SOCIAL PHARMACY

Patient Counselling

CONSTIPATION

Bowel movements may vary among healthy people. Normal bowel movement ranges from 2-3 times
daily to 3 times weekly. Any abnormal decrease in a person’s usual bowel movement frequency or
pain during stool passage is termed as constipation. Accumulation or impaction of the intestinal
contents leads to stool hardening resulting in defecation. This may be caused by not drinking enough
fluids, not eating enough fiber (e.g, fruit, vegetables and cereals), consumption of bulk diet, lack of
regular exercise, frequent repression of the urge to defecate or adverse effect of some medications.

SCENARIO

First scene: Joanna, is crying while looking at the picture of her husband who’s already deceased.

Hope: Ayo! Dzai?! Mang-hingi ako ng malunnggay! Ayo! *Enters the door and saw Joanna crying.
‘Hala, anong nangyari sayo daii? Okay ka lang ba?’ *she sits down beside Joanna and realizes she’s
crying over her husband’s death. Hope caresses Joanna’s back as a sign of comfort. Then, proceeds to
hug Joanna.

Joanna: *takes a moment of silence before she replies…. ‘Salamat dzai…eto na naman ako dzai uy.’
Joanna wipes her tears using the back of her hands. ‘It’s already been five months that he’s gone but
it still hurts.’ *Joanna said

Hope: Everything will be fine, daii. Just trust and offer everything to Him.

Joanna: Thank you, dzaii. *they hug each other again.

After a few seconds*

Hope: ‘hooo, what is this smell? Did you just fart?’ *they detached themselves from their embrace.

Joanna: *nods her head. ‘I dunno dzaii uy. It’s almost a week already and I still could not defecate.’

Hope: Hala uyy, it is very concerning naman dzaii. Your fart smells like poop already.

Joanna: I know! Although, I tried many times to sit on the bowl, but I don’t know why I still could not
deposit.

Hope: Hoyrrr! It is very scary naman uyy. Your baby might swallow your poop.

Joanna: Hoyrrrr, simbako ka dzai uyyy, grabeh. Is that even possible?

Hope: We don’t know dzai. You are pregnant and your baby primarily relies nutrients on you. Your
baby might ingest your feces.

Joanna: Hala dzai uy. Actually, I was even started to get worried and scared about my situation ayy.
Hope: As you should dai uyy. Go to AALAGAN KITA PHARMACY in downtown dzai and go get
counselled. As what I have heard, maganda daw doon dahil grabe daw yon na pharmacist. Top
notcher daw yon sa board and a lot of people testified that she is good in advising and counselling
her patients.

Joanna: Really dzai? huhu. sige dzai. I’ll go there later.

SCENARIO 2 (AT THE PHARMACY)

Aparilla is currently busy serving other customer who’s buying a sex stimulant supplement. The
customer leaves and Aparilla then entertains Joanna.

Joanna: Hello, good morning.

Aparilla: Good morning po ma’am. How can I help you ma’am?

Joanna: Is your Pharmacist available?

Aparilla: Yes, maam. She’s currently in the counselling area po. May I ask po why are you looking for
her?

Joanna: Magpapa-advise sana ako regarding my situation. Matagal-tagal na rin kasi na hindi pa ako
tumata-e and I am five months pregnant pa. I will ask some questions sa kanya.

Aparilla: Ah, sge ma’am. Pasok lang po tayo dito sa counselling area ma’am.

Joanna: Sige ma’am, salamat.

SCENARIO 3 (In the counselling area)

Joanna: Hi ma’am, good morning.

Canencia: Oh, hi. Good morning. Please have a seat ma’am.

Joanna: Thank you.

Canencia: Ano po ba ang maipag-lilingkod ko po ma’am.

Joanna: Ma’am, I started to get worried and scared about my current situation ma’am ba. It’s
already almost a week since my last bowel and I still could not defecate no matter how hard I try to.

Canencia: May I ask if how many days to be exact ma’am?

Joanna: Around 5 days na, I think. But I remember, one time, I was able to defecate but it’s very
small as in and then it’s also hard. Do you know the feces of goats? The small black circles? Just like
that.

Canencia: *nods her head. Are you currently taking other medications ma’am?
Joanna: Yes, ma’am. I am currently maintaining calcium carbonate, folic acid and iron vitamins for
my pregnancy and other than that, wala na.

Canencia: How long have you been pregnant ma’am?

Joanna: five months na.

Canencia: Are you maintaining a specific diet maam? Or what kind of food do you usually eat on a
daily basis?

Joanna: Syempre hindi mawawala ang white rice. But our viands usually revolve around canned
goods, eggs and poultry. I also like eating bananas a lot especially the unripe ones that you cook and
dip into the Ginamos. I also drink coffee twice a day because I was accustomed to it and I feel like my
body will be looking for coffee when I can’t drink. I think my consumption of food doubled up this
time since maybe because I am pregnant.

Canencia: *nods her head and write it in her record book. Okay, so you are five months pregnant and
currently taking supplements. Do you do exercise po ba ma’am? Or are you doing any physical
activity?

Joanna: Hindi po, because I think it’s not recommended. Is it even okay to do exercise while
pregnant ma’am?

Canencia: Yes, ma’am., pwede po… Doing light physical activity is safe and will not put your baby in
danger. In fact, mas nakakatulong po yung exercise to have a relax and active mind -- and a strong
heart. At maganda rin po yon para sa circulation ng dugo which in the end makakatulong sa inyong
dalawa ng baby mo.

Joanna: Is that so?

Canencia: Yes po ma’am… You can also ask your husband to assist you doing exercises.

Joanna: My husband’s already dead.

Canencia: I am very sorry ma’am.

Joanna: Just smiled*

Canencia: If you don’t mind me asking ma’am, who’s together with you in the house to help you
out?

Joanna: It’s only me, my lolo and lola in the house. My husband passed away four months ago na
and thinking of it still stresses me out. Nakakapagod kung wala kang matatawag sa oras ng
pangangailaingan. Hindi naman pwede yung grandparents ko palagi dahil matatanda rin naman po
sila. I am super stressed but I am trying not to deal with it para sa aking baby. Pero hindi talaga
maiiwasan minsan eh.

Canencia: I am so sorry to hear your loss again, ma’am.

Canencia: Ma’am, I am asking these questions because I want to know the possible reasons why you
are experiencing your complaint. Based on the information that you provided, you have constipation
po and I am positive that these factors contribute to your condition. Your iron supplementation,
lacking of physical activity, your stress and unhealthy diet are all contributing factors of your
condition which is constipation especially that you are pregnant that affect most of females.

Joanna: Really? Then what should I do?

Canencia: First is to increase your fluid intake ma’am. Please don’t forget to drink at least 8-12
glasses of water per day. Our body needs to be hydrated because that will keep our food moving
through our digestive tract and help keep stools soft. Also, mag maintain po tayo ng healthy diet
ma’am, especially that you are pregnant and you have a developing baby inside of you. Avoid
drinking too much coffee po ma’am kasi that is one of the factors na maka-contribute po ng ating
constipation and masama po yan sa health pag sumobra. Let us eat green leafy vegetables and foods
that contain high fibers like beans such as legumes, soybeans and peas. I also encourage you to eat
fruits like apples, oranges and pears kasi makakatulong sila to easily absorb water that softens stool
and making it easier to pass. Also maam, please avoid too much unripe bananas because that is also
a contributor na hindi ka po makaka-tae. And also, ini-encourage ko rin po kayo to do light physical
activity ma’am, like yoga or walking. Exercise helps constipation by lowering the time it takes food to
move through the large intestine. This limits the amount of water your body absorbs from the stool.
Plus, nakakawala po rin yan ng stress ang pag exercise and whenever you feel stress naman po
maam, just close your eyes, take deep breaths, stretch, or meditate. Malaking tulong rin po yung
meditation para mapagaan ang loob natin.

Joanna: Okay, ma’am. But can I still continue my iron supplement?

Canencia: Yes po ma’am. You can continue your iron supplementation. Wala pong problema as long
as you will just comply with what I have recommended you to do.

Joanna: Noted po. May gamot ka po bang ibibigay sa akin for my constipation?

Canencia: Yes po ma’am. Just wait here for a second. I’ll just get your medicine.

After a few moments…

Canencia went back with Docusate sodium with her.

Canencia: Here is your medicine po ma’am. This is Docusate sodium that helps to moisten the stool
and make it easier to pass. This product is unlikely to harm a developing baby because their active
ingredient is only minimally absorbed by the body. Kaya safe po ito, but please follow to stay
hydrated po maam because this medicine may potentially cause dehydration po.

Joanna: May I know its dosage?

Canencia: Of course ma’am. Take this medicine orally, three times a day every 8 hours for 5-7 days
of use. Take this with a glass of water one hour before or after meals. In case you forgot to take the
medicine, take it as soon as you remember, take a dose and then continue the normal course of
treatment. Do not take a double dose to make up for a forgotten dose. Did you just get it ma’am?

Joanna: Yes, I do.

Canencia: However, still follow the things I have said earlier po ma’am to facilitate easy bowel
movements and so we can have a more effective therapeutic outcome po.

Joanna: I’ll keep the things you said in mind. Thank you so much ma’am.

Canencia: You’re welcome po.

THE End…