DSI Newsletter: Constipation

DSI Newsletters, Issue 29:
Constipation

Diet
A diet with enough fiber (20 to 35 grams each day) helps form soft, bulky stool. A doctor or dietitian can help plan an appropriate diet. High-fiber foods include beans, whole grains and bran cereals, fresh fruits, and vegetables such as asparagus, brussels sprouts, cabbage, and carrots. For people prone to constipation, limiting foods that have little or no fiber, such as ice cream, cheese, meat, and processed foods, is also important.
Lifestyle Changes
Other changes that can help treat and prevent constipation include drinking enough water and other liquids such as fruit and vegetable juices and clear soups, engaging in daily exercise, and reserving enough time to have a bowel movement. In addition, the urge to have a bowel movement should not be ignored.
Laxatives
Most people who are mildly constipated do not need laxatives. However, for those who have made diet and lifestyle changes and are still constipated, doctors may recommend laxatives or enemas for a limited time. These treatments can help retrain a chronically sluggish bowel. For children, short-term treatment with laxatives, along with retraining to establish regular bowel habits, also helps prevent constipation.
A doctor should determine when a patient needs a laxative and which form is best. Laxatives taken by mouth are available in liquid, tablet, gum, powder, and granule forms. They work in various ways:

Bulk-forming laxatives generally are considered the safest but can interfere with absorption of some medicines. These laxatives, also known as fiber supplements, are taken with water. They absorb water in the intestine and make the stool softer. Brand names include: Metamucil, Citrucel, Konsyl, and Serutan.
Stimulants cause rhythmic muscle contractions in the intestines. Brand names include Correctol, Dulcolax, Purge, and Senokot. Studies suggest that phenolphthalein, an ingredient in some stimulant laxatives, might increase a person's risk for cancer. The Food and Drug Administration has proposed a ban on all over-the-counter products containing phenolphthalein. Most laxative makers have replaced or plan to replace phenolphthalein with a safer ingredient.
Stool softeners provide moisture to the stool and prevent dehydration. These laxatives are often recommended after childbirth or surgery. Products include Colace and Surfak.
Lubricants grease the stool enabling it to move through the intestine more easily. Mineral oil is the most common example.
Saline laxatives act like a sponge to draw water into the colon for easier passage of stool. Laxatives in this group include: MOM (Milk of Magnesia) and Haley's M-O.
Hyperosmolar laxatives: Hyperosmolar laxatives are undigestible, unabsorbable compounds that remain within the colon and retain the water that already is in the colon. The result is softening of the stool. The most common hyperosmolar laxatives are lactulose (e.g., Kristalose), sorbitol, and polyethylene glycol (e.g., MiraLax). They are available by prescription only. These laxatives are safe for long-term use and are associated with few side effects. Hyperosmolar laxatives may be digested by colonic bacteria and turned into gas, which may result in unwanted abdominal bloating and flatulence. This effect is dose-related. Therefore, gas can be reduced by reducing the dose of the laxative. In some cases, the gas will decrease over time.

People who are dependent on stimulant laxatives need to slowly stop using them by increasing the dose of Metamucil. A doctor can assist in this process. In most people, this restores the colon's natural ability to contract and have a normal BM.

What do I take for Constipation?

In summary, to prevent your stool from becoming hard (constipation), I recommend use of Metamucil (bulk-forming laxative) with meals. This will also help lower cholesterol and reduce weight.
If the stool is hard while taking Metamucil with every meal, you can try adding Miralax.
Next, take Mylanta (antacid that softens stool) one tablespoon every hour as needed.
Next, add Senokot (stimulant) in addition to the Metamucil.
Next, add Colace 100mgm (stool softener) three times a day to the above.
Next, add Mineral Oil (lubricant grease) to the above treatments.
Next, add MOM (saline laxative) to the above.
Next, Go-Lytely (used usually as a bowel prep.)
Consider Arthrotec (a voltaren based NSAID that has diarrhea as a side effect.)
Finally, Xenical (weight loss med) or Colchicine (a gout medication that has diarrhea as a side effect.)

Joseph Saponaro, MD, DABIM, FACP, CPI, CCI, CCRI, CCRC, CCRP
Board Certified Internist, JPMC
Principal Investigator, DSI
Diplomat American Board of Internal Medicine
Fellow American College of Physicians
Certified Physician Investigator by the AAPP
Certified Clinical Investigator by the DIA
Certified Clinical Research Investigator by the ACRP
Certified Clinical Research Coordinator by the ACRP
Certified Clinical Research Professional by SoCRA
Member: The American College of Preventive Medicine

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