When constipation goes on for months at a time, it's considered chronic. Your doctor will need to find out what's causing it. But before she suggests medications to treat it, she may first suggest you make some changes in your daily life. She may recommend you:
Eat more fiber. Pack your plate with lots of veggies, fruits, and whole grains and don't eat too many low-fiber foods like dairy and meat.
Drink more water. Your digestive system needs water to help flush things out.
Exercise. This helps the muscles in your digestive system work better, so solids can move through more smoothly. Try to be active every day of the week, if your doctor says it's OK.
Take the time to go. Don't put it off -- go to the bathroom when you need to. Give yourself the time you need to get everything out.
It's possible these changes alone will be enough to get things moving, but you may need further treatment. And that will depend on the cause.
Pelvic Muscle Training
Constipation sometimes happens because the muscles that help you pass stool stop working well. You can exercise these muscles with the help of a physical therapist. This retrains them so they can do their job again.
This training is called biofeedback. Your physical therapist inserts a small tube called a catheter into your rectum. It measures muscle tension. As you go through the exercises, a machine can tell you when you're relaxed and when you've tightened your muscles. This can help you learn how to relax when you need to pass a stool.
If your constipation is caused by irritable bowel syndrome or chronic idiopathic constipation, your doctor may prescribe you a chloride channel activator such as lubiprostone (Amitiza). It works by turning on switches in your cells that tell more fluid to come into your gastrointestinal tract. That can help:
- Ease stomach pain
- Soften your stool
- Keep you from needing to strain when you go
- Increase the number of times you need to go to the bathroom
Guanylate cyclase-C agonists are also used for patients with chronic idiopathic constipation. These medications, which include linaclotide (Linzess) and plecanatide (Trulance), help make you more regular. They can lessen the pain in your abdomen and make bowel movements happen more often.
Depending on the cause of your constipation, your doctor may suggest one of these drugs:
Misoprostol (Cytotec) works as a stimulant to get your bowels working faster. You shouldn't take it if you're pregnant.
Colchicine/probenecid (Col-Probenecid) helps you have more bowel movements. It's not recommended for people with kidney problems.
OnabotulinumtoxinA (Botox) helps soften stool and makes it less painful to go. It's been used to treat people with pelvic floor dysfunction.
You can also try laxatives. Different types work in different ways to help you have a bowel movement.
Fiber supplements add bulk to your diet, which can help you go. They come in all kinds of forms including pills, powder, and chewable tablets. Your doctor may recommend one of these:
- Calcium polycarbophil (FiberCon)
- Methylcellulose fiber (Citrucel)
- Psyllium (Metamucil, Konsyl)
Stool softeners draw water from your intestines into your stool. This keeps your waste from getting hard, making it easier to pass. Two different kinds are docusate sodium (Colace) and docusate calcium (Surfak).
Lubricants coat your stool to help it hold in fluid so it can pass out of your body more easily. Mineral oils work as lubricants.
Osmotics keep water in your stool. This helps you go more often and keeps your stools soft when you do. You should take extra care if you have heart or kidney failure because these medications may cause dehydration or mineral imbalance. Some osmotics include:
- Magnesium hydroxide (Milk of Magnesia)
- Magnesium citrate
- Lactulose (Kristalose)
- Polyethylene glycol (Miralax)
Stimulants make your intestines contract, helping stool move through. Your doctor may only recommend this type of medication if other treatments haven't worked. Stimulants include:
- Bisacodyl (Ducodyl, Dulcolax)
- Senna-sennosides oral (Senokot)
Laxatives aren't right for everyone with constipation. You should only use them under a doctor's care, for a short amount of time. They're not meant for long term (aside from fiber supplements, which add fiber to your diet).
Taking laxatives for too long can cause other issues. You may have to reteach your body how to pass stools normally. Also, using lubricants for too long may rob your body of important vitamins.
If your constipation isn’t getting better with other treatments, surgery may be an option. But it depends on what’s causing your problem.
Surgery can help if you have a blockage, rectal prolapse (part of your rectum bulging outside your body), or anal fissure (small tears in your anus). It can repair these problems.
If your constipation is being caused by a part of your colon that isn’t working the way that it should, you may need surgery to remove that area.