasing fiber and fluids, plus regular activity and a consistent toilet routine. Aim for about 25–30 g of dietary fiber daily from a mix of fruits, vegetables, whole grains, and pulses. Encourage steady fluid intake and regular physical activity, such as walking most days. Suggest establishing a regular time for trying to have a bowel movement and not ignoring the urge. Also review any medicines or factors that could be contributing to constipation and discuss limiting constipating habits.

Prescribing laxatives, referring to a GP, or starting saline enemas isn’t the best course here unless the constipation persists or red flags appear. A GP referral would be considered if constipation continues despite lifestyle changes, if there are warning signs (such as blood in stool, weight loss, severe or persistent abdominal pain, vomiting, new onset in someone over 50, or pregnancy), or if there’s concern about a medication causing the symptoms. Saline enemas are more invasive and require medical supervision, so they aren’t first-line in this scenario.

If you’re advising for someone else, obtain consent to discuss their health information and ensure there are no red flags before suggesting any escalation. In the meantime, provide practical lifestyle guidance and monitor symptoms, advising them to seek further help if there’s no improvement.