Constipation medications & treatments
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Most everyone has a bout of constipation or a hard time passing stool at some point in their life. It is the most common GI (gastrointestinal) problem that affects up to 27% of the population. About 4 million people in the United States have frequent constipation and it’s estimated that at least 2.5 million people see their doctor each year because of it. Although constipation is usually not serious, it can affect your quality of life so it is important to keep this from turning into a chronic condition.
What is constipation?
Constipation is generally defined as having 3 or fewer complete bowel movements a week. Normal bowel habits vary from person to person. Some people “go” several times a day while others only go 1 to 2 times a week. As long as you are having your normal frequency of bowel movements, there shouldn’t be any concern.
Dry, hard stools are the usually result of the colon absorbing too much water. This occurs because the stool moves through the digestive tract too slowly which results in the excessive loss of water. The most common causes of constipation include:
- Medications such as opioid pain medications, some antidepressants, and iron supplements
- Not enough water or fiber in your diet
- Getting little or no physical activity
- Eating a lot of dairy products
- Ignoring the urge to have a bowel movement
- Changes in your lifestyle or daily routines such as pregnancy or traveling
- Overuse of laxatives
- Certain medical conditions such as irritable bowel syndrome (IBS), eating disorders, multiple sclerosis, Parkinson’s disease, hypothyroidism (underactive thyroid), and diabetes
How is constipation diagnosed?
To diagnose constipation, your doctor or healthcare professional may look at your symptoms, review your medical and family history, perform a physical exam, and run some tests to find the cause.
Although every individual will experience them differently, the most common symptoms of constipation include:
- Fewer than 3 bowel movements a week
- Having dry, hard, or lumpy stools
- Straining to have a bowel movement
- Your stools are difficult or painful to pass
- Stomach bloating
- Abdominal pain
- Feeling that you didn’t completely empty your bowels after a movement
In addition to reviewing your symptoms and history, your doctor may order some tests to rule out or confirm the cause of your chronic constipation. These can include:
- Blood tests. These look for signs of hypothyroidism, diabetes, high calcium levels, anemia, celiac disease, or other possible causes of your constipation.
- Digital rectal exam (DRE). This involves your doctor inserting a gloved, lubricated finger into the rectum to check for any masses, blood, or other problems.
- X-ray. An x-ray can show any blockages in your intestines and how full your bowels are.
- Colonoscopy. A colonoscopy or a sigmoidoscopy may be performed using a small, flexible, lighted tube to examine your rectum and colon for blockages as well as getting tissue samples (biopsy) to screen for colorectal cancer.
- Anorectal manometry. This test along with balloon expulsion therapy (BET) can be used to determine if the anal muscles are working properly.
- Colonic transit study. This involves consuming a small dose of a radioactive substance, either in pill form or in a meal, and then tracking both the amount of time and how the substance moves through your intestines.
- Imaging tests. To look for other causes of your constipation, you may be asked to have imaging tests performed, such as a lower GI series using a barium enema, an MRI, or a CT scan.
What are some constipation treatment options?
The treatment of chronic constipation typically starts with diet and lifestyle changes. This is usually enough to resolve mild to moderate cases. For severe constipation or for cases that don’t go away after making these changes, you may also need medications or surgery.
Laxatives are the drug of choice to treat constipation. Several types of laxatives are used and each works in a different way to help you pass stools. These include:
- Bulk-forming laxatives. They are the first-line therapy for constipation and are generally safe and effective. These fiber supplements add bulk to your stool making it softer and easier to pass. The most common bulk-forming laxatives used are Metamucil (psyllium), Fibercon (polycarbophil), and Citrucel (methylcellulose).
- Osmotic laxatives. Osmotic laxatives draw water out of the tissue in the colon, which softens and adds bulk to your stool, making it easier to pass. These are most effective if taken with plenty of water. Examples include Phillip’s Milk of Magnesia (magnesium hydroxide), magnesium citrate, Miralax (polyethylene glycol), and Cholac (lactulose).
- Stimulant laxatives. Stimulant laxatives cause your intestines to contract, forcing stool to move through the colon. They may relieve constipation that is severe or has not responded to other treatments. These include Dulcolax (bisacodyl) and Senokot (sennosides).
- Stool softeners. Stool softeners cause your stool to absorb more water from the colon, making them softer and easy to pass. The most commonly used stool softener is Colace (docusate sodium).
- Meds for chronic idiopathic constipation. These meds work by drawing water from your intestines to bulk and soften your stool. They work similarly to osmotic laxatives. Some examples include Amitiza (lubiprostone), Linzess (linaclotide), and Trulance (plecanatide).
- Serotonin 5-hydroxytryptamine 4 receptors. Meds such as Motegrity (prucalopride) work on nerve cells to stimulate the colon muscles to contract.
- Peripherally acting mu-opioid receptor antagonists (PAMORAs). Movantik (naloxegol) and Relistor (methylnaltrexone) are used to relieve constipation caused by opioid use.
- Lubricants. Fleet (mineral oil) is used to help your stool move easily through the colon.
Diet and lifestyle changes
You can often treat your constipation at home by making the following lifestyle and dietary changes:
- Increase your fiber intake with high-fiber foods such as whole-grain bread and cereal, fresh fruits, and vegetables. You should aim for 20 to 35 grams of fiber per day.
- Also include foods that are natural laxatives such as prunes and pears.
- Drink plenty of water and other fluids.
- Avoid alcohol and caffeine.
- Exercise regularly.
- Don’t ignore the urge to poop.
- Train your muscles to have a bowel movement at the same time each day.
Although surgery is rarely needed, your doctor may recommend it if you have a blockage or a structural problem. Some structural problems include:
- An intestinal stricture, which is a narrowing in a portion of the intestine.
- An anal fissure, which is a tear in the anus.
- A rectal prolapse, where straining causes a part of your lower intestine to fall out of place and protrude from your anus.
If you have problems with the muscles that control bowel movements, your doctor may recommend biofeedback to retrain your muscles.
What is the best medication for constipation?
The best medication for the treatment of constipation will depend on the individual’s specific medical constipation, medical history, medications that the individual is already taking that may potentially interact with constipation medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter constipation medications approved by the Food and Drug Administration (FDA).
Best medications for constipation
|Drug name||Drug class||Administration route||Standard dosage||Common side effects|
|Motegrity (prucalopride)||Prokinetic agent||Oral||1mg to 2mg once daily.||Headache, abdominal pain, diarrhea, nausea|
|Amitiza (lubiprostone)||Chloride channel activator||Oral||8mcg to 24mcg twice daily.||Nausea, diarrhea, headache, abdominal pain|
|Linzess (linaclotide)||Guanylate cyclase-c agonist||Oral||72mcg to 290mcg once daily.||Diarrhea, abdominal pain, gas, headache|
|Trulance (plecanatide)||Guanylate cyclase-c agonist||Oral||3mg once daily.||Diarrhea, gas, abdominal pain|
|Metamucil (psyllium)||Bulk-forming laxative||Oral||2.5g to 30g daily in divided doses.||Abdominal cramping, constipation, gas|
|FiberCon (polycarbophil)||Bulk-forming laxative||Oral||1250mg with 8 ounces of water up to 4 times a day.||Abdominal fullness, gas, vomiting, stomach cramps|
|Colace (docusate)||Stool softener||Oral/rectal||Oral: 50mg to 300mg once daily or in divided doses.|
Rectal: 283mg (1 enema) per your rectum up to 3 times daily.
|Abdominal cramping, diarrhea|
|MiraLax (PEG 3500)||Osmotic laxative||Oral||17g capful/packet dissolved in 4oz to 8oz of a beverage once daily.||Abdominal cramping, gas, nausea, diarrhea, bloating|
|Dulcolax (bisacodyl)||Stimulant laxative||Oral||5mg to 15mg once daily.||Abdominal cramping, nausea, electrolyte and fluid imbalance, diarrhea, dizziness|
|Senokot (senna-sennosides)||Stimulant laxative||Oral||15mg to 100mg per day divided every 12 hours.||Abdominal pain, diarrhea, nausea, low blood potassium, yellow-brown urine discoloration|
|Movantik (naloxegol)||PAMORA||Oral||12.5mg to 25mg once daily in the morning 1 hr before a meal or 2 hrs after.||Abdominal pain, diarrhea, nausea, gas, vomiting, headache|
|Relistor (methylnaltrexone)||PAMORA||Injection/oral||Injection: Dose based on weight then given under the skin every other day.|
Oral: 150mg to 450mg once daily in the morning.
|Abdominal pain, gas, nausea, diarrhea, excessive sweating|
Your healthcare provider will determine the right dosage based on your response to the treatment, medical constipation, weight, and age. Other possible side effects may exist; this is not a complete list.
What are the most common side effects of constipation medications?
As with all medicines, those used for constipation will have some side effects. There are some differences between each class but they share many common side effects, including:
- Abdominal pain
- Abdominal cramps
What are some home remedies for constipation?
Most often, constipation can be treated through dietary and lifestyle changes, which relieve symptoms. You can also use these same things to prevent it from becoming a chronic problem.
- Drink more water
- Get regular exercise
- Eat a well-balanced diet with fruits, vegetables, and other high-fiber foods
- Go to the bathroom when you feel the urge
- Reduce stress
- Add probiotics to your diet
- Try to have a bowel movement at the same time each day
Frequently asked questions about constipation
What are some complications of constipation?
Constipation is not typically a serious condition, but it can cause complications if not treated effectively, including:
- Anal fissures
- Fecal impaction
- Rectal prolapse
When should you contact your doctor about your constipation?
Everyone has a bout with constipation occasionally that can be treated successfully from home. However, if you have the following symptoms, you should contact your doctor and get an appointment to be seen:
- Constipation is a new problem for you and lifestyle changes haven’t helped.
- Blood in your stools.
- Have unintentional weight loss.
- You have severe pain with each bowel movement.
- Your constipation has lasted longer than 3 weeks.
What are some medications to avoid if I have constipation?
Medications and supplements that can cause or worsen constipation include:
- Antacids that contain calcium and aluminum
- Opioid pain medications
- Calcium-channel blockers
- Iron supplements
- Meds for urinary incontinence
- Meds for Parkinson’s disease
What are some food and drinks that I should avoid with constipation?
Foods low in fiber and high in fat should be avoided, which include:
- Ice cream
- Fast food
- Red meats
- Frozen meals
- Potato chips
- Hot dogs
- White bread
Related resources for constipation
- What is constipation? WebMD
- Constipation symptoms and causes? Cleveland Clinic
- Constipation overview. MayoClinic
- What is constipation? Hopkins Medicine
- Constipation definition and facts. National Institute of Diabetes and Digestive and Kidney Diseases
- What is constipation? Cedars Sinai
- About constipation. NHS Inform
- Constipation and defectation problems. American College of Gastroenterology