Preventing constipation

By Colleen Brady

Ask a pharmacist
Lately I’ve been constipated. Should I take a laxative? My health is pretty good otherwise.

Constipation is a common problem; up to 20 percent of healthy people have experienced it at some point. A decrease in the number of your bowel movements (a normal number of bowel movements is anywhere from three per day to three per week, depending on the person), accompanied by gas, bloating, abdominal discomfort and a loss of appetite are classic signs.

Taking a look at your health and lifestyle can help you figure out the cause of constipation. Lack of exercise, poor eating habits, dehydration, stress and changes in your daily routine (for example, travelling) can all cause constipation. Age, pregnancy and ignoring or postponing the urge to go (because of time pressures or hemorrhoid pain, for instance) can also be factors. Your medication may be the culprit: non-prescription iron supplements and upset stomach remedies containing aluminum (such as Gaviscon and Amphojel) can be constipating. So can prescription drugs used to treat depression or manic depression disorders (for example, amitriptyline or lithium), diuretics (for example, hydrochloro-thiazide and furosemide), heart medications (such as Verapamil) and narcotic painkillers (for example, codeine and morphine). Ask your pharmacist for more information.

If you have any rectal pain or bleeding, blood in the stools or a fever or if you haven’t had a bowel movement in more than two weeks, contact your doctor right away.

If you are otherwise a healthy person and constipation is an occasional problem, your treatment begins with non-drug measures. Slowly increase your fibre intake to 10 to 20 grams a day (increasing fibre too quickly leads to cramping and gas). Try a bowl of bran cereal and get at least five servings of fruit and veggies a day. Drink 1.5 litres (equal to six glasses) of water each day to help keep things moving, especially when you’re increasing the fibre in your diet. A glass of prune juice or apple juice may also be helpful. Regular exercise, such as a brisk 20-minute walk a few times a week, not only gives you a healthy appetite but also promotes bowel movements. If you don’t have any relief after several days, medication is the next step.

Bulk-forming laxatives such as psyllium (like Metamucil)
How they work: They absorb fluids and create an increase in stool bulk.
Relief: A few days
Cons: Psyllium may prevent medication from being absorbed into your body, so you need to wait at least two hours after you have taken your psyllium before taking any drugs.

Stimulant laxatives such as bis-acodyl (for example, Dulcolax) and sennosides (for example, Senokot)
How they work: They stimulate the muscles of the bowels.
Relief: Six to 12 hours
Cons: Don’t use them more than seven days in a row. Over time, they cause your bowel to work poorly.

Rectal products such as glycerin suppositories and enemas
How they work: Glycerin draws water into the bowel. Enemas contain different ingredients and each works differently. The most common ingredient is phosphate, which draws water into the bowel. Enemas can also contain bisacodyl (which has a stimulating effect on the bowel).
Relief: Up to one hour for the glycerin suppository; in approximately 15 minutes for the enema.
Cons: Don’t use enemas more than seven days in a row (see stimulant laxatives, above).

Stool softeners such as docusate sodium (for example, Colace) and docusate calcium
How they work: They soften the stool.
Relief: 24 to 72 hours
Cons: Can take up to three days to be effective.

Saline laxatives such as magnesium citrate (for example, Citro-Mag) and magnesium hydroxide (for example, milk of magnesia) and osmotic laxatives such as lactulose (Laxilose)
How they work: They draw or keep water in the bowel.
Relief: Saline laxatives work within 30 minutes to three hours; osmotic laxatives work within one to three days.
Cons: Saline laxatives can lead to dehydration if used too frequently. Osmotic laxatives can cause gas and cramps and should be used with caution if you are diabetic.

Lubricants such as mineral oil
How they work: Swallow a couple of teaspoonfuls (10 mL) a few hours before bedtime. They coat the stool, allowing it to pass through the bowel more easily.
Relief: Six to eight hours
Cons: Prolonged use can lead to a deficiency in your fat-soluble vitamins (A, D, E and K). Can cause rectal itchiness and soiling of your clothes. Before using any of the medications listed above, check with a pharmacist or health-care professional. Colleen Brady is a practising pharmacist in Vancouver and lecturer in the faculty of pharmaceutical sciences at the University of British Columbia.< Colleen Brady is a practising pharmacist in Vancouver and lecturer in the faculty of pharmaceutical sciences at the University of British Columbia.