Treating Chronic Constipation without Over-treating

As someone living with chronic constipation, you may sometimes feel like your only treatment option is to go, well, in the complete opposite direction. In actuality, diarrhea isn’t something that you should want — or need — to succumb to. Find out what you can do to ease your symptoms without going in the other direction completely.

Laxatives work in many different ways, and their effects vary from person to person. With several varieties and types of laxatives available for helping with constipation, picking the best one for your body while avoiding those that are too aggressive requires knowledge and awareness.

Some types of laxatives are harsher than others and can result in diarrhea, abdominal cramping, and other nasty side effects if you take too much. Most people don’t know that it’s possible to overdose on certain types of laxatives, which could lead to kidney damage or even death.

Here’s a list of over-the-counter (OTC) medications available for treating constipation and details about what could happen if you end up taking more than you should.

Osmotic agents

How they work: Osmotic agents draw water into your bowel from nearby tissues and help retain the water in your stool, making it softer. Softer stool is easier to pass.

Examples: Some examples of osmotic agents include

• magnesium preparations (Milk of Magnesia)
• polyethylene glycol PEG (Miralax)
• citrate salts (Royvac)
• sodium phosphates (Fleet Phospho-Soda)
• glycol (Lax-A-Day, Pegalax, Restoralax)
• sorbitol
• glycerin

Precautions: Taking too much of an osmotic agent can lead to the following side effects:

• diarrhea
• cramping
• dehydration
• electrolyte imbalance

Osmotic laxatives should be used with caution by older adults and people with kidney problems because of the risk of dehydration and electrolyte imbalances.

Additionally, the U.S. Food and Drug Administration (FDA) has issued a

The FDA doesn’t recommend sodium phosphates for the following people:

• those taking medications that affect kidney
  function, such as diuretics or fluid medications, blood pressure drugs called
  angiotensin receptor blockers (ARBs) or ACE inhibitors, and nonsteroidal
  anti-inflammatory drugs (NSAIDs)
• those with inflammation of the colon

Signs of a kidney injury include:

• decreased urine output
• drowsiness
• sluggishness
• swelling of your ankles, feet, and legs

Seek help right away if you have any of these symptoms after taking a laxative containing sodium phosphates.

Stool softeners

How they work: A stool softener adds water to stool to soften it and make it easier to pass.

Examples: Examples of stool softeners include docusate sodium (Colace, Docusate, Surfak).

Precautions: Stool softeners may take a couple of days to start working. They are better at preventing constipation than treating it, but they are generally gentler than other types of laxative.

Taking a stool softener for an extended period of time can lead to an electrolyte imbalance. Electrolytes include sodium, magnesium, potassium, calcium, and chloride. They help regulate certain functions in your body. An imbalance of electrolytes can lead to weakness, confusion, seizures, and irregular heart rhythms.

Bowel stimulants

How they work: Stimulant laxatives function by making your intestines contract and moving stool along.

Examples: Some examples of bowel stimulants include

• senna (Senokot)
• bisacodyl (Ex-Lax, Dulcolax, Correctol)

Precautions: Stimulants are the most aggressive type of laxatives. They only take a few hours to start working. Taking too much of a stimulant laxative can lead to:

• abdominal cramping
• explosive diarrhea
• nausea
• weakness

Don’t take stimulant laxatives regularly. Taking them for a long period of time can change the tone of your large intestine and cause it to stop functioning correctly. If this happens, your colon may become dependent on laxatives to have a bowel movement. Regular use can also change your body’s ability to absorb important vitamins including vitamin D and calcium. This can lead to weakening of your bones.

Lubricants

How they work: Lubricants work by coating your stool and intestines to prevent water loss. They also lubricate your stool so it moves more easily.

Examples: Mineral oil is a type of lubricant laxative.

Precautions: You shouldn’t use lubricants for longer than a week. They can interfere with your body’s ability to absorb fat-soluble vitamins (vitamins A, D, E, and K). They also might affect the way your body absorbs certain medications.

Rectal stimulants

How they work: Rectal stimulants can be given as an enema, which injects fluid injected into your rectum. They also come in suppository form, which is solid medicine that dissolves or melts after you insert it into your rectum. They work by triggering your intestinal muscles to contract and eliminate stool or drawing water into your intestine.

Examples: Rectal stimulants have the same active ingredients as oral stimulants, except they’re are dosed via a suppository or enema instead of an oral pill. Examples are bisacodyl (Ex-Lax, Dulcolax, Fleet).

Precautions: Side effects of rectal stimulants include irritation, burning, rectal bleeding, cramping, and stomach pains.

You also need to be very careful if a rectal dose doesn’t produce a bowel movement. If the dose is retained in the rectum, it could lead to dehydration and dangerous changes in electrolyte levels. Contact a doctor right away if a rectal stimulant is retained in your body for more than 30 minutes.

Fluid Stimulators

How they work: An adequate amount of fluid in your body is needed to prevent constipation. This medication works by helping your small intestine release the appropriate amount of fluid based on the food you eat.

Examples: Plecanatide (Trulance) was recently approved by the FDA in the treatment of constipation.

Precautions: A major side effect of Trulance is diarrhea, which can be severe. This medication shouldn’t be used by children younger than the age of six because of risk of intestinal obstruction.

Now that you know the risks and side effects of laxatives, the next step is learning what you can do to avoid them. Here’s a list of best practices for staying safe when treating constipation problems.

• Read the label carefully.
• Double-check the dosage.
• Don’t mix two or more different types of
  laxatives.
• Check with a doctor or pharmacist to make sure
  the laxative doesn’t interact with a medication you’re taking.
• Be patient. Laxatives take time to start
  working. Don’t take another dose earlier than what’s stated on the product’s
  label.
• Drink plenty of water.
• Don’t take stimulant laxatives regularly.
• Keep all medications out of the reach of
  children.
• If you’re pregnant or have kidney problems,
  check with your doctor before taking a laxative.

Though they take much longer to work, gentler ways to treat constipation problems than laxatives are available. These methods are also better as a long-term solution.

Bulk-forming agents

How they work: Bulk-forming agents work by absorbing water in your intestines to bulk up your stool. Bulky stools make your bowel contract, which helps push out the stool.

Examples: Examples of bulk-forming agents include:

• polycarbophil (FiberCon)
• inulin (Metamucil)
• wheat dextrin (Benefiber)
• methylcellulose (Citrucel)

Precautions: In general, this type of medication is the gentlest and safest on your body to treat constipation. However, you still need to be cautious. Always drink a lot of water along with a bulking agent, or it could lead to a blockage in your bowel. You may also experience mild abdominal pain, bloating, or gas after taking a bulk-forming agent.

Dietary changes

The simplest remedy for constipation is to eat more high-fiber foods. Slowly add the following foods to your diet:

• whole wheat bread
• fruit, like berries and prunes
• bran flakes
• vegetables, such as broccoli, spinach, sweet
  potatoes, Brussels sprouts, carrots, squash, and avocado
• beans and lentils
• shredded wheat
• oatmeal
• flaxseed

Try not to eat processed snack foods and fast food, as well as too much meat and dairy. These foods have very little fiber or none at all.

Increasing your fluid intake

Another simple therapy to help with constipation problems is to increase your intake of water and other liquids. Target at least 1.5 liters per day or more. Also, limit your intake of caffeine and alcohol. These may result in dehydration.

Get moving

Lack of exercise causes your bowel to slow down. If you’re not too active right now, try to find ways to include more movement in your life. Take the stairs instead of the elevator, walk instead of using your car, park far away from your office so you have to walk a bit, or try taking regular breaks from work to get up and walk around. Do some form of exercise every day, like jogging, walking, swimming, yoga, Pilates, or cycling.

Unless otherwise directed by a doctor, remember that laxatives are only intended for short-term use. Always read the label and never take more than what is directed on it. You put yourself at risk of dangerous side effects both when you take too much of a laxative at once and also when you take them too frequently. Abusing laxatives can lead to serious problems with bowel motility as well as electrolyte imbalances.

It’s fine to take laxatives every now and then when you just need some relief from your constipation. However, for a long-term solution, make sure you are also adding more fiber to your diet, increasing your physical activity, and drinking plenty of water. If your constipation problems continue for more than a few months, seek the advice of your doctor.