Constipation

Key points:

  • Constipation is common. Nearly everyone will feel constipated some time in his or her life.

  • More than 20 million Americans have constipation each year.

What is it?

Most people pass stool more than 3 times per week, but less than 3 times per day. It’s called constipation when a person passes stool less often, has very hard stool, or has trouble passing stool.

If constipation lasts for more than 3 months, it is thought of as chronic (or ongoing).

If you have chronic constipation, talk with your doctor to:

  • Make sure there is not a serious problem
  • Find a treatment

What are the symptoms?

Patients may feel constipated when they have one or more of the following symptoms:

  • Pass stool less often
  • Have hard or lumpy stools
  • Have to strain very hard to pass stool
  • Feel that stool can't pass at all
  • Feel that the rectum isn't completely empty, even after passing stool
  • Have a swollen belly
  • Have a feeling of fullness or bloating
  • Have belly pain, cramping, or discomfort

What causes it?

People may feel constipated when:

  • Stool moves too slowly through the colon
  • The colon takes too much water out of stools
  • Pelvic floor muscles don't relax like normal, so stool doesn't pass easily

Constipation can be caused or made worse by:

  • Not eating enough fiber
  • Not drinking enough water
  • Not enough physical activity
  • Side effects of some medicines
  • Irritable Bowel Syndrome (IBS)
  • Pregnancy
  • Aging
  • Travel
  • Not passing stool when the urge strikes
  • Some medical conditions (like a stroke)

How do I manage it?

Fiber draws fluid into the bowels. This helps soften stools so they can pass more easily during a bowel movement.

  • It may take up to 25 to 35 grams of fiber a day to help.
  • Try to drink extra water to help the fiber do its job.
  • Some high fiber foods also act as natural laxatives, such as prunes, prune juice, and dried apricots.
  • Good sources of fiber include: Fruits, Vegetables and Whole Grains
  • Add fiber to your diet slowly (over a few weeks) – especially if you don’t get much now. At first, your body may make more gas, but it can get better over time.

image

To help the bowels work well:

  • The body has a natural rhythm or schedule. The rhythm can be off if your routine changes. Sometimes it can help the bowels work more regularly if you keep a regular routine, including meals, sleeping and waking.
  • When you have to go to the bathroom, listen to your body. Go when your body tells you it needs to. Try not to hold it for too long.
  • Eat breakfast every day.
  • Eat up to 25-35 grams of fiber each day.
  • Drink lots of water – try to get 8 glasses a day.
  • Exercise regularly.
  • Try stomach massage.

Stool softeners add water to stool, which loosens it and makes it easier to pass.

Docusate sodium or docusate calcium:

  • Docusate helps the fat in stool to mix with water, which softens stool.
  • It may take 1 to 3 days to work.
  • Docusate enemas may take 2 to 15 minutes to produce a bowel movement.

Suppositories:

  • Glycerin suppositories cause the intestines to hold more water and soften stool.
  • They may produce a bowel movement within 1 hour and should not be taken more than once in a 24-hour period.
  • Suppositories should only be inserted into the rectum and should NOT be taken by mouth.

Common names:

  • Colace™
  • DOK™
  • Dulcolax™
  • Sur-Q-La™
  • Surfak™
  • Fleet Sof-Lax™

Fiber draws fluid into the bowels. This helps soften stools so they can pass more easily during a bowel movement.

Fiber supplements can be found at most grocery stores and pharmacies. Read the directions to know how much to take each day.

Common names:

  • Citrucel™
  • Fibercon™
  • Konsyl™
  • Metamucil™
  • Acacia fiber

Osmotic laxatives increase the amount of water in stool, making stool easier to pass.

Polyethylene glycol (PEG) 3350:

  • PEG 3350 is a powder that is mixed with fluid to drink.
  • It usually takes 1 to 3 days for PEG 3350 to work.

Common names:

  • MiraLAX™
  • ClearLax™
  • GaviLAX™
  • GlycoLax™
  • Purelax™

There are several ways to take magnesium.

  • Food. Magnesium is found in green leafy vegetables, beans and peas, nuts, seeds, and whole grains
  • Supplements. These are taken by mouth once or twice each day.
  • Magnesium laxatives. Some magnesium laxatives come in a pill form, others come in a liquid form.

Common names:

  • Supplements:
    • Slow-Mag™
    • Mag-Ox™
    • Mag-Tab™
  • Laxative pills:
    • Phillip's Chews™
    • Mag-Caps™
  • Laxative liquids:
    • Citroma™
    • Phillip's Milk of Magnesia™

Stimulant laxatives cause the bowel to contract and relax, which results in a bowel movement.

Sennosides:

  • Sennosides are taken by mouth with plenty of water or as a tea.
  • People usually have bowel movements 6 to 12 hours after taking sennosides.
  • Common names:
    • Senokot™
    • Senna-Lax™

Bisacodyl:

  • Bisacodyl comes as a pill taken by mouth, an enema, or a suppository.
  • People usually have bowel movements 6 to 12 hours after taking bisacodyl.
  • Common names:
    • Dulcolax™
    • Correctol™
    • Gen Lax™
  • Fleet
  • Bisacodyl™

Many herbal laxatives contain stimulants such as cascara, aloe, and rhubarb.

  • An enema puts liquids into the rectum and colon through the anus.
  • The extra liquid in the bowels causes them to contract and relax strongly. This means a person will feel an urgent need to have a bowel movement.
  • Enemas work quickly to soften stool and clean the bowels.
  • They can be made at home using an enema bag, or they can be bought at a drug store.
  • Enemas should NOT be used regularly for constipation that lasts a long time (chronic). They should only be used if you are severely constipated and other methods aren’t working.

Common enemas:

  • Mineral oil
  • Olive oil
  • Tap water
  • Phosphate
  • Soap suds

Fruits that are high in fiber include:

  • Apples with skin
  • Bananas
  • Kiwi
  • Pears
  • Peaches
  • Strawberries

Please be mindful of your own dietary needs when choosing foods to try. These foods are examples and may not work for everyone.

Vegetables that are high in fiber include:

  • Beans
  • Beet root
  • Carrots
  • Cauliflower
  • Plantains
  • Spinach

Please be mindful of your own dietary needs when choosing foods to try. These foods are examples and may not work for everyone.

Whole grains that are high in fiber include:

  • Barley
  • Brown rice
  • Buckwheat
  • Bulgur (cracked wheat)
  • Corn
  • Farro
  • Flaxseed
  • Oats
  • Quinoa
  • Rye
  • Spelt
  • Whole wheat
  • Wild rice

Please be mindful of your own dietary needs when choosing foods to try. These foods are examples and may not work for everyone.

image

Massaging the stomach can help ease cramping, bloating, and constipation by helping to move stool along the colon.

  • Lie down on your back, with your knees bent and feet flat on the floor.
  • Place your fingers on the right side of your stomach down by the bone of your pelvis.
  • Rub in a circular motion lightly up to the right side until you reach your rib bones.
  • Move straight across to the left side.
  • Work your way down to the left to the hipbone and back up to the belly button for 2-3 minutes.
  • Rub with your fingertips in a circular motion. You may press a little deeper with your fingers.
  • Spend about 1 minute moving from the right hip bone to the right ribs, then 1 minute across the middle (gently), and then 1 minute down to the left bone by your pelvis to the belly button.
  • Repeat, always in clockwise motion, for 10 minutes.

Caution: Stool softeners should not be used by people who have:

  • Nausea, vomiting, or stomach pain
  • Blockage in the intestines

Caution: Your doctor should monitor you if you use suppositories every day. Using them too much can cause damage.

Caution: Glycerin should not be used by people who have:

  • Rectal bleeding
  • Allergy to glycerin

There are two kinds of fiber: soluble and insoluble.

Soluble fiber:

Research studies show that eating foods high in soluble fiber can help with constipation. However, eating soluble fiber may cause gas and bloating.

You can get soluble fiber from:

Insoluble fiber:

There's less information about whether insoluble fiber can help with constipation. Insoluble fiber may cause less gas and bloating than soluble fiber.

Foods:

  • Apples
  • Beans
  • Carrots
  • Lentils
  • Oatmeal
  • Oat cereal
  • Oranges
  • Peas
  • Tomatoes
  • Strawberries

Suplements:

  • Citrucel™
  • Benefiber™
  • Fiberchoice™
  • Fibercon™
  • Metamucil™

You can get insoluble fiber from foods:

  • Barley
  • Broccoli
  • Cabbage
  • Celery
  • Leafy vegetables
  • Nuts
  • Seeds
  • Tomatoes
  • Whole grains
  • Whole wheat

and suplements:

  • Citrucel™
  • Normacol™
  • Normafibe™

Everyone is different. Most people find it helpful to try different kinds of fiber until they find something that works for them.

Please be mindful of your own dietary needs when choosing foods to try. These foods are examples and may not work for everyone.

Caution: Usually these are safe and well tolerated. But sometimes they can cause bloating, gas, and cramping at higher doses

Caution: Patients with heart or kidney disease should talk to their doctor before adding magnesium.

Magnesium supplements that also have calcium can make constipation worse.

Generic Names:

  • Magnesium aspartate - Maginex®
  • Magnesium chloride - Mag-Carb®
    • Dewee's Carminative®
  • Magnesium chloride - Chloromag®
    • Mag 64®
    • Mag Delay®
    • Slow-Mag®
  • Magnesium gluconate - Almora®
    • Mag G®
    • Magonate®
    • Magtrate®
  • Magnesium hydroxide - Phillips' Milk of Magnesia®
    • Phillips' Chews®
  • Magnesium lactate - Mag-Tab®
  • Magnesium oxide - Mag-Caps®
    • MagGel®
    • Mag-Ox®
    • Uro-Mag®
  • Magnesium citrate - Magnesium citrate*
  • Magnesium hydroxide - Phillips' Chews®
  • Magnesium oxide - Mag-Caps®
    • MagGel®
    • Mag-Ox®
    • Uro-Mag®
  • Magnesium citrate - Citroma®
  • Magnesium hydroxide - Phillips' Milk of Magnesia®
  • Magnesium sulfate - Epsom Salts®

Caution: Stimulant laxatives can cause abdominal cramping or pain, especially when taken in higher doses. See your doctor if you need large daily doses of stimulant laxatives to have a bowel movement. These drugs should not be used if you have a history of blockages in your bowel.

Other Resources

To learn more about constipation, please visit these websites: