CSA – Cheboygan Surgical Associates
Definition
Small, hard stools. Bowel movements (B.M.’s) may be infrequent and passing them may be difficult, painful or impossible. You may also have bloating or cramping.
- Mild Constipation: no bowel movements for 1-2 days longer than usual
- Moderate Constipation: no bowel movements for 2-3 days longer than usual
- Severe Constipation: no bowel movements for 4-5 days longer than usual
Causes
Disease, side effects of treatment, decreased activity, lack of liquid in the diet and emotional stress can all cause constipation. Constipation is also caused by medications, such as:
| Darvocet | Duragesic Patch | Norco | Tylenol #3 & #4 |
| Darvon | Kytril | Percocet | Tylox |
| Demerol | Lortab | Percodan | Vicodin |
| Dilaudid | Morphine Sulphate | Roxanol | Zofran |
| Duramorph | M.S. Contin | Roxicet |
Prevention
If possible, try to increase the amount of liquids you drink. Make some dietary changes, such as increasing fruits, vegetables and bran, and decrease starchy foods such as white bread, cakes and cheese. Many people find hot water or tea with lemon or prunes has a laxative effect. Use stool softeners and/or laxatives (see below).
Treatment
Most people have their favorite remedy for treating constipation. We recommend that you check with your physician before taking any medications. The following is a list of medications that we have found to be safe and effective when taken as directed. We show both the better-known brands and the generic names for a number of laxatives and stool softeners. The generic products are generally much less expensive.
Effective Medicines (generic names in parentheses)
Stool Softeners:
- Colace (Docusate Sodium) – liquid or tablets
- Surfak (Docusate Calcium) – capsules
Laxatives:
- Milk of Magnesia – liquid or tablets
- Dulcolax (Bisacodyl) – tablets
- Senokot (Senna) – liquid or tablets
- Magnesium Citrate – liquid
Combination of Stool Softener-Laxative:
- Pericolace (Casanthranol & Docusate Sodium)
- Senokot S (Senna Concentrate & Docusate Sodium)
Laxative Rectal Suppositories:
- Glycerine
- Dulcolax (Bisacodyl)
Enemas:
- Fleets (Phosphates Enema)
Narcotics and Constipation
Narcotic pain medication can be very constipating. If you are taking narcotic pain medication, you should start taking stool softeners/laxatives right away (before constipation begins), and keep taking them regularly. For example, take one Senokot S tablet twice daily if you are taking more than 2-3 narcotic pain pills daily. We are all individual and respond differently to medications. The goal is to have soft, formed stools at least every other day. You may need to adjust slightly the amount of medication you take, to fit your personal needs. We will be happy to answer any questions you may have.
How to Use Laxatives
Senna fruit (Senokot) is a naturally-occurring laxative. Start out taking 1-2 tablets at bedtime. If this is not enough, add 2 tablets in the morning. Sometimes it is easier to take the pills when you take your pain pills. Do not take more than 8 tablets in 24 hours.
Bisacodyl (Dulcolax) is given by pills or suppositories. Usual dosage is 1 to 3 tablets at bedtime, or the suppository can be used every other day.
Docusate Sodium (Colace) or Docusate Calcium (Surfak) is used for hard, dry stools. These may be used with senna fruit or bisacodyl and are taken at bedtime or up to 3 times a day.
Bulk-forming laxatives (Metamucil, FiberCon, Citrucel, Benefiber) help keep water in the stool to keep it soft and add bulk/fiber. This should be used only if you can drink 6-8 or more glasses of fluid per day, otherwise there is a risk of fiber impaction with possible obstruction within the intestines.
Magnesium products (Milk of Magnesia, Citroma, Citrate of Magnesia), stimulants (GoLYTELY, Fleets Phospho-Soda, castor oil, Feen-A-Mint), or lubricants (mineral oil) should be used when other methods do not work.
Enemas should only be used when directed by your physician. Using pills or suppositories is the preferred way to treat constipation if prevention has failed.
Contact Physician
If vomiting occurs when you are moderately to severely constipated, notify your physician. If you notice rectal bleeding or blood in the stools, notify your physician.
Do not use any bowel program without first checking with your physician. Each program will be adapted to your medical needs.
Contact your physician if you are moderately to severely constipated and develop abdominal distension, fever, chills or acute abdominal pain.
If you have questions or problems, contact your physician’s office.
He knows everything about medications – to which pharmacological group the drug belongs, what components are included in its composition, how it differs from its analogs, what indications, contraindications, and side effects remedy has. John is a real pro in his field, so he knows all these subtleties and wants to tell you about them.