CONSTIPATION, CHRONIC: TREATMENT
If you are constipated only once in a while, you probably have nothing to worry about. If you are under 50 and you have had no lifestyle changes, as reflected in your answers to the questions above, you should simply try to increase the amount of exercise you get, the amount of fiber in your diet, and the amount of water you drink. I’ve found exercise to be the best cure for constipation. If you use laxatives, you should use them for only a few days. If you find, that your constipation worsens without laxatives and you use them regularly, you should see your doctor, who will help wean you from them.
There are a number of preparations that can help ease the discomfort of constipation. In the laxative category, there are bulk agents such as Metamucil. They help ease constipation and can also help regulate a sluggish bowel. I suggest one tablespoon of Metamucil in eight ounces of water three times a day. A high-fiber cereal such as All Bran can also do the trick. Some people prefer to mix plain bran flakes into a glass of water in the morning. If you find that powders like Metamucil are difficult to swallow, you can try a product in pill form such as FiberCon, which can be taken four times a day. Bran muffins are not a good way to increase your fiber intake, as they are actually low in fiber and high in fat.
A stool softener such as Colace will help if the stool is very hard and especially if you also have hemorrhoids. Stool softeners are not laxatives, however, so once the stool has softened, you should stop taking the medication.
Preparations such as milk of magnesia and Dulcolax work by irritating the lower rectum so that the stool can be evacuated; they come in suppository form or in a pill or liquid. A suppository will provide quick relief, while one tablespoon of milk of magnesia taken at night before sleep should ensure a bowel movement in the morning. They can, how-ever, cause permanent damage if they’re used for many years.
Glycerine suppositories provide immediate relief when the stool is stuck at the bottom of the rectum and are safe when used occasionally. In fact, glycerine suppositories are commonly used in young children since they don’t irritate the lining of the bowel.
Enemas should be used only on rare occasions, for example, for cleaning out the bowel for a test of the large intestine or following major surgery. I remember one patient who fractured his leg in a car accident. During his hospital stay, he refused the bedpan and eventually needed an enema. For most people, however, I do not believe in using enemas as a way to clean out the bowel, since with routine use, they can eventually destroy the rectal reflex that normally initiates evacuation of the bowel.
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