Constipation: Treatment Overview

Constipation is a common digestive problem in which a person has trouble with regular bowel movements, and it’s defined as having fewer than three bowel movements per week. A person with constipation may also find it hard to pass stool. This can happen due to several reasons like not eating enough fiber, not drinking enough water, not being active or taking certain medicines.

Although constipation can be a common occurrence in people of all ages, it can be uncomfortable. Fortunately, there are numerous treatment options available to help manage constipation, ranging from lifestyle changes to the use of medications. Many medications for occasional constipation are available over-the-counter (OTC) but if they do not provide relief or if you have chronic constipation, you may need a prescription medication. According to a report in 2021, constipation affects around 15% of the U.S. population. Read on to learn more about constipation treatment options.

Lifestyle Changes

Making lifestyle changes may help manage or prevent constipation. For example, dietary changes may help in maintaining a healthy digestive system. Here are some tips for a better diet:

• Increase fiber intake: Consuming more fiber-rich foods can help improve bowel movements. Foods high in fiber include fruits, vegetables and whole grains. Examples of fiber-rich foods are raspberrries, apples, bananas, avocado, beans, whole-wheat bread and broccoli.
• Stay hydrated: Drinking plenty of water and other fluids can help keep the stool soft and easy to pass. It’s recommended that women consume 91 ounces of fluids and men to consume 125 ounces of fluids per day.
• Avoid processed foods: Processed and convenience foods tend to be low in fiber and high in unhealthy fats, which may contribute to constipation. Examples include frozen meals, packaged snacks and fast food.

Being active on a regular basis may help get your bowels moving and promote regularity. Try to aim for a minimum of 30 minutes of moderate exercise on most days of the week. Exercise could involve activities like walking, swimming or doing yoga.

Medications

Various over-the-counter (OTC) and prescription drugs may help provide relief for constipation. Consult a healthcare provider before starting any constipation treatments, especially if you have other medical conditions or medications. A pharmacist or doctor can advise you on the dosages, potential side effects and interactions with other medications. Let’s go over some of the drug classes used for constipation.
Fiber supplements

These products can help add bulk to the stool, making it easier to pass. They may be helpful for those with a low-fiber diet and are generally safe for daily use. Examples include Metamucil® (psyllium) and Citrucel® (methylcellulose).

Stool softeners

These medications work by drawing water into the stool, making it softer and easier to pass. They are particularly helpful for those who experience hard stools or have difficulty passing them. Examples are Colace® (docusate sodium) and Surfak® (docusate calcium).

Laxatives

Laxatives can stimulate bowel movements or increase the amount of water in the stool. However, they should generally be used with caution and only when other methods have failed, as they may cause side effects or become less effective over time. They are typically used short-term. Examples of different laxative types include:

• Bulk-forming laxatives: These function similarly to fiber supplements by adding bulk to the stool. They are typically gentle on the body and can be used daily. Examples are Benefiber® (wheat dextrin) and FiberCon® (calcium polycarbophil).
• Lubricant laxatives: By coating the stool, lubricant laxatives help it glide through the bowel with less friction. Mineral oil is a common example in this category.
• Osmotic laxatives: These drugs stimulate the intestines to draw water into the stool, making it easier to pass. As osmotic laxatives may cause dehydration, it’s recommended to stay hydrated while taking them. MiraLAX® (polyethylene glycol) and Milk of Magnesia (magnesium hydroxide) are common examples.
• Stimulant laxatives: These medications stimulate the bowel muscles to contract and promote a bowel movement. They are typically recommended when other laxatives haven’t been effective. Examples include Dulcolax® (bisacodyl) and Senokot® (senna).

Osmotic agents

These medications work by drawing water into the intestines, softening the stool and making it easier to pass. Some examples of osmotic agents include:

• Kristalose™ (lactulose): This is a synthetic sugar that increases the amount of water in the stool, making it softer and easier to pass.
• Movicol® (macrogol): This is a type of polyethylene glycol that helps increase water content in the stool.

Prokinetics

This type of prescription medication helps to speed up the movement of food and waste through the digestive system, which may help alleviate chronic constipation. An example of a prokinetic agent is Motegrity® (prucalopride). This medication is a serotonin receptor agonist that promotes the movement of stool through the colon.

Secretagogues

These prescription medications stimulate the release of fluids in the intestines and help move waste through the digestive system which promotes bowel movements for people suffering from chronic constipation, as well as other types of constipation. Some examples of secretagogues are:

• Linzess® (linaclotide): This drug triggers certain receptors in the intestines, causing more fluid to be released. It is available as a once-daily capsule.
• Amitiza® (lubiprostone): This medication works by increasing the amount of fluid in the intestines, which softens the stool and makes it easier for it to pass. It is available as a capsule that is usually taken twice daily.
• Trulance® (plecanatide): This medication works by stimulating the secretion of chloride and water in the intestines. As a result, it helps increase the frequency of bowel movements. It is available as a once-daily tablet.

When to Consult a Healthcare Professional

If you are experiencing constipation for more than a few days with treatment, it may be time to consult a healthcare professional. Prolonged constipation lasting three weeks or more could indicate a more severe problem. You should also consult a healthcare professional if you experience severe stomach pain, blood in the stool or unexplained weight loss that accompanies constipation.

A healthcare provider may conduct a general physical exam in addition to blood tests to potentially diagnose any conditions that may be causing chronic constipation, such as low thyroid or high calcium levels. After a proper diagnosis, a healthcare provider can recommend an appropriate constipation treatment plan.

Sources:

• https://gastro.org/press-releases/acg-and-aga-guideline-on-chronic-constipation-management-is-first-to-recommend-supplements-magnesium-oxide-and-senna-as-evidence-based-treatments/
• https://pubmed.ncbi.nlm.nih.gov/37211380/