Treatment of Constipation

Most cases of constipation respond to conservative treatment such as dietary and lifestyle changes or mild laxatives.

Dietary changes include getting enough of the recommended daily amount of fiber (20 to 35 grams), drinking 64 ounces of water or juice a day, and limiting foods that have little or no fiber, such as ice cream, cheese, meat and processed foods.

Lifestyle changes consist of exercising, reserving enough time to have a bowel movement and having a bowel movement when needed.

Laxatives may be recommended if the above changes did not help the constipation.

There are four types of laxatives - bulk-forming, stimulant, lubricant and saline. Bulk-forming laxatives, such as Metamucil, Citrucel and Serutan increase the volume of feces, making them softer and easier to pass. Stimulant laxatives, such as Correctol, Ex-Lax, Dulcolax, Purge, Feen-A-Mint and Senokot stimulate the intestinal wall to contract. Lubricant laxatives, such as mineral oil, soften the stool so it is easier to pass. Saline laxatives, such as Milk of Magnesia, Citrate of Magnesia and Haley's M-O, increase the concentration of salts within the feces.

Note: Laxatives can be habit-forming. If laxative use causes asthma, skin rash, dizziness, irregular heartbeat, dehydration, muscle cramping, nausea or other side effects, please see a doctor immediately.

Other treatment methods may include:

Bowel retraining - may provide relief for people who have gotten into the habit of ignoring the urge. If a tight schedule has produced a tight sphincter, it may help to sit on a toilet, with book in hand, about 20 minutes each morning to encourage a return of reflexes that have disappeared. Straining is not recommended, since it may lead to tightening of muscles that should be relaxed for comfortable defecation.

Rectal suppositories - helpful in providing lubrication and in stimulating the defecation reflex. They are usually composed of glycerin, which is sometimes blended with sodium sterate, a fatty acid. Bisacodyl-containing suppositories have added potency, because they act directly on the bowel to stimulate emptying.

Enemas - usually become attractive only when oral laxatives cannot do the job. Introducing water into the colon helps to stimulate defecation. "Disposable" enemas deliver a solution of highly concentrated, nonabsorbable salts into the rectum and sigmoid colon. These salts attract an outpouring of fluid into the bowel and thus promote bowel contraction. Oil-containing enemas are sometimes recommended as softeners for feces that have become hardened within the rectum.

Biofeedback - may be recommended for people with chronic constipation caused by anorectal dysfunction. Biofeedback involves using a sensor to monitor muscle activity displayed on a computer screen allowing for accurate assessment of body functions. With this information, the doctor helps the person learn how to use the anorectal muscles.

Surgery - Surgical removal of the colon may be an option for people with severe symptoms caused by colonic inertia (lack of movement in the colon) and unremitting extreme constipation.