There are a lot of medicines to choose from for relief from chronic constipation. Some are over-the-counter treatments, and others need a doctor's prescription. You'll want to know what types of medications are available and what other treatments there are if those don't work.
Of course, lifestyle changes (like getting more fiber in your diet, drinking more water, and being physically active) are usually the first things to try. Your doctor can also check to see if any medicines you take to treat other conditions might be part of the problem.
Keep in mind that with any type of laxative, if you take them regularly or in large amounts, you can get side effects, including electrolyte imbalances. Electrolytes include calcium, chloride, potassium, magnesium, and sodium. Your body needs them to do a lot of things, so make sure you let your doctor know if you find you need to use these often.
Many people start with products they can buy without a prescription. Your doctor can help you choose the right product for you. One thing to keep in mind: Your insurance plan might cover some of these over-the-counter medicines. Check with your doctor and your health insurance company to see if you need a prescription to get the best deal.
Some types of OTC products that you can take are:
Fiber supplements. They absorb water to help form bulky stool to get your bowels going. Make sure to drink lots of water with fiber so it doesn't block you up instead. For some people, it may cause bloating and pain in your belly. Common choices include:
- Calcium polycarbophil (FiberCon)
- Methylcellulose fiber (Citrucel)
- Psyllium (Metamucil, Konsyl)
- Wheat dextrin (Benefiber)
Osmotics. These help draw water into your large intestine, so your stool is softer. They can cause cramping diarrhea, and nausea. If you're an older adult or have heart or kidney failure, check with your doctor first. At the drugstore, look for:
- Magnesium citrate
- Magnesium hydroxide (Milk of Magnesia)
- Polyethylene glycol (Miralax)
Stimulants. It’s better to try these if your constipation is severe and other drugs haven't worked. They cause your intestines to squeeze so things get moving. Two of the more common ones are bisacodyl (Correctol, Ducodyl, Dulcolax) and senna (Senexon, Senokot). Some people overuse stimulant laxatives.
Stool softeners. You might get these if you need to avoid straining when you have a movement, like after surgery. They're best for short-term use. They work by pulling in water from your intestines to soften your stool. Docusate sodium (Colace) is one you can find easily.
Besides constipation treatments that come in pill form, your doctor may also suggest suppositories or enemas:
Suppositories. These go directly into your rectum. They typically work by making your intestines squeeze so you have a movement. Some also soften your stool. Glycerin and bisacodyl (Dulcolax) are typical choices.
Enemas. With these, you push fluid directly into your rectum. Sometimes you use plain tap water, but there are also bisacodyl enemas and mineral oil enemas. The fluid softens your stool and makes for an easier movement.
Lubricant laxatives. Slippery substances like mineral oil make it easier to move stool through your colon.
If OTC products don't help enough, there are a variety of Rx medicines that work in different ways. Work with your doctor to figure out which type is the best one to try for your situation.
Lactulose (Cephulac, Kristalose). This drug is an osmotic that draws water into the bowel to soften and loosen the stool. Side effects include gas, diarrhea, upset stomach, and stomach cramps.
Linaclotide (Linzess). This is a capsule you take once a day. It's used to treat chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C). Linaclotide may ease your constipation by drawing water into your intestines, so stools pass more easily, and helps bowel movements happen more often. The most common side effect is diarrhea. Doctors may suggest it if other treatments don't work.
Lubiprostone (Amitiza). Your doctor may suggest this drug if you have chronic constipation or constipation brought on by opioids. It's also used to treat IBS-C (which means that constipation is the main symptom) in women. The drug softens the stool by putting more water into it, so the stool can pass easily. You take this medicine twice a day with food. Some possible side effects are headache, nausea, diarrhea, abdominal pain, and vomiting.
Plecanatide (Trulance). It's a tablet you take once a day. It helps your body make fluids in your intestines, which helps your stool move through the bowel. Your doctor may suggest it if your other treatments aren't working. The drug is made specifically for people who have chronic idiopathic constipation (CIC) and IBS-C. Diarrhea is one of the possible side effects.
Polyethylene glycol (PEG) (Golytely, Nulytely): This powder gets mixed with water. When you drink it, it puts a lot of water into your colon to help you go. Common side effects can include nausea, bloating, cramping, and vomiting. Tell your doctor right away if your vomit is bloody or looks like coffee grounds, or if your heart starts beating fast, if you have shortness of breath, or if your stomach pains become severe.
Prucalopride (Motegrity): You take this tablet once a day. It helps your colon make movements to get your stool going through your bowel. This drug is also specifically for chronic idiopathic constipation (CIC), which means that it's long-term constipation with no known cause. Common side effects are headache, belly pain, nausea, diarrhea, vomiting, dizziness, and fatigue. It could also change your mood or behavior, sometimes by a lot. If this happens, reach out to your doctor right away.
Other Treatment Types
In addition to the OTC and prescription medicines (along with lifestyle changes), you may also want to know about these methods.
Biofeedback: This helps you train the muscles that control bowel movements. You work with a therapist, using a machine that teaches you how to relax your pelvic floor muscles to allow for a bowel movement.
Surgery: It's rare for people to need this to treat constipation. Your doctor may consider whether surgery to remove part of the colon may be an option if you've tried other treatments and your chronic constipation is caused by a blockage, rectocele (in which part of the rectum wall bulges into the vagina), or an anal tear (fissure) or narrowing (stricture). Surgery to remove all of the colon is rarely needed.