William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
What is the approach to the evaluation and treatment of constipation?
There are several principles in approaching the evaluation and treatment of constipation.
The goal of treatment in constipation should not be a bowel movement every day, but a bowel movement every two to three days without difficulty (without straining).
Start with the simple things.
What if constipation does not respond to these simple, safe measures? These efforts should not be discontinued but other measures should be added. If the constipation 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 laxatives is to unconsciously increase the frequency of their use. Before you know it, you're taking them every week, or more often, and permanent damage might result.
If constipation is a continuous rather than an intermittent problem, probably the safest laxatives 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 laxatives 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 laxatives usually are recommended only as a last resort after non-stimulant treatments have failed.
Many people take herbs to treat their constipation because they feel more comfortable using a "natural" product. Unfortunately, most of these herbal preparations contain stimulant laxatives and their long term use raises the possibility that they also may damage the colon.
Medically Reviewed by a Doctor on 7/15/2014
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