Table of Contents
- Constipation definition and facts
- What is constipation?
- What causes constipation?
- Medications that cause constipation
- Other causes of constipation
- What are constipation symptoms?
- What tests help diagnose the cause of severe constipation?
- How are the causes of constipation treated?
- Dietary fiber, bulk-forming and lubricant laxatives, and stool softeners
- Over-the-counter (OTC) laxatives
- Biofeedback, exercise, and surgery
- Prescription drugs to treat constipation
- Home remedies for constipation relief
- When should I seek medical care for chronic constipation?
- What is new in the treatment of constipation?
Quick Guide19 Constipation Myths and Facts
Home remedies for constipation relief
Start with the simple things.
- Don't suppress urges to defecate. When the urge comes, find a toilet.
- With the assistance of your physician and pharmacist, determine if there are drugs that you are taking that could be contributing to the problem. See if the drugs can be discontinued or changed.
- Increase the fiber in your diet by consuming more fruits, vegetables, and whole grains. (There are other health benefits from this recommendation as well.)
- It may be difficult to get enough fiber in the diet to effectively treat constipation, so don't hesitate to take fiber supplements if necessary (wheat bran, psyllium, etc.).
- Use increasing amounts of fiber and/or change the type of fiber consumed until there is a satisfactory result.
- Don't expect fiber to work overnight. Allow weeks for adequate trials.
What if constipation does not respond to these simple, safe measures?
These efforts should not be discontinued but other measures should be added. If it is infrequent, that is, every few weeks (as it can be when due to the menstrual cycle), it probably doesn't matter what other measures are added-emollient, saline, or hyper-osmolar laxatives, enemas, and suppositories. Even stimulant laxatives every four to six weeks are unlikely to damage the colon. Unfortunately, the tendency when using stimulant products is to unconsciously increase the frequency of their use. Before you know it, you're taking them every week, or more often, and there is concern (though no proof) that permanent colonic damage might result.
If it is a continuous rather than an intermittent problem, probably the safest products to take on a regular basis are the hyper-osmolar laxatives. Their use should be supervised by a physician. As with fiber, increasing doses of different hyper-osmolar products should be tried over several weeks until a satisfactory type and dose of laxative is found. Hyper-osmolar laxatives, however, can be expensive. Milk of magnesia is the mildest of the saline laxatives, is inexpensive, and provides a good alternative. Most patients can adjust the dose of milk of magnesia to soften the stool adequately without developing diarrhea or leakage of stool.
Prunes and prune juice have been used for many years to treat mild constipation. There is no evidence that the mild stimulant effects of prunes or prune juice damage the colon.
Stronger stimulant products usually are recommended only as a last resort after non-stimulant treatments have failed.
Many people take herbs to treat the problem because they feel more comfortable using a "natural" product. Unfortunately, most of these herbal preparations contain stimulant products and their long term use raises the possibility that they also may damage the colon.
When should I seek medical care for chronic constipation?
If the main problem is straining to push the stool out, chronic constipation should probably be evaluated early. This difficulty might be due to pelvic floor dysfunction, and the treatment of choice is biofeedback training, not laxatives. If it is not responding to the simple measures discussed previously with the addition of hyper-osmolar products or milk of magnesia, it is time to consult a physician for an evaluation. If a primary doctor is not comfortable performing the evaluation or does not have confidence in doing an evaluation, he or she should refer the patient to a gastroenterologist. Gastroenterologists evaluate constipation frequently and are very familiar with the diagnostic testing described previously.
What is new in the treatment of constipation?
Each part of the intestine (stomach, small intestine, and colon) has a network of nerves that controls its muscles. A great deal of research is being done in order to gain an understanding of how these nerves control each other and ultimately the muscles. Much of this research involves the study of neurotransmitters. (Neurotransmitters are chemicals that nerves use to communicate with each other.) This research is allowing scientists to develop drugs that stimulate (and inhibit) the various nerves of the colon which, in turn, cause the muscles of the colon to contract and propel the colonic contents. Such drugs have great potential to treat constipation that is due to colonic inertia. The first of these drugs is in clinical trials and is likely to be available soon. These drugs are an exciting development because they offer a new treatment for a difficult-to-treat form of the problem. The most studied drug is prucalopride which has been approved for use in several countries but not the U.S.
Nevertheless, there are many questions about these types of drugs that must be answered. How effective are they? Will they work in many or only a few patients? Will they work in patients who have damaged their nerves with stimulant products? Since these medications are likely to be used for a lifetime, how safe will they be with many years of use? Will they be used indiscriminately in situations for which simple treatments (for example, fiber) or more appropriate treatments (for example, biofeedback training) should be used?
Fauci, Anthony S., et al. Harrison's Principles of Internal Medicine. 17th ed. United States: McGraw-Hill Professional, 2011.