Treating Constipation

By Pharmacist Anusuya Kashi
Treating constipation

Being able to pass stools regularly without pain or discomfort is important. You see, it is an indication that the digestive system is functioning normally.

Unfortunately, modern-day eating habits and lifestyles have made this an elusive goal for many.

There are numerous over the counter (OTC) laxatives that are available for general use without a prescription. 

In this article I will present detailed information about OTC constipation remedies to enable you in making an informed choice to treating constipation.

Bulk Forming Agents/ Fiber

Products: Citrucel, Metamucil, Benefiber, Fibercon, Fiber-Lax, Equilactin

Mechanism of action:

Bulk forming agents are composed of indigestible fiber. As fiber passes through the intestine, it absorbs water and swells up. This further increases the bulk of the stool. Bulk is needed to stimulate peristalsis, to get stool moving through the colon.

By absorbing water, fiber also helps to keep stool from drying out and turning hard.

Make sure to drink extra water when taking fiber laxatives.

  • Without proper hydration, these laxatives can cause cramping, bloating and gas.

  • If the body doesn’t have sufficient moisture to keep stool from drying out, a large, bulky stool may even make constipation worse.

Although this class of products is useful, for chronic constipation it is better to harness the laxative action of foods that are naturally rich in fiber such as dark leafy vegetables, fruit, whole grains, nuts and seeds.

Stool Softeners / Emollient Laxatives

Products: Surfak, Colace, Correctol Soft Gel, Diocto, Ex-Lax Stool Softener

Mechanism of action

As the name indicates, these drugs draw water into the stool to make it softer, allowing easier passage out of the colon. Stool softeners contain a surfactant material called docusate that helps to make stools wet and soft. 

Stool softeners work well for those with hard, dry stool, which causes pain during elimination.

Taking these drugs ensures a strain-free movement of the bowels. They are especially useful for those who have been advised to avoid straining during defecation.

However, stool softeners are not advised for long-term use. The ions present in the stool softener can interfere with the normal ion levels in the body, causing an electrolyte imbalance.

Therefore, it is unwise to rely on stool softeners for long-term relief. Changes in diet to include more fiber and liquids is the better way to keep the stools soft and greatly aids in treating constipation.

Osmotics /  Hyperosmolar Laxatives

Products: Miralax, Milk of Magnesia, Epson Salt, Cehulac, Kristalose

Mechanism of action

These drugs tend to draw water from the surrounding tissues into the colon. This moistens stool, which increases stool volume, which helps to stimulate peristalsis.

Since osmotic laxatives help to moisten stool, they help to make stool soft, slippery and easier to eliminate. 

Osmotic laxatives are good for an occasional bout of constipation. However, they are not recommended for individuals with chronic constipation.

These magnesium or sodium containing products need to be taken as large doses. Long term use has been linked with a gradual accumulation of magnesium or sodium, which in turn may lead to magnesium or sodium toxicity.

The danger is even greater for those with impaired kidney function, since their kidneys have a problem excreting the excess magnesium.

In some persons, the use of osmotic laxatives may lead to unpleasant side effects such as cramping, bloating, nausea and diarrhea.

Those with diabetes are also likely to suffer from electrolyte imbalance with osmotic laxatives.

A magnesium supplement

An alternative to osmotic laxatives is to take a daily magnesium supplement with a dose of 200 mg. to 400 mg. a day. This amount may be as little as 1/10th that of a single dose of an osmotic laxative.

However, this is usually enough magnesium to exert the laxative action without the inherent danger of magnesium toxicity.

When such magnesium supplements are made a part of the daily routine, they provide relief from constipation without the usual side effects associated with conventional magnesium-containing osmotic laxatives.

Since 80% of Americans don’t get enough magnesium in their diets, taking a magnesium supplement may result in certain health benefits.

Caution: Those with kidney disease may still have a problem excreting excess magnesium and should not take a magnesium supplement unless requested to do so by their doctor.

Stimulant Laxatives

Products: Senokot, Dulcolax, Correctol, Feen-a-Mint

Mechanism of action

Oral stimulants contain herbs such as cascara and senna which are made up of constituents called anthraquinones.

These chemicals have a strong irritant action on the muscles lining the intestines and trigger the contraction of these muscles, forcing peristalsis. 

These laxatives should be restricted for use during bouts with severe constipation.

  • Their intense action can lead to side effects like severe cramping, belching, nausea and diarrhea.

  • The continued use of oral stimulants can make the gut dependent on the chemicals they contain for stimulating peristalsis.  When stimulant laxatives are stopped, the digestive system may grow sluggish.

    The strong action of this class of laxatives is harmful for those suffering from irritable bowel syndrome, hemorrhoids and peptic ulcer. They should not be used by pregnant women

Lubricant Laxatives

Products: Fleet Mineral Oil

Mechanism of action

These laxatives add a lubricating, slick layer to both stool and intestinal walls.

This layer hinders the colon from extracting moisture from stool, which keeps stool from drying out and can really be effective in treating constipation.

The friction during the movement of stool is reduced, making it less painful and easier for stool to be eliminated from the body.

Lubricant laxatives are highly effective for constipation but they should not be used for chronic constipation.

  • The mineral oil in the laxative tends to dissolve the fat-soluble vitamins in the intestine and absorbs them, making them unavailable for the body’s use.

  • Mineral oil may be absorbed into the body. If it is deposited in the spleen, liver or lymph glands, it can lead to inflammation and further complications.

Rectal Stimulants

Products: Bisacodyl, Dulcolax, Pedia-Lax

Mechanism of action

As implied by the name, these laxatives have a stimulatory effect on the muscles of the rectum, which is the final section of the large intestine.

Rectal stimulants trigger the forcible contraction of rectal muscles to help facilitate the elimination of stool. Rectal stimulants are generally administered as suppositories or enemas

Like oral stimulants, rectal stimulants tend to cause a powerful cramping action that can lead to pain and discomfort in the stomach.

They may also irritate the lining of the rectum, causing damage to the rectal wall. This damage can cause further complications.

Persons with ailments such as heart disease, kidney disease, bowel obstruction and appendicitis should not use rectal stimulants for constipation. Neither should women who are breastfeeding or pregnant.

Conclusion, treating constipation

There are numerous OTC remedies available for treating constipation. Their use may provide some much-needed relief for attacks of acute constipation

Although these laxatives are readily available, this should not become an excuse to become dependent on them.

Those who suffer from chronic constipation should instead seek to adopt a lifestyle that includes a healthy, fiber-rich diet and regular exercise to enable optimum bowel movements without the need for external aids like laxatives in treating constipation.

(Return from Treating Constipation to What to Take for Constipation)

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