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Treating Constipation

 

Q. I occasionally have a problem with constipation, and fortunately it usually clears up by itself. But if I ever should need to take something for it, what should I take? I’ve noticed all kinds of laxatives, stool softeners and other treatments for constipation at the drug store, but I’m not sure what works best. Also, should I ever be concerned about what’s causing the constipation?

A.Many people have constipation from time to time, and it’s usually not a sign of anything wrong. Every now and then, however, it can be a clue to an underlying problem with your intestines, even something as serious as cancer. So if your constipation is severe or persistent, check with your doctor to make sure nothing serious is going on.

Oddly enough, there’s no universally accepted definition of constipation. For some people, it means moving your bowels less often than usual; for some it means having painful or difficult bowel movements. And for others, it’s both. Even excluding serious problems, there can be many reasons why you’re constipated.

These include being inactive, not drinking enough fluids and not eating enough fiber. You can also develop constipation if you don’t answer nature’s call and avoid going to the bathroom when you first feel the urge. Many medicines can make you constipated.

Ask your doctor whether you should try going off a certain medicine to see if it might be causing the problem. Surprisingly, even laxatives can lead to constipation if you overuse them. “Laxative abuse,” as doctors call it, develops after prolonged use of stimulant-type laxatives: After a while, your bowels become dependent on them. Certain medical problems can lead to constipation.

In fact, constipation might be one of the first clues to an underlying medical disorder, such as an underactive thyroid gland (hypothyroidism), depression or an imbalance of minerals in the body (too much calcium or too little potassium, for example).

Treating Constipation

Treatment for constipation depends on whether the problem is recent or longstanding, mild or severe. Often you can take care of it with relatively minor dietary and lifestyle changes. Drink plenty of water, up to two quarts a day. Eat plenty of fruits and vegetables. Try some bran cereal for breakfast. Exercise regularly. And be sure to answer nature’s call as soon as possible.

If you need to take medicine for constipation, here’s a rundown on the different types available:

* Mineral salt laxatives, such as milk of magnesia (magnesium hydroxide). These increase the amount of water in the intestines, and increase the pressure within them.

* Stimulant laxatives, such as cascara, senna (Senokot) and bisacodyl (Dulcolax, Correctol). These work by irritating and stimulating the intestines into having a bowel movement. They are the strongest laxatives, and the ones most likely to cause dependence.

* Bulk-producing laxatives, such as psyllium (Metamucil), methylcellulose (Citrucel) and polycarbophil (Fibercon). These work by absorbing water, increasing the size of the stool, and thus increasing the pressure within the intestines to have a bowel movement. They are the safest and most “natural” type of laxative.

* Lubricants, such as mineral oil. These work by retaining water in the stool and softening it. Although mineral oil is an old-time remedy that is often used for chronic constipation in children, it can occasionally get into the lungs and lead to a chemical irritation.

* Detergent laxatives, such as docusate (Colace). These work by making it easier for water to mix with the fats present in stool, thus softening the stool. These laxatives are good when the stool is hard or dry, or when having a bowel movement is painful, such as when hemorrhoids are acting up.

* Lactulose (Chronulac). This works by increasing the water in the stool and softening it.

* Suppositories, such as glycerin or bisacodyl (Dulcolax), work by stimulating the nerves of the rectum to have a bowel movement.

The fastest acting laxatives are the suppositories (which work within minutes), followed by mineral salts (a few hours), then the stimulant laxatives (several hours to overnight). The bulk-forming and detergent laxatives (which are more stool softeners than stimulants), take from one to three days to show results. So for occasional use when you’d like results within hours, try a mineral salt or stimulant laxative.

For a more natural regularity, use a fiber-type, bulk-forming laxative. If your bowel movements are hard or painful, use a detergent laxative (after checking with your doctor to see why they’re painful). But first, see if you can manage the problem without taking any medicine at all. Jay Siwek, chairman of the department of family medicine at Georgetown University Medical Center, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington. Consultation is a health education column and is not a substitute for medical advice from your physician.

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