Thursday 26th August 1993 Morning surgery 11:20

“How long have you been constipated, Mrs Evans?”
“Ever since I was a child, Dr Lewis. I was a holder then. I never had time to go to the toilet. I think I was about 11 years old when I realised that, if I took a book, I could sit there for a bit longer. It has gradually got worse as I have got older. I have to take laxatives now.”
“When do you take them, exactly?”
“If I haven’t been for a few days, I will take some lactulose. I’ll take four teaspoons every night until I am opening my bowels properly.”
“I see,” Dr Lewis nodded.
“Of course, it’s a cycle that keeps repeating itself.”
“Well, that’s the problem, Mrs Evans. Most laxatives take a day or two to work so you have got to plan ahead. I think you would be better off taking a small dose every day. You can fine tune the exact amount depending on how things are going. Two teaspoons in the morning might be a good staring point.”
Mr Evans nodded. “I could try that.”
“What are you aiming for?”
“As you’ve always said, Dr Lewis, a Bristol 4: the perfect stool.”

The Bristol 4.