What is constipation?

It means that a person has 3 bowel movements or fewer in a week. The stools are hard and dry and sometimes painful to pass. Contrary to popular belief, you do not need to have a bowel movement every day. Each person’s body is different and many factors contribute to your gut regularity. Normally, if you’re eating a high fiber diet, drinking at least 6-8 glasses (250 ml or 8 oz) of liquids a day, and exercising daily, this is enough to keep your digestive system regular. However, in some cases regardless of the amount of fiber and water, many other factors can contribute to constipation such as:

• Stress
• Underlying conditions like narrowing or blockage of the colon, IBS, SIBO, underactive thyroid, diabetes and/or neurological conditions
• Side effects from medications, like those for pain, depression, high blood pressure, and Parkinson’s disease
• Calcium and iron supplements

Therefore, diet and lifestyle regimes may not be enough to alleviate constipation and your doctor may recommend laxatives. Here are some of the most common types:

Bulk-forming

Your body does not digest bulk-forming laxatives; instead, the fiber they contain absorbs and retains a large quantity of liquid, thereby forming a soft, bulky stool. The bulky size stimulates the intestinal muscles to naturally contract (peristalsis), causing digestive contents to move along, leading to an easier bowel movement. It usually works anywhere from about 12 hours to 3 days to show results, depending on individual digestive system transit times. Therefore, it will not provide immediate relief of constipation. It is the optimal aid for ongoing digestive regularity and is helpful for conditions such as diverticular disease, IBS and hemorrhoids. They are believed to be safe for long-term use and are usually well tolerated. Some side effects include bloating, gas, cramping, and/or increased constipation, especially if you don’t consume enough water. Examples: psyllium (Metamucil®), inulin (Metamucil® Simply Clear), wheat dextrin (Benefibre®), methylcellulose (Citrucel®), and polycarbophil (FiberCon®, Prodiem®). Psyllium, but not wheat bran, has been associated with less sides effects of gas and bloating.

Stool softeners

These enable easier incorporation of water into the stool to keep it soft and easier transit. This reduces or eliminates the need to strain. They do not directly affect the digestive tract muscles but some people may create a tolerance to softeners and may require higher doses over time. Examples: docusate sodium (Colace®). 

Stimulant laxatives

They increase peristalsis to move contents along, facilitating a shorter colonic transit time and have a more immediate effect, about 6-10 hours after intake. However, it may cause the colon to stop functioning correctly (cathartic colon) which often occurs with daily use after which the body becomes dependent for normal peristaltic activity. For patients who have chronic constipation caused by IBS-C, stimulants may be the only solution but, even then, it should only be used for a short term and under the supervision of a healthcare provider. Examples: bisacodyl (Ex-lax®, Dulcolax®), castor oil, and senna.

Osmotic laxatives

They act as hyperosmolar agents, increasing water content of stool and therefore making stool softer and easier to pass, as well as increasing colonic peristalsis. A few include lactulose, milk of magnesia and polyethylene glycol (PEG). Examples are: GoLYTELY®, MiraLax®, GlycoLax®

Prunes/dried plums

The laxative mechanism of prunes is not yet fully understood but researchers suspect it is likely related to the combination of sorbitol, soluble fiber, and polyphenols content. Fiber acts as a bulking agent, and sorbitol acts as an osmotic laxative even without any fiber. 

Coffee

Coffee’s effect is not solely due to caffeine, since decaf coffee has shown the same effect for some individuals. Coffee stimulates the contractions of the stomach and intestinal tract, and it stimulates bile excretion. It also helps to release gastrin, a hormone that plays a role in the motility of the intestinal tract. Drinking coffee or any other beverage in the morning stimulates a defecation reflex known as the gastrocolic reflex. This reflex helps jump-start your bowels whenever you eat or drink with an empty stomach.

If you suffer from chronic constipation and are unsure of the right treatment for you, talk to your physician for a specific recommendation.