Constipation Treatment

Although treatment depends on the cause, severity, and duration, in most cases dietary and lifestyle changes will help relieve symptoms and help prevent 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 soup, 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 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^®, Feen-A-Mint^®, 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^®, Dialose^®, and Surfak^®.

• Lubricants grease the stool enabling it to move through the intestine more easily. Mineral oil is the most common lubricant.

• Saline laxatives act like a sponge to draw water into the colon for easier passage of stool. Laxatives in this group include Milk of Magnesia^®, Citrate of Magnesia^®, and Haley's M-O^®.

Other Treatment

Treatment may be directed at a specific cause. For example, the doctor may recommend discontinuing medication or performing surgery to correct an anorectal problem such as rectal prolapse.

People with chronic constipation caused by anorectal dysfunction can use biofeedback to retrain the muscles that control release of bowel movements. Biofeedback involves using a sensor to monitor muscle activity that at the same time can be displayed on a computer screen allowing for an accurate assessment of body functions. A health care professional uses this information to help the patient learn how to use these muscles.

Surgical removal of the colon may be an option for people with severe symptoms caused by colonic inertia. However, the benefits of this surgery must be weighed against possible complications, which include abdominal pain and diarrhea.

Can Constipation Be Serious?

Sometimes constipation can lead to complications. These complications include hemorrhoids caused by straining to have a bowel movement or anal fissures (tears in the skin around the anus) caused when hard stool stretches the sphincter muscle. As a result, rectal bleeding may occur that appears as bright red streaks on the surface of the stool. Treatment for hemorrhoids may include warm tub baths, ice packs, and application of a cream to the affected area. Treatment for anal fissure may include stretching the sphincter muscle or surgical removal of tissue or skin in the affected area.

Sometimes straining causes a small amount of intestinal lining to push out from the anal opening. This condition is known as rectal prolapse and may lead to secretion of mucus from the anus. Usually, eliminating the cause of the prolapse such as straining or coughing is the only treatment necessary. Severe or chronic prolapse requires surgery to strengthen and tighten the anal sphincter muscle or to repair the prolapsed lining.

Constipation may also cause hard stool to pack the intestine and rectum so tightly that the normal pushing action of the colon is not enough to expel the stool. This condition, called fecal impaction, occurs most often in children and older adults. An impaction can be softened with mineral oil taken by mouth and an enema. After softening the impaction, the doctor may break up and remove part of the hardened stool by inserting one or two fingers in the anus.

Points to Remember

1. Constipation affects almost everyone at one time or another.

2. Many people think they are constipated when, in fact, their bowel movements are regular.

3. The most common causes of constipation are poor diet and lack of exercise.

4. Additional causes of constipation include medications, irritable bowel syndrome, abuse of laxatives, and specific diseases.

5. A medical history and physical examination may be the only diagnostic tests needed before the doctor suggests treatment.

6. In most cases, following these simple tips will help relieve symptoms and prevent recurrence of constipation:
   • Eat a well-balanced, high-fiber diet that includes beans, bran, whole grains, fresh fruits, and vegetables.
   • Drink plenty of liquids.
   • Exercise regularly.
   • Set aside time after breakfast or dinner for undisturbed visits to the toilet.
   • Do not ignore the urge to have a bowel movement.
   • Understand that normal bowel habits vary.
   • Whenever a significant or prolonged change in bowel habits occurs, check with a doctor.

7. Most people with mild constipation do not need laxatives. However, doctors may recommend laxatives for a limited time for people with chronic constipation.

• What Is Constipation?
• Causes
• Diagnostic Tests