Tests and Treatment
Constipation can usually be prevented or treated successfully. It is best to start with simple strategies and move on to stronger measures when necessary.
Although most of us will suffer from constipation at some point in our lives, chronic constipation is not normal. If you continue to be constipated after unsuccessfully trying the lifestyle changes suggested below it is important to speak with your doctor about treatment options.
Pharmacy products for constipation
If dietary and other lifestyle changes do not relieve constipation, you have several options for over-the-counter and prescription products.
Products such as psyllium or methylcellulose help hold water in the stool and add bulk to it, which stimulates normal bowel contractions.
Also known as stool softeners, these products contain a wetting agent that helps water penetrate and mix with the stool, so it becomes softer and easier to pass. It may take a week or longer for stool softeners to take effect. Examples include docusate sodium and docusate calcium.
This type of laxative may contain mineral oil, which coats the particles of stool to prevent water from escaping. Because fat-soluble vitamins (A, D, E and K) dissolve in the oil, they will not be absorbed as well by the intestine. For this reason, lubricant laxatives should only be used short-term.
These medications help retain the water in the stool, making it softer. Products in this class contain polyethylene glycol, undigestible sugars (lactulose, sorbitol) or ions such as magnesium, sulfate, phosphate or citrate; some require a prescription but many are available, ‘over-the-counter’, without a prescription. Osmotic laxatives are not absorbed or are poorly absorbed by the bowel, have few side effects, and are generally safe for long-term use with your health care provider’s recommendation.
As a general rule, try gentler products such as those listed above first. If they fail to provide relief move on to those that follow below.
This group of laxatives causes the bowel muscles to propel their contents more rapidly and also increases the amount of water in the stool. While very effective, using them can lead to diarrhea, dehydration and intestinal cramping.
Although there is no proof that chronic use damages the colon or worsens constipation, most experts agree that these products should be used sparingly. Common stimulant laxatives contain cascara, senna, bisacodyl, or aloe.
Enemas and suppositories
Enemas expand or irritate the rectum, which stimulates the colon to contract and eliminate stool. Especially useful when the stool is hardened and blocked (impacted) in the rectum, they are meant for occasional use and can disrupt the balance of fluids and electrolytes in the body if used regularly or in access. Suppositories also trigger bowel movements by stimulating or “irritating” the rectum.
Prokinetic agents (e.g. prucalopride)
These medications, available by prescription only, improve the motility (movement) and contraction of the bowel which speeds up the passage of stool through the bowel and increases stool frequency to relieve constipation.