Constipation

Constipation

Constipation refers to decreased bowel movement frequency or difficulty passing stools, characterized by hardened stools and discomfort. Normal bowel habits can vary widely, ranging from 2–3 times per day to as infrequently as 3 times per week. Causes include dehydration, dietary factors, sedentary lifestyle, ignoring the urge to defecate, or side effects from certain medications. Severe constipation may lead to bowel obstruction.

Patient Advice

• Gradually increase fiber intake, starting with small amounts (5 g/day) and slowly progressing to 20–35 g/day.
• Avoid foods and beverages contributing to constipation (tea, coffee, unripe bananas, cheese).
• Drink 6–8 glasses of water daily.
• Exercise regularly, at least 3–4 times per week, for 10–15 minutes each session.
• Establish regular bowel habits, avoiding prolonged sitting on the toilet (such as reading or using phones).
• Avoid holding back the urge to defecate.

When to See a Doctor

Seek medical attention if:

• No improvement or worsening of symptoms after 1 week despite behavioral changes and appropriate medication.
• Unexplained weight loss.
• Blood in stool.
• Increased fatigue.
• Persistent bloating or chronic constipation.
• Sudden or frequent changes in bowel habits.

Treatment Options

1. Laxatives & Purgatives

Bulk-Forming Laxatives

Examples: Psyllium husk (ispaghula), methylcellulose, polycarbophil,sterculia

• Increase stool bulk by absorbing water, stimulating bowel movement.
• Onset: 12–24 hours. Must be taken with adequate fluids to prevent obstruction.
• Side effects: bloating, flatulence.
• Contraindications: bowel obstruction, fecal impaction.

Osmotic Laxatives

Examples: Lactulose, macrogol (polyethylene glycol), magnesium preparations, sodium sulfate, sorbitol

• Draw water into the intestines to soften stools. Regular use required for effectiveness.
• Macrogol: Commonly used for bowel preparation before surgery or colonoscopy.
• Lactulose: Suitable for chronic constipation but may cause abdominal cramps or electrolyte imbalance.
• Glycerin (suppository): Occasional constipation relief.

Stimulant Laxatives

Examples: Bisacodyl, senna, sodium picosulfate, cascara

• Stimulate intestinal muscle contractions for rapid relief.
• Use only if other treatments fail; limit use to no more than 1 week due to risk of cramps, diarrhea, and dependence.
• Castor oil: Highly unsafe, strictly contraindicated in pregnancy.

Lubricant Laxatives

Example: Mineral oil

• Softens stool; suitable for elderly, bedridden patients,fecal impaction, or hemorrhoids.

Emollient Laxatives (Stool Softeners)

Example: Docusate

• Allows water and fats to penetrate stool, softening it for easier passage.

Chloride Channel Activators

Example: Lubiprostone

• Increases fluid secretion into the intestine, facilitating stool passage.
• Indicated for chronic idiopathic constipation.

Selective 5-HT₄ Receptor Agonists

Example: Prucalopride

• Stimulates peristalsis in chronic constipation unresponsive to other laxatives.

Note: Chronic laxative use may reduce nutrient absorption and induce "lazy bowel syndrome" characterized by dependency on laxatives for bowel movements.

2. Other Treatments

Biofeedback Therapy

• Retrains natural bowel movements by teaching correct abdominal and sphincter muscle coordination, beneficial for chronic constipation resistant to standard treatments.