Constipation is defined as difficult or infrequent passage of feces, hardness of stool, or a feeling of incomplete evacuation. Chronic constipation is harmful to the body potentially leading to serious health conditions.

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Constipation diet
A person's diet should contain enough fiber to ensure adequate stool bulk in order to prevent constipation. Vegetable fiber, which is largely indigestible and unabsorbable, increases stool bulk and reduces the risk for constipation; certain components of fiber also absorb fluid into the solid phase, making stools softer and facilitating their passage. Fruits and vegetables are recommended, as are cereals containing bran taken to tolerance.

Fluids and Constipation
One of the most important steps I recommend in order to reduce the risk for constipation is to drink plenty of fluids. The most important time to drink water is upon awakening. Drink one or two glasses of room temperature or cold water to stimulate peristalsis, and hence reduce your risk for constipation the rest of the day. I also recommend prune juice. You can drink a couple of ounces before bed, and when you wake up in the morning you will have an urge to empty your bowels, especially if you drink a glass or two of cool water when you wake up.

Laxatives
Laxatives should be used carefully for constipation. Some laxatives may interfere with absorption of various drugs by binding them chemically (eg, tetracycline, Ca, phosphate) or physically (eg, digoxin on cellulose matrices). Rapid fecal transit may rush some drugs and nutrients beyond their optimal absorptive locus. Laxative supplements are sometimes used as weight loss pills, but there are healthier options.

Bulking agents
Fiber and bulking agents (eg, bran, Psyllium, calcium polycarbophil, methylcellulose) provide fiber and are the only laxatives acceptable for long-term use. They act slowly and gently and are the safest agents for promoting elimination and preventing constipation. Proper use involves gradually increasing the dose--best taken tid or qid with sufficient liquid (by adding 20 oz/day of extra fluid) to prevent impaction --until a softer, bulkier stool results. This approach produces natural effects and is not habit forming. Bulking agents normalize both constipation and diarrhea.
   Psyllium is a bulk-forming fiber. Other fibers that belong to the class of bulk-forming fibers are cellulose, methylcellulose, carboxymethylcellulose sodium, karaya, malt soup extract, polycarbophil, and wheat bran. Bulk-forming fibers are laxatives because of their water-holding properties. They exert their action primarily through mechanical effects by bulking the colonic contents and decreasing transit time.

Secretory or stimulant cathartics (eg, cascara sagrada, senna and its derivatives, bisacodyl, phenolphthalein, castor oil) are often used to cleanse the bowel for diagnostic tests. They act by irritating the intestinal mucosa or by directly stimulating the submucosal and myenteric plexus. Some are absorbed, metabolized by the liver, and returned to the bowel in bile. Peristalsis and intraluminal fluid both increase, with cramping and passage of semisolid stool in 6 to 8 h. With continued use, melanosis coli, neuronal degeneration in the colon, "lazy bowel" syndrome, and serious fluid and electrolyte disturbances may occur. See also buckthorn.

Wetting agents (detergent laxatives [eg, docusate]) soften stools, making them easier to pass. They break down surface barriers, allowing water to enter the fecal mass to soften and increase its bulk. Increased bulk may stimulate peristalsis, which moves the softened stool more easily. Mineral oil softens fecal matter, resulting in more easily passed stool mass, but it may decrease absorption of fat-soluble vitamins. Wetting agents and mineral oil act slowly; either may be useful after MI or anorectal surgery and when prolonged bed rest is required.

Osmotic agents are used to prepare patients for some diagnostic bowel procedures and occasionally to treat parasitic infestations. They contain poorly absorbed polyvalent ions (eg, Mg, phosphate, sulfate) or carbohydrates (eg, lactulose, sorbitol) that remain in the bowel, increasing intraluminal osmotic pressure and drawing water into the intestine. The increased volume stimulates peristalsis, which moves the water-softened stool easily through the bowel. These agents usually work within 3 h.

Constipation in pregnancy
Half of all pregnant women will suffer from constipation at some time during their pregnancy, new research shows. Women who take iron supplements are more likely to have constipation. Women who have been treated for constipation in the past had a hihger risk of constipation during pregnancy.

Other links of interest
Diverticulitis information

Other over the counter products for constipation
MiraLax appears to be safe when use for up to 6 months in patients with chronic constipation. MiraLax is, also known as polyethylene glycol (PEG) 3350 and is currently approved for the short-term treatment of occasional constipation. Side effects of MiraLax include diarrhea, flatulence and nausea. However, it is best to take breaks from the use of MiraLax, and substitute other products useful in constipation. American Journal of Gastroenterology, July 2007.

Constipation in children
Parents and doctors may overlook constipation as the cause of stomach pain in children, but constipation may account for most of the abdominal pain among kids.

Constipation questions
Q. When is the best time to drink prune juice to relieve constipation?
   A. Anytime of the day is fine. A good option is to drink one to three ounces of prune juice an hour or two before bed, and when you wake up in the morning you will have a natural urge to eliminate, particularly if you drink a glass of cool or cold water as soon as you wake up.

This constipation page was last updated March 2008.

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