Constipation is among the most typical gastrointestinal complaints, and it typically happens when people have fewer than 3 bowel actions per week.1
Signs could embody dry and onerous stools, a sense of not totally emptying the bowels, and straining throughout bowel actions.1 Many elements can contribute to constipation, together with an absence of train or not getting sufficient fiber; circumstances comparable to diabetes, irritable bowel syndrome, or being pregnant; and medicines comparable to antidepressants, blood strain drugs, or opioids.1 Growing fiber, health, and fluids are vital way of life modifications to start out with for sufferers with constipation. If these adjustments aren’t sufficient, well being care suppliers can assist sufferers choose an applicable OTC laxative to handle their constipation.
Earlier than recommending laxatives, remember that people with indicators of appendicitis, comparable to decrease stomach ache, nausea, and vomiting, ought to search medical consideration instantly and never use laxatives. If a affected person is utilizing laxatives, they need to take them individually from different drugs to stop decreasing the efficacy of these medicine.1-3
Fiber dietary supplements comparable to Benefiber, Citrucel, and Metamucil enhance the frequency of bowel actions by retaining water within the stool and rising stool consistency and weight.2,3 These are usually powder formulations that may simply be combined with liquid. Advise sufferers to drink a minimum of 8 ounces of water with bulk-forming laxatives to stop bloating, bowel obstruction, and cramping.1,4 Benefiber is protected to make use of in kids and causes much less bloating than different fiber merchandise. People who’re motionless, on fluid restriction, or have bother swallowing ought to keep away from bulk laxatives.1 It typically takes roughly 12 to 72 hours to see outcomes with fiber dietary supplements.1
Medicines comparable to bisacodyl (Dulcolax) and senna (Senokot) work by rising intestinal motility.2 Stimulant laxatives typically take roughly 6 to 10 hours to work earlier than a bowel motion happens, with the commonest adversarial impact being cramping.2-4 Sufferers ought to begin taking stimulant laxatives when beginning opioid drugs to stop constipation.3,4 Sufferers with intestinal obstruction ought to keep away from oral stimulant laxatives.2 Clinicians ought to monitor for indicators of laxative abuse that may happen in sufferers with consuming issues and people who proceed to make use of these drugs long run.2-4 Signs could embody dehydration, electrolyte disturbances, and extreme diarrhea.4 Some mixture merchandise can be found that comprise greater than 1 laxative. Nevertheless, these could trigger extra adversarial results, so it is very important advise sufferers to learn the drug details label.
Osmotics embody lactulose, magnesium hydroxide (Phillips’ Milk of Magnesia), polyethylene glycol (PEG) 3350 (Miralax), and sodium phosphate enema (Fleet). They work by drawing water into the bowel surrounding the physique tissues.2 They normally take 2 to three days to provide a bowel motion, though enemas work inside 1 to five minutes.2 Sufferers recovering after a coronary heart assault or after surgical procedure can use osmotics to keep away from straining throughout bowel actions. Osmotics are also another choice for managing constipation in sufferers taking opioids. Sufferers in danger for electrolyte issues, comparable to these with coronary heart or kidney failure or who’re aged or taking diuretics, ought to keep away from osmotic saline laxatives that comprise magnesium or sodium.4 Enemas can be utilized by people with fecal impaction, however they shouldn’t be used incessantly to deal with constipation. Glycerin (Pedia-Lax) suppositories are a sort of osmotic laxative thought of protected to be used in kids and infants to handle constipation and can normally produce a bowel motion in 15 to 60 minutes.2 Advise mother and father to make use of only one suppository in a 24-hour interval.
PEG merchandise additionally are sometimes beneficial to deal with constipation in kids.5 Neuropsychiatric adversarial results, comparable to anger, nervousness, melancholy, and paranoia, have been reported in kids taking PEG.5 Extra research must be performed to find out the long-term results of PEG in kids and whether or not it might be related to security issues. Clinicians ought to advise mother and father in regards to the doable danger of neuropsychiatric adversarial results with long-term use of PEG merchandise in kids.
Medicines comparable to docusate sodium (Colace) moisten the stool by drawing water from the intestines to stop straining throughout bowel actions and usually take 24 to 48 hours for outcomes.2 Moreover, these merchandise are sometimes added to stimulant laxatives to deal with constipation. Stool softeners are thought of protected throughout being pregnant and can assist with pregnancy-related constipation.6 Well being care professionals can also advocate stool softeners to stop constipation in pregnant sufferers taking iron dietary supplements for anemia.6
Merchandise comparable to mineral oil work by coating the bowel and stool with a water-resistant movie to advertise bowel actions and make them simpler to move.2 Mineral oil shouldn’t be taken when mendacity down and must be separated by roughly 2 hours from meals as it might intrude with meals digestion and absorption of vitamins and nutritional vitamins. Mineral oil shouldn’t be given to younger kids or bedridden aged people as a result of lipoid pneumonia can happen, which is brought on by inhaling oil droplets into the lungs.2
1. Constipation. Cleveland Clinic. Up to date November 7, 2019. Accessed Could 8, 2021. https://my.clevelandclinic.org/well being/illnesses/4059-constipation
2. Laxative (oral route). Mayo Clinic. Up to date Could 1, 2021. Accessed Could 7, 2021. https://www.mayoclinic.org/drugs-supplements/laxative-oral-route/description/drg.20070683
3. Bharucha A, Lacy BE. Mechanisms, analysis, and administration of persistent constipation. Gastroenterology. 2020;158(5):1232-1249.e3. doi:10.1053/j.gastro.2019.12.034
4. Bashir A, Sizar O. Laxatives. StatPearls. Up to date September 23, 2020. Accessed Could 7, 2021. https://www.ncbi.nlm.nih.gov/books/NBK537246/
5. Dabaja A, Abbas M. Polyethylene glycol. StatPearls. Up to date October 20, 2020. Accessed Could 7, 2021. https://www.ncbi.nlm.nih.gov/books/NBK557652/
6. Tobah YB. Is it protected to take stool softeners to deal with being pregnant constipation? Mayo Clinic. April 11, 2020. Accessed Could 7, 2021.
ABOUT THE AUTHOR
Jennifer Gershman, PharmD, CPh, is a drug data pharmacist and Pharmacy Occasions® contributor who lives in South Florida.