Coping with constipation? Help is here

Constipation. It’s uncomfortable and inconvenient, and it can get in the way of everyday life. It’s also quite common. About a third of adults over age 60 have problems with infrequent or incomplete bowel movements or hard stools, according to the American Gastroenterological Association (AGA).

Most people take care of the occasional “stuck” situation with lifestyle changes or over-the-counter (OTC) laxatives, a 2020 survey from Cedars-Sinai Medical Center in Los Angeles indicates. But among those with long-term constipation, just 2 out of 5 saw a health care provider to figure out the cause or to take advantage of prescription laxatives if needed. That’s unfortunate, because it means people are suffering way more than they need to.

Here are some questions you may have wanted to ask, along with advice on when you should talk to your health care team.

Question: I’m really constipated and need help now. What’s effective, safe and fast?

Answer: Try an OTC osmotic laxative. “These pull fluid into your colon so stools are easier to pass,” says Charlene Prather, MD, a gastroenterologist and professor of internal medicine at Saint Louis University School of Medicine. The extra fluid makes bowel movements softer. These types of laxatives take a couple of hours or overnight to work. Plan to first take them when you know you’ll be home for a while; you’ll want to see how your body responds. OTC osmotic laxatives include:

• Saline laxatives, which often have magnesium, such as Milk of Magnesia®, Pedia-Lax®, Citroma® and ez2go Stimulax®
• Polyethylene glycol–based laxatives, such as MiraLAX®

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Q: What about stimulant laxatives? Wouldn’t those be faster?

A: If you’ve used an osmotic laxative and are still stuck, you may want to try an OTC stimulant laxative for a brief period of time. These medications act on your intestinal wall, making them contract to move stool along. “They’re great for short-term help, but make sure you’ll be near a bathroom,” Dr. Prather cautions. “You don’t want to take one on vacation and get on a tour bus for a couple of hours! These are OK for most people for occasional use only.” Be careful with stimulants; use only as instructed on the label. They can become habit-forming. Stimulant laxatives include:

• Bisacodyl (Correctol® and Dulcolax®)
• Senna (Senokot®)
• Phenolphthalein

Q: I get constipated on and off, a couple of times a month. What will help me stay regular all the time?

A: “Getting enough fiber and drinking enough water is important, along with regular exercise,” says Sunny Linnebur, PharmD, a professor at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. A fiber supplement, such as psyllium, may also help, she says.

Dr. Prather agrees. “I’m a huge fan of fiber for regular bowel movements that are easy to pass,” she says. If you’re not getting enough fiber from food, fiber supplements are an effective and safe choice. But be sure to drink about 8 glasses of water a day and follow the label directions for having water with your fiber supplement. And start with a small amount. Slowly build up to the recommended levels to keep bloating and gas at bay. Try one that has insoluble fiber. That helps bring more fluid into the intestines, creating softer stools. Some options:

• Psyllium husk (Metamucil®, Konsyl® and others)
• Methylcellulose (Citrucel®)
• Calcium polycarbophil (FiberCon®)
• Ground flaxseed
• Wheat dextrin (Benefiber®)

Q: My bathroom habits are fairly regular, but my bowel movements are hard, lumpy and scratchy. What will soften them up?

A: Have a couple of old-fashioned prunes! “Stewed or dried are both fine,” says Dr. Prather. “Have 1 or 2 and see what happens over the next day. You want to hit that ‘sweet spot’ of a normal, firm bowel movement that’s easy to pass. With prunes, it’s easy to overdo it.” Prunes work because they have fiber as well as sorbitol and other compounds that draw water into the intestines.

Q: What about stool softeners?

A: Your doctor may suggest a stool softener for short-term use if a medical condition or recent surgery makes straining to poop a bad idea. But these popular laxatives don’t work as quickly for constipation as other osmotic and stimulant laxatives, Linnebur says. Here are some examples of stool softeners:

• Colace®
• Regulax SS®
• Correctol Soft Gels®
• Ex-Lax Stool Softener®
• Fleet Sof-Lax®
• Phillips’ Liqui-Gels®

Q: I’m over age 60. What’s the best constipation-beating strategy for older adults?

A: “Constipation is common among older adults. It’s often due to many factors,” Linnebur says. For occasional issues, try a product like polyethylene glycol or senna. But if you’re older and regularly constipated, you may need to change your diet and drink more water. Ease into exercise if you’re sedentary. And always check with your health care provider if you find yourself tempted to take laxatives regularly.

Q: What about constipation during pregnancy?

A: To stay regular, focus on high-fiber foods, plenty of fluids and exercise (with your doctor’s guidance), according the Mayo Clinic. Increased hormone levels can slow digestion, but talk with your doctor before you take a laxative. If you take iron supplements, mention the constipation to your healthcare provider. Iron is an important nutrient during pregnancy, but too much of it can contribute to pregnancy constipation.

Q: When should I seek medical help for constipation? Could a prescription laxative be a good option?

A: Here’s when it’s time to call, according to the American Gastroenterological Association:

• Your constipation doesn’t get better within 3 weeks.
• It’s getting worse.
• You have ongoing stomach pain with bowel movements.
• You see blood in your stool.

Your doctor will do a physical exam, review your medical history, and ask what medications you’re on. Dietary fiber and OTC laxatives may be the first recommendation, depending on your symptoms and recent lifestyle routine. If your constipation persists, medical tests may be ordered to check for conditions that can cause constipation.

Your doctor may also try prescription laxatives in some cases. These include:

• Lubiprostone (Amitiza®). This medication brings more fluid into the bowel so your stool is softer and more frequent. This helps relieve constipation-related bloating and abdominal pain.
• Linaclotide (Linzess®) or plecanatide (Trulance®). These medications can help ease constipation associated with irritable bowel syndrome, as well as long-term constipation that has no clear cause.
• Prucalopride (Motegrity®). This medication is typically recommended for people with long-term constipation with no known cause.

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