Constipation occurs due to an underlying disruption in the normal bowel movement. It can be caused by a variety of factors, and often times, the cause of the constipation is not always immediately known. The resulting imbalance between ingestion, digestion and excretion (bowel movement) is what most people experience as constipation. It is generally described by fewer than 3 bowel movements in 1 week. It is a very common digestive issue that at one point in time, we have all had it. It is seen in kids and adults alike. Some of the signs and symptoms patients complain of include, frequent straining, feeling unwell, abdominal bloating, frequent belches, hard/lumpy/dry stools that are painful to pass, and rectal bleeding. In this article, we will only be focusing on acute constipation.
Acute constipation may be prevented by practicing some healthy eating habits and consuming a balanced diet. Most acute cases can be treated by many over-the-counter medication options.
The goal for the management of constipation should really focus on addressing the offending issues or agents rather than treating with medications. This is true for most acute cases and some of the chronic cases of constipation.
Possible preventative measures may include:
A) Increased Fluid (water) daily intake: The National Academies of Sciences, Engineering, and Medicine determined that around 15.5 cups (124 U.S. ounces) of fluids is an adequate daily intake for men; about 11.5 cups (91 U.S. ounces) of fluids a day is determined adequate for women. Daily fluids generally comprise of those coming from water (80%), food and other beverages. Depending on your health or underlying health conditions, this value may change.
B) Increasing Fiber content of diets. This may be supplemented with high fiber content meals or over-the-counter fiber supplements.
C) Eating a balanced diet and nutrition.
D) Stress management (exercise, good sleep)
E) Stopping and/or finding an alternative to the offending agents (e.g. Opioids)
Possible Treatment Options:
1) Emollient Stool Softener (Docusate Sodium - Colace): These are generally easier to use and they relieve occasional constipation. They generally produce bowel movement within 12 to 72 hours of consumption. It is recommended to stop use of these products if you experience rectal bleeding or fail to have a bowel movement after a few doses. This could be a sign of a serious condition. In some products, docusate is combined with sennosides such as senna, and the combination generally causes bowel movement within 6-12 hours.
2) Bulk forming Laxatives: (Fibers). These could work as a preventative measure as described above or as a treatment in non-severe cases. Examples include Psyllium (Metamucil, Fiberall, etc)
3) Miralax (Poly Ethylene Glycol 3350): A powder osmotic laxative that can be mixed in water or other recommended beverages. It is very easy to use and most people respond to treatment following 1 dose of the recommended amount (usually 17 grams or 8.5 grams). Some patients may need more than 1 dose of the product depending on the severity of their symptoms.
4) Mineral Oil (Fleet): A lubricant laxative that generally produces bowel movement in 2 to 15 minutes. It produces a generally milder response compared to other laxatives. Please keep in mind that the rectal enema is for rectal use only. It is not recommended for a long term use. Click chat now to be connected with one of our pharmacists
5) Magnesium Hydroxide (Phillips Milk of Magnesia, Pedia-Lax) and other Magnesium Salts. These are salts laxative that are thought to work by osmotic retention of fluid within the colon, thus increasing and promoting bowel movements. In most patients, they work within few hours following an oral administration. It is important to follow the recommended dosing on the package as failure could lead to electrolyte imbalance.
6) Lactulose (Generalac, Enulose): This works directly and specifically in the colon. It produces osmotic effect in the colon from its breakdown by colonic bacteria into lactic acid and few other acids. The end result is an increase in the water content of stool, which leads to bowel distention and movement.
7) Stimulant Laxatives (Senna, Bisacodyl-Dulcolax, Castor Oil). All of these are thought to work by stimulating peristalsis or bowel movements through direct action on the intestinal cells.
Others: Lubripristone (Amitiza), Linaclotide (Linzess)
1) US National Library of Medicine. Constipation. Medline Plus. Accessed May 14, 2020
2) Dietary reference intake: Electrolytes and water. The National Academies of Science, Engineering, and Medicine. Accessed May 15, 2020.
3)Colace (docusate sodium) [prescribing information]. Stamford, CT: Purdue Products LP; May, 2020
4)Peri- Colace (docusate sodium-sennosides) [prescribing information]. Stamford, CT: Purdue Products LP; May, 2020
5)Mineral Oil [prescribing information]. Olive Branch, MS: Natureplex LLC; May. 2020
6)Lactulose Solution [prescribing information]. Ahmedabad, India: Torrent Pharmaceuticals Limited; May. 2020
Adeboye O. PharmD