Treatment of Constipation

Constipation is a very common problem. It is usually caused by a diet low in fiber and fluid. Some people are particularly susceptible to constipation even when they try to eat the right foods. In most cases, constipation is not a sign of any underlying disease, but if your bowel patterns change dramatically, you should bring it to my attention. I would be especially concerned if the stools become very thin, or if you notice blood in your stools.

Whenever you increase the amount of fiber in your diet, you will notice an increase in gas. This is normal, and is simply released by the bacteria in your colon breaking down some of the fiber. It will go away after a few weeks or months on your new diet. If you are unable to tolerate the increased fiber due to gas pains, you can try Citrucel or FiberCon. These medicines are made of a type of fiber that the bacteria can't break down, so gas is not usually a problem. Metamucil is another type of fiber you can buy, but it may produce extra gas in some people.

Bulk and fiber remain the foundation in treating constipation. If the stool remains hard in spite of eating high fiber foods, drinking enough water (I recommend 6 eight-ounce glasses of water each day initially), and using a bulking agent like Metamucil, Citrucel or FiberCon, then you might try a simple stool softener, like Colace (ducosate sodium) in a dose of 100 mg twice each day.

The next step, if constipation persists, would be to add a bowel stimulant. Senokot is a mild bowel stimulant. It is made from senna, a natural laxative. It is usually taken in a dose of 2-8 tablets each day (usually at bedtime). Another stimulant is Dulcolax (the generic name is bisacodyl), taken as a pill (5 mg; 1-3 pills at bedtime) or a suppository (10 mg in the morning).

Another approach would be to draw more fluid into the colon. Milk of Magnesia is very good at doing this. As more fluid is drawn into the colon, the stool becomes softer, allowing it to be passed more easily. Lactulose is a prescription medicine that does the same thing; it is usually taken in a dose of 1 Tbsp 1-3 times each day. Lactulose sometimes produces extra gas, which can cause some cramping and pain.

If all this fails, you can use magnesium citrate; this works just like Milk of Magnesia, except it is a little more potent when taken in the usual dose (1/2 to 1 bottle, drank over a few minutes to an hour). It usually produces significant diarrhea. As a last resort, you can use a Fleet enema; if you prefer, you can give yourself a tap water enema, but that is a little more difficult.

It is recommended that you try to get about 30 grams of fiber in your diet every day. Below, I have given you the fiber content of some common foods: