Overview of Constipation Treatments
A day without a bowel movement is no cause for concern. Bowel movements should be easy and soft. When you feel the urge, it is important to respond promptly. Don’t postpone it if you can.
Constipation treatments include dietary and lifestyle changes, fiber supplements, and laxatives. Sometimes prescription medicines and therapies such as biofeedback may be tried. Rarely, surgery may be necessary for carefully defined neuromuscular abnormalities.
The first step is to determine the underlying cause of constipation.
Treatment of Mild Constipation
Constipation is mild when it’s short-lived, and happens only now and then. The best treatment is prevention; dietary measures usually accomplish this. Be sure to drink enough fluid daily to avoid dehydration. Dietary fiber can help or prevent mild constipation. Try…
- regular ingestion of fruits and vegetables, especially uncooked
- whole grain breads and cereals
If fiber is lacking in the diet, it may help to try raw wheat bran as a supplement. If bran causes bloating or excessive gas, try a fiber substitute such as psyllium (e.g., Metamucil, Konsyl). Be sure to drink plenty of water with psyllium.
If gas is still a problem, methylcellulose (Citrocel) or polycarbophil (e.g., FiberCon, Equalactin) may create less gas. Drink a generous glass of water to wash fiber down.
Reserve the use of laxatives for temporary constipation due to illness, incapacity, or travel. Talk to your doctor about selecting a laxative.
Treatment of Chronic or Long-term Constipation
If constipation becomes chronic or persistent, seeing a doctor is in order. Give your doctor a list of medicines you are taking. Some medicines are constipating.
In a survey of 311 practicing primary care physicians, most felt constipation was difficult to manage, and 90% felt there were needs for better treatment options.
Should simple dietary measures fail, the addition of a laxative is the next step. These include…
- Osmotic laxatives, which work by drawing water into the colon. They are safe and perhaps are the preferred all-purpose laxatives.
- Stimulant laxatives such as bisacodyl (e.g., Dulcolax, Bisco-Lax), or senna (e.g., Senecott, Senexon), which work by signaling the muscles and nerves of the intestine to contract. These laxatives work relatively quickly, but tend to produce more cramping.
Many herbal medicines contain laxatives. These are unregulated. The dose of any contained drug is often unknown. Some can cause diarrhea. They are best avoided.
In 2012, linaclotide (Linzess) was approved by the FDA to treat chronic idiopathic (of unknown cause) constipation in adults aged 18 and older. Linaclotide is in a class of medications called guanylate cyclase-C agonists. The oral treatment (capsule) works by increasing the movement of food and waste through the stomach and intestines and by blocking pain signals in the intestines.
Lubiprostone (Amitiza) is an oral treatment (capsule) approved by the FDA in 2006. It works by increasing fluid secretion in the small intestine. It helps to ease the passage of the stool. It improves symptoms associated with chronic idiopathic constipation.
When Treatment Isn't Working
"Intractable" constipation means that the symptom does not respond to the treatments described above. Persons with intractable constipation may see a specialist for diagnostic tests. These may include…
- Transit time or colonic marker studies: A simple test that measures movement of material through the colon over time.
- Colonic scintigraphy: An imaging method to show how material moves through the GI tract.
- Endoscopy: Visual examination of the colon using a lighted tube (colonoscopy or sigmoidoscopy).
- Lower GI series or barium enema: X-rays of the colon and rectum.
- Defecography: An x-ray test to look at the behavior of the rectum and anus during attempts to defecate.
- Anorectal manometry: A test that measures pressure or contractions in the anus and rectum
Behavioral treatments work by helping to change abnormal patterns to patterns that are more normal. These include…
- Bowel retraining: Methods to establish or re-establish bowel control.
- Biofeedback: A method to re-train muscles.
Surgery is a rare "last resort" for constipation. It is important to discuss any recommended surgery thoroughly with the doctors. Be familiar with the procedure. Understand the potential risks as well as proposed benefits.
- Schiller LR, Dennis E, Toth G. Primary care physicians consider constipation as a severe and bothersome medical condition that negatively impacts patients lives. American Journal of Gastroenterology 99 (10 Suppl): S235 - 236, 2004.
- Thompson, WG. Functional diarrhea, constipation, abdominal bloating, and gas. Functional GI disorders Education Program Guide, Chapter 3, IFFGD, 1997.
- Thompson, WG. What is constipation anyway? IFFGD Fact Sheet No. 170, 2002.