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Although treatment depends on the cause, severity, and duration of the
constipation, in most cases dietary and lifestyle changes will help relieve
symptoms and help prevent them from recurring.
Diet
A diet with enough fiber (20 to 35 grams each day) helps the body 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 may help treat and prevent constipation include drinking
enough water and other liquids, such as fruit and vegetable juices and clear
soups, so as not to become dehydrated, 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 diet and lifestyle changes and are still constipated, a
doctor may recommend laxatives or enemas for a limited time. Some laxatives
can be bought without prescription.
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 they 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, Fiberall, Citrucel, Konsyl, and Serutan. These agents
must be taken with water or they can cause obstruction. Many people also
report no relief after taking bulking agents and suffer from a worsening
in bloating and abdominal pain.
- Stimulants cause rhythmic muscle contractions in the
intestines. Brand names include Correctol, Dulcolax, Purge, 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.
- Osmotics cause fluids to flow in a special way through
the colon, resulting in bowel distention. This class of drugs is useful
for people with idiopathic constipation. Brand names include Cephulac,
Sorbitol, and Miralax. People with diabetes should be monitored for
electrolyte imbalances.
- Stool softeners moisten the stool and prevent
dehydration. These laxatives are often recommended after childbirth or
surgery. Brand names include Colace and Surfak. These products are
suggested for people who should avoid straining in order to pass a bowel
movement. The prolonged use of this class of drugs may result in an
electrolyte imbalance.
- Lubricants grease the stool, enabling it to move
through the intestine more easily. Mineral oil is the most common example.
Brand names include Fleet and Zymenol. Lubricants typically stimulate a
bowel movement within 8 hours.
- Saline laxatives act like a sponge to draw water into
the colon for easier passage of stool. Brand names include Milk of
Magnesia and Haley's M-O. Saline laxatives are used to treat acute
constipation if there is no indication of bowel obstruction. Electrolyte
imbalances have been reported with extended use, especially in small
children and people with renal deficiency.
- Chloride channel activators increase intestinal fluid
and motility to help stool pass, thereby reducing the symptoms of
constipation. One such agent is Amitiza, which has been shown to be safely
used for up to 6 to 12 months. Thereafter a doctor should assess the need
for continued use.
- Serotonin agonists help the muscles in your intestines
work correctly when a slow-moving digestive system is caused by low levels
of serotonin. Serotonin is a neurotransmitter found mostly in the
digestive tract. One brand-name agent is Zelnorm, which is prescribed for
the short-term treatment of chronic constipation in people less than 65
years of age.
People who are dependent on laxatives need to slowly stop using them. A
doctor can assist in this process. For most people, stopping laxatives
restores the colon's natural ability to contract.
Other Treatments
Treatment for constipation 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, a condition
in which the lower portion of the colon turns inside out.
People with chronic constipation caused by anorectal dysfunction can use
biofeedback to retrain the muscles that control bowel movements. Biofeedback
involves using a sensor to monitor muscle activity, which is 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 retrain 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.
Reference:
National Digestive Diseases Information Clearinghouse, USA.
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