Constipation is usually more bothersome than it is a serious medical concern. However, you should see a doctor if you notice an abrupt change in bowel habits, develop a fever or severe abdominal pain in addition to constipation, or notice blood in your stool.
Often, dietary and lifestyle changes will help alleviate constipation. If these do not work, over-the-counter laxatives may provide relief. Bulking agents are a safe and easy way to relieve constipation. Natural bulking agents include bran and psyllium. Try adding 2 to 6 tablespoons of bran to your cereal in the morning. You should notice results after a few days. Or, you may prefer over-the-counter psyllium products like Metamucil or Konsyl. Synthetic bulking agents include methylcellulose (Citrucel) and calcium polycarbophil (Mitrolan). These usually work within 24 hours, and side effects are rare. Be sure to drink plenty of fluids when you are using any bulking agent to aid the passage of that extra bulk.
Stool softeners and mineral oil are not the best choices for chronic constipation. Stool softeners such as docusate (Colace) promote easier bowel movements by drawing water into stools, forming a softer mass. The increased bulk stimulates contractions in the colon, which may cause cramping. These agents, however, are better at preventing constipation than relieving it. Mineral oil acts as a lubricant, making stool easier to pass, but may decrease the absorption of certain fat-soluble vitamins. Mineral oil can be dangerous if accidentally inhaled.
Osmotic laxatives can relieve constipation within 3 hours, but may cause bloating and gas. These laxatives include the salts magnesium hydroxide (Phillips' Milk of Magnesia) and magnesium citrate and the sugars known as sorbitol and lactulose, which are poorly absorbed by the body. Osmotic laxatives pull lots of water into the colon, making stool soft and loose. The extra fluid also stretches the colon walls and stimulates contractions. Polyethylene glycol (PEG) is a newly approved agent that does not cause as much bloating and gas as the other osmotic laxatives.
If bulk or osmotic laxatives do not relieve constipation, stimulant laxatives may be tried (but not for longer than a week). If you keep using laxatives, you will reach a point where you will not be able to defecate without them. Because they can be habit-forming and can lead to diarrhea, dehydration, and electrolyte imbalances, many doctors recommend taking stimulant laxatives no longer than a week. These laxatives directly stimulate the walls of the colon, causing them to contract and move stool along. Orally, they work within 6 to 8 hours. If you take the suppository form, they will work within an hour. Overuse of laxatives causes the body to rely on the laxatives to bring on bowel movements.
Of the subgroup of stimulant laxatives called anthraquinones, cascara sagrada is the mildest. It produces soft-formed stool with little or no cramping. Senna may be particularly helpful in patients with severe constipation. Belching, cramping, diarrhea, and nausea are common side effects. When combined with psyllium or other bulk-forming agents, however, smaller doses can be used. Aloe preparations are the most potent, but are best avoided because they can cause severe cramping. All of these anthraquinone laxatives are derived from plants.
Bisacodyl and phenolphthalein both stimulate peristalsis. Bisacodyl produces soft-formed stool, whereas phenolphthalein may produce semifluid stool. Because phenolphthalein was found to be carcinogenic in animals, it is no longer available without a prescription.
Your doctor is the best source of information on the drug treatment choices available to you.
If laxatives do not help constipation, enemas can be tried. Self-administered enemas can be done every few days to relieve constipation. These should not be used for more than one to two weeks at a time, because, like laxatives, overuse can cause the bowel to lose its ability to work on its own. The small-volume sodium phosphate-biphosphate enema kits are easy and safe to use, but should only be used if suggested by your doctor.
When doing an enema, never use hot water, peroxide, household detergents, or strong hypertonic salt solutions. They are irritating, and can result in rectal bleeding, weakness, shock, convulsions, or coma in some people.
Habit training can be helpful for children and adults who suffer from severe constipation. The first step involves cleansing the bowel. Polyethylene glycol is a safe and effective laxative, however, it may take two to four days to produce a bowel movement, and should not be used for more than 14 days. Laxatives are then used to promote daily bowel movements. Patients are instructed to go to the bathroom after eating to take advantage of the colonic stimulation that occurs after a meal. Enemas are given if two days pass without a bowel movement (but should not be used in children under two years of age). Once regularity is established, patients are gradually weaned off laxatives.
Children with functional constipation usually improve with a combination of daily laxatives and behavior modification therapy. Some children require manual disimpaction by a healthcare professional who inserts a gloved finger into the child’s rectum to remove stool.
Infants may need to take certain medications to relieve constipation. You should discuss this with your child’s pediatrician.
Children with an underlying medical disorder leading to constipation, such as diabetes or thyroid disease, require treatment for that condition.
Children with sensitivity to cow’s milk should avoid drinking cow’s milk and drink soy milk or soy formula instead.
People suffering from chronic, severe, disabling constipation symptoms who have not been helped by medical therapy may benefit from surgery. Although controversial, partial removal of the colon (subtotal colectomy) with restructuring of the intestines (ileorectal anastomosis) can relieve incapacitating constipation. This surgery is performed only in carefully chosen patients with definite abnormalities in the bowel. Complications include persistent abdominal pain and bloating, diarrhea, small intestine obstruction, and postoperative infections. However, 90% of patients have satisfactory long-term results.
Rarely, children will not respond to laxatives and other measures. Some children may need to have special surgery on the muscle that controls the anus or to undergo injections of botulinum toxin into the anal muscle. Your doctor will try other measures before referring your child to a specialist for possible surgical treatment.
Several herbs are thought to help relieve constipation by both softening the stool and stimulating contractions in the colon. Those on the milder side include yellow dock, dong quai, licorice, burdock, and dandelion. Until you know how your body reacts to these herbs, you should introduce the herbs slowly; cramping and other gastrointestinal disturbances might result otherwise. Although not widely recognized treatments, some believe that a chiropractic realignment of the spine can alleviate constipation, while others suggest practicing yoga.
There are certain circumstances to be aware of when dealing with constipation if you are pregnant or have certain diseases. In addition, if you are caring for a child with constipation, always consult a pediatrician before giving your child a laxative. If you are pregnant, consult your doctor for the proper choice of laxative.
If you develop sudden constipation accompanied by abdominal pain, distention, nausea and vomiting, seek urgent medical care before using any laxative.
If you have renal failure, certain types of laxatives are not suitable for you. Some may even be harmful. Be sure to check with your doctor before taking one.
If you suffer from inflammatory bowel disease and develop constipation, consult your doctor before taking a laxative.
Familiarize yourself with proper use of enema nozzles to avoid damage to the rectal mucosa.
Constipation usually resolves within a few weeks after dietary measures, fiber supplements, and laxatives have been tried. Regularity is often achieved within a matter of weeks when a change in lifestyle is made. Therapeutic options for more severe constipation include enemas, behavioral approaches, and biofeedback.
If you are still constipated after several weeks of trying dietary and lifestyle changes, especially after using a laxative, see your doctor.
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