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Treatments and drugs
By Mayo Clinic staffIn most cases, simple changes in your diet and lifestyle can help relieve symptoms and manage constipation. Less often, you may need medical treatment. Above all, recognize that a successful treatment program can take time and effort.
Diet and lifestyle changes
The following simple changes can go a long way toward reducing constipation:
- A high-fiber diet. A diet with at least 20 to 35 grams of fiber each day helps your body form soft, bulky stool. High-fiber foods include beans, whole grains, and fresh fruits and vegetables. Limit foods that have little to no fiber, such as cheese, meat and processed foods.
- Regular exercise. Physical activity can help stimulate intestinal activity.
- Adequate fluid intake. Drinking plenty of water and other fluids will help soften your stool.
- Take the time for bowel movements. Set aside sufficient time to allow undisturbed visits to the toilet. And don't ignore the urge to have a bowel movement.
Laxatives
These over-the-counter medications should be considered only when diet and lifestyle changes aren't effective. Some can become habit-forming.
There are several different types of laxatives:
- Fiber supplements, or bulk laxatives, are generally considered the safest of laxatives. Examples include FiberCon, Metamucil, Konsyl, Serutan and Citrucel. These agents must be taken with plenty of water.
- Stimulants cause rhythmic contractions in the intestines. Examples include Correctol, Dulcolax and Senokot.
- Lubricants enable stool to move through your colon more easily. Examples include mineral oil and Fleet.
- Stool softeners moisten the stool and help prevent dehydration. Examples include Colace and Surfak.
- Osmotics help fluids to move through the colon. Examples include Cephulac, Sorbitol and Miralax.
- Saline laxatives act like a sponge to draw water into the colon for easier passage of stool. Examples include milk of magnesia and Haley's M-O.
Other medications
If lifestyle changes and over-the-counter medications don't improve your symptoms, your doctor may recommend prescription medications, such as:
- Chloride channel activators. The agent lubiprostone (Amitiza) is available by prescription and increases fluid content of stool.
- 5-HT-4 agonists. These agents stimulate release of compounds in your body that increase fluid secretion in the intestines and decrease colonic transit time. Prucalopride is one such 5-HT-4 agonist. These drugs are not available in the U.S., and there have been some concerns about the safety of their use.
Procedures
If your constipation doesn't respond to changes in lifestyle or medical treatment, your doctor may recommend in-office or, rarely, surgical procedures.
- Manual procedures. To help clear your colon of retained, impacted stool if laxatives are not effective, your doctor may first gently insert a gloved finger and manually break up the impacted stool (disimpaction). Next, you'll be given a laxative enema to soften the stool and provide lubrication for a bowel movement.
- Surgical procedures. If you have chronic, severe constipation and other treatments haven't helped, surgical removal of part of your colon may be recommended. In this procedure, the problem segment or segments of the anal sphincter or rectum are removed.
Treating underlying causes
If an underlying disorder is causing your constipation, treatment will be aimed at the specific cause. If pelvic floor dysfunction is the cause of your constipation, your doctor may suggest biofeedback as a treatment. This retraining technique may help you learn to better coordinate the muscles you use to have a bowel movement.
If you're pregnant and have constipation, try eating lots of high-fiber foods, such as fruits, vegetables and whole grains. Drink plenty of fluids and get as much exercise as you can. Discuss with your doctor any plan, including exercise, to treat your constipation. Swimming and walking may be good choices.
- Constipation. National Digestive Diseases Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/. Accessed Dec. 16, 2010.
- Lembo AJ, et al. Constipation. In: Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4160-6189-2..X0001-7--TOP&isbn=978-1-4160-6189-2&about=true&uniqId=229935664-2192. Accessed Dec. 16, 2010.
- Wald A. Etiology and evaluation of chronic constipation in adults. http://www.uptodate.com/home/index.html. Accessed Dec. 16, 2010.
- Wald A. Management of chronic constipation in adults. http://www.uptodate.com/home/index.html. Accessed Dec. 16, 2010.
- Constipation. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/sec02/ch008/ch008b.html . Accessed Dec. 16, 2010.
- Hass DJ. Complementary and alternative medicine. In: Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4160-6189-2..X0001-7--TOP&isbn=978-1-4160-6189-2&about=true&uniqId=229935664-2192. Accessed Dec. 16, 2010.
- How much physical activity do adults need? Centers for Disease Control and Prevention. http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html. Accessed Dec. 16, 2010.
- Picco MF (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 20, 2010.
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