Constipation

It’s been two days since you’ve had a bowel movement. Do you reach for a laxative or let nature take its course?

Many people expect a bowel movement to occur every day, so they choose a laxative. But in reality, “normal” varies quite a bit, from three times a day to three times a week.

If you are bothered by occasional irregularity, more than likely you can manage the situation with some lifestyle changes like eating lots of fiber, drinking plenty of fluids, getting regular exercise, and using medications cautiously.

But if you’ve tried these changes and nature still needs a little help, talk with your doctor about using an over the counter laxative.

MANY TYPES OF LAXATIVES: KNOW WHAT YOU ARE USING

Many laxative options exist, from powders you dissolve in water to tablets, wafers or liquids. Some you take by mouth and some you insert on the other end. Some soften the stool, making it easier to pass, and some create muscle contractions that propel the stool forward. Laxatives aren’t all the same so it is important to find one that suits your needs.

BULK FORMING LAXATIVES: ALSO CALLED FIBER SUPPLEMENTS

Bulk forming laxatives absorb water from the intestine, making the stool soft and bulky. A larger stool mass helps trigger normal contractions of the intestines which expel waste.

Because these laxatives are so absorbent, make sure you take them with plenty of water. If you don’t, these supplements can actually increase constipation.

Over the counter brand names of bulk forming laxatives include Metamucil, Citrucel and Fibercon.

STOOL SOFTENERS

Stool softeners make your stool soft by helping liquids mix with the stool, thereby making it easier to pass. They’re sold over the counter under several brand names including Colace and Surfak. These are especially useful after childbirth or surgery or times when it is very important to have a bowel movement without much straining.

LUBRICANTS

Lubricants coat the bowel and stool with a waterproof film that allows easier passage through the colon and rectum. The lubricant also helps retain moisture in the stool to prevent it from becoming hard and dry.

However, oily lubricants also block the absorption of key vitamins and minerals, so make sure that you don’t take this kind of laxative two hours before or after a meal.

Lubricants generally aren’t recommended for long term use except in special circumstances because of potential side effects.

Mineral oil is the most common type of lubricant.

SALINE LAXATIVES

This type of laxative works by significantly increasing the water content in your stool by drawing fluids from surrounding body tissues.

These laxatives produce results quickly but may be toxic in high doses. In addition saline laxatives can be dangerous for children or adults with certain kidney diseases.

Milk of Magnesia is one type of saline laxative that may be safe for long term use if taken in the small doses that are recommended. Check with your doctor if you desire to take this type of laxative for an extended period of time.

STIMULANTS

Stimulant laxatives cause the muscles of the intestine to contract, which pushes the stool forward.

Even though this type of laxative is perhaps the most popular, it’s also the most likely to cause side effects such as cramping, diarrhea or nausea.

Stimulants are usually taken at bedtime to produce results in the morning. Castor oil, Dulcolax, Ex-Lax, and Senokot are examples of over the counter stimulant laxatives.

COMBINATIONS

Some products contain more than one type of laxative. For example, you can buy a bulk-forming laxative with a stimulant or a saline laxative with a lubricant.

These products however may not be any more effective and may cause increased side effects due to multiple ingredients. Read the labels carefully to know what you are choosing.

DON’T BE LAX ABOUT LAXATIVES!

Even though you can buy laxatives over the counter does not mean they are harmless.

Regular use of laxatives can actually aggravate constipation, and your body can become dependent on them for all bowel movements. In severe cases, overuse of laxatives can cause damage to the nerves, muscles and tissues of the large intestine.

Other problems associated with the use of laxatives include abdominal cramping, nausea, gas, bloating, decreased nutrient absorption and diarrhea. In addition, laxatives may be especially dangerous if your constipation is due to a more serious condition, such as bowel obstruction or appendicitis.

See your doctor if you have unexplained changes in bowel patterns or habits or if your constipation lasts longer than seven days, despite changes in diet or exercise.

To avoid dependence on laxatives, make sure that you use them only periodically and follow the instructions carefully.

If you use laxatives regularly, talk to your doctor about other ways to manage your constipation.

Cordially,

Helen Pensanti M.D.