Constipation treatment

Dietary fiber (bulk-forming laxatives)

The most common sources of fiber include:

• fruits and vegetables,
• wheat or oat bran,
• psyllium seed (for example, Metamucil, Konsyl),
• synthetic methyl cellulose (for example, Citrucel), and
• polycarbophil (for example, Equilactin, Konsyl Fiber)

Lubricant laxatives

Lubricant laxatives contain mineral oil as either the plain oil or an emulsion (combination with water) of the oil. The oil stays within the intestine, coats the particles of stool, and presumably prevents the removal of water from the stool. This retention of water in the stool results in softer stool. Mineral oil generally is used only for the short-term treatment of constipation since its long-term use has several potential disadvantages

mollient laxatives (stool softeners)

Emollient laxatives are generally known as stool softeners. They contain a compound called docusate (for example, Colace). Docusate is a wetting agent that improves the ability of water within the colon to penetrate and mix with stool. This increased water in the stool softens the stool. Studies, however, have not shown docusate to be consistently effective in relieving constipation. Nevertheless, stool softeners often are used in the long-term treatment of constipation. It may take a week or more for docusate to be effective. The dose should be increased after one to two weeks if no effect is seen

Hyperosmolar laxatives

Hyperosmolar laxatives are undigestible, unabsorbable compounds that remain within the colon and retain the water that already is in the colon. The result is softening of the stool. The most common hyperosmolar laxatives are lactulose (for example, Kristalose), sorbitol, and polyethylene glycol (for example, MiraLax). and are available by prescription only. These laxatives are safe for long-term use and are associated with few side effects.

Saline laxatives

Saline laxatives contain non-absorbable ions such as magnesium, sulfate, phosphate, and citrate [for example, magnesium citrate (Citroma), magnesium hydroxide, sodium phosphate). These ions remain in the colon and cause water to be drawn into the colon. Again, the effect is softening of the stool

Stimulant laxatives

Stimulant laxatives cause the muscles of the small intestine and colon to propel their contents more rapidly. They also increase the amount of water in the stool, either by reducing the absorption of the water in the colon or by causing active secretion of water in the small intestine

Stimulant laxatives are very effective, but they can cause severe diarrhea with resulting dehydration and loss of electrolytes (especially potassium). They also are more likely than other types of laxatives to cause intestinal cramping. There is concern that chronic use of stimulant laxatives may damage the colon and worsen constipation, as previously discussed. Bisacodyl (for example, Dulcolax, Correctol) is a stimulant laxative that affects the nerves of the colon which, in turn, stimulate the muscles of the colon to propel its contents. Prunes also contain a mild colonic stimulant.

Enemas

Suppositories

There are stimulant suppositories containing bisacodyl (for example, Dulcolax). Glycerin suppositories are believed to have their effect by irritating the rectum

Combination products

ex.e senna and psyllium (Perdiem), senna and docusate (Senokot-S), and senna and glycerin (Fletcher’s Castoria).

olchicine

Colchicine is a drug that has been used for decades to treat gout. Most patients who take colchicine note a loosening of their stools. Colchicine has also been demonstrated to relieve constipation effectively in patients without gout.

Misoprostol (Cytotec)

Misoprostol (Cytotec) is a drug used primarily for preventing stomach ulcers caused by nonsteroidal antiinflammatory drugs such as ibuprofen. Diarrhea is one of its consistent side-effects. Several studies have shown that misoprostol is effective in the short term treatment of constipation. Misoprostol is expensive, and it is not clear if it will remain effective and safe with long-term use. Therefore, its role in the treatment of constipation remains to be determined.

Orlistat (Xenical)

Orlistat (Xenical) is a drug that is used primarily for reducing weight. It works by blocking the enzymes within the intestine that digest fat. The undigested fat is not absorbed, which accounts for the weight loss. Undigested fat is digested by bacteria within the intestine and the products of this bacterial digestion promote the secretion of water. The products of digestion also may affect the intestine in other ways, for example, by stimulating the intestinal muscles. In fact, in studies, orlistat has been shown to be effective in treating constipation. Orlistat has few important side effects, which is consistent with the fact that only very small amounts of the drug are absorbed from the intestine.

It is unclear if these prescribed drugs should be used for the treatment of constipation. Although it is difficult to recommend them specifically just for the treatment of constipation, they might be considered for constipated individuals who are overweight, have gout, or need protection from nonsteroidal antiinflammatory drugs.

Risks of laxative use

Interaction with medications
Your medical history and other medications you’re taking may limit your laxative options. Laxatives can interact with blood thinners such as warfarin (Coumadin), antibiotics such as tetracycline and ciprofloxacin (Cipro), and certain heart and bone medications. Before using any laxative, read the label carefully. If you’re not sure whether a particular laxative is right for you, ask your pharmacist or doctor. Don’t exceed recommended dosages unless your doctor tells you otherwise.

Complicating conditions
Just because laxatives are available without a prescription doesn’t mean that they’re without risk. Laxative use can be dangerous if constipation is caused by a serious condition, such as appendicitis or a bowel obstruction. If you frequently use certain laxatives over a period of weeks or months, they can decrease your colon’s natural ability to contract and actually worsen constipation. In severe cases, overuse of laxatives can damage nerves, muscles and tissues of your large intestine.

Unsafe if you’re pregnant or under age 6
Don’t give children under age 6 laxatives without a doctor’s recommendation. If you’re pregnant, get your doctor’s advice before using laxatives. Bulk-forming laxatives and stool softeners are generally safe to use during pregnancy, but stronger laxatives can harm you or your baby. The stimulant laxative castor oil, for example, can cause womb contractions. If you’ve recently given birth, consult your doctor before using laxatives. Although laxatives are usually safe to use during breast-feeding, some ingredients may pass into breast milk and cause diarrhea in nursing infants.

Don’t be lax about laxatives

Talk to your doctor before using laxatives if you have the following:

• Kidney disease
• Heart disease or high blood pressure
• Stomach pain, nausea, vomiting or rectal bleeding

Call your doctor if you’re taking laxatives and have these symptoms:

• Bloody stools
• Constipation doesn’t improve after a week of laxative use

If you’re dependent on laxatives, ask your doctor for advice on how to gradually withdraw from them and restore your colon’s natural ability to contract.