• Disease states (thyroid disease, Parkinson's disease, irritable bowel syndrome, depression, eating disorder and diabetes)
• Diseases of the colon such as slow-transit constipation or rectal prolapse
• Medications (see table 5)
• Lifestyle factors (see table 5)
• Ignoring the urge to have a bowel movement
• Painful lesion in the rectal area such as hemorrhoids or fissures

  Table 5: Causes of Constipation

• Adults should have 20-35 grams of fiber each day.
• Increasing the amount of whole grain foods, legumes, fruits and vegetables can do this. Multiple fiber bars are available including Fiber One Bars.
• Reduce the amount of food without fiber – such as simple sugars
• If diet alone does not get fiber intake up to recommended range - add fiber supplements (see table below)
• Gradually increase fiber intake as major increases in fiber intake can lead to abdominal distention or excessive flatulence
• Drink a lot of water with the increase in fiber intake
• Positive effect may not be noticed for 3-5 five days, but onset may be in as soon as 12 hours.
• Fiber can interact with medications and medications should be avoided within 2 hours of taking the fiber supplement

Other tips to reduce constipation include:

• Limit diary intake
• Reduce psychological stress
• Become more physically active
• Avoid dehydrating drinks such as caffeine or alcohol

Medications to alleviate constipation can be used for periods less than 7 days. If they are needed beyond 7 days than a visit to the physician is indicated.

Laxatives are commonly used to treat constipation. Laxatives can be broken down into multiple classes.

Saline Laxatives

Saline laxatives draw water into the colon and work within 30 minutes to 3 hours. The most common example of a saline laxative is milk of magnesia.

These products are generally safe for those who are healthy. Side effects include electrolyte imbalance and diarrhea and should be used with extreme caution (if at all) in children, patients who are older and those with kidney problems or heart disease. Overdose of this medication has the potential to result in death.

Hyperosmotic laxatives

Hyperosmotic laxatives are given in suppository form and work within 30 minutes. Glycerin suppositories are the most common laxative in this category. They are safe and have minimal side effects such as local irritation. It is probably the safest laxative for all age groups when used intermittently. There are no interactions with other drugs.

Stimulant laxatives

Stimulant laxatives help push the stool through the colon. The two OTC medications in this class are senna and bisacodyl. They can be used for occasional constipation as well as for those with chronic constipation.

The onset of action is usually 6 to 10 hours when taken by mouth. The onset of action for bisacodyl is about 30 minutes when taken via suppository.

Side effects include cramping, electrolyte disturbance and fluid loss. Bisacodyl can cause GI upset. On occasion it can cause the urine to turn red, violent or brownish. These drugs are associated with dependence.

Emollient laxatives

Emollient laxatives (Colace) help soften the stool and are better at preventing constipation than treating it. This class of medication works in 1-2 days, but may take 3 - 5 days to work.

They are helpful in making the stool easier to pass and may work best for those who strain a lot with bowel movements. In addition they can be used in those with high blood pressure, women who recently gave birth, those who recently had surgery or had a recent heart attack to prevent straining.

Side effects include: diarrhea and abdominal cramping.




Lubricant laxatives

Lubricant laxatives (the most popular product is mineral oil) are given orally and coats the stool. The medications will work within 6 to 8 hours. It should not be used in those younger than 6-years-old, older adults and pregnant women. This product should not be used in favor of the safer emollient laxatives.

Side effects are more common in those who have used this medication for an extended period of time. The most common side effects are anal irritation and itching. If the mineral oil is aspirated it can lead to aspiration pneumonia. It can also impair the absorption of vitamins A, D, E and K. It may lead to impaired absorption of oral contraceptives, blood thinners and digoxin.

Polyethylene Glycol

Polyethylene Glycol (MiraLax) is a fairly recently approved over-the-counter medication. It is a safe and effective product for the short-term treatment of constipation. It increases the amount of water in the stool and helps with constipation. The medications is taken by measuring about one teaspoon (the cap has a measuring device) and mixing it with 4-8 ounces of liquid (water, juice, tea, coffee or soda). It is indicated for those over the age of 16.

Side effects include: diarrhea, abdominal bloating or distention, gas, cramping and nausea.