treatment for constipation

"by Diane K. Newman, RNC, MSN, CRNP, FAAN

There are several different ways to treat constipation.

The better-educated person can make the correct decision on use of laxatives, purgatives and fiber. For most persons, dietary and lifestyle improvements can lessen the chances of constipation.

Fluids: Drinking plenty of fluids, preferably water, helps stimulate intestinal activity. Drinking a glass of prune juice daily or eating prunes may help with bowel regulation. Prune juice has almost no fiber, but does have a laxative effect, probably on account of its content of magnesium salts. Prunes are relatively high in fiber (2 Grams).

Fiber-rich Foods: Foods rich in fiber help a person avoid constipation. Foods that have a high fiber content help to form stool, which has more bulk and passes more easily. High fiber foods include:

Whole grain breads and cereals (All Bran, for example); whole grain bread contains 8 to 10% dietary fiber but some fiber-rich breakfast cereals contain 25 percent.
Raw vegetables especially green leafy ones and fresh fruits with skins (apples, for example.) Vegetables contain cellulose, hemicellulose, and lignin. Lignin is not digested in the human intestine and, therefore, adds to stool weight.
Fresh fruit and vegetables, especially with the skin, are rich sources of fiber.

Adding Bran: One solution to constipation, if you can tolerate wheat products, is to use whole, unprocessed, coarse wheat bran, often called Miller's bran. This is not the same type of bran that is in the widely advertised commercial bran cereals. Whole, unprocessed, coarse wheat bran can be purchased very inexpensively at health food stores and local grocery stores. The goal in using the bran is to produce one soft, well-formed bowel movement daily.

You should begin using the bran in small amounts, such as one tablespoon, and gradually, over time, increase the amount you use. Use of bran can have side effects -- flatulence (gas), abdominal bloating, and cramps. By starting out small and increasing the amount, you can usually avoid any side effects. In any case, if they do occur, they'll disappear in a few weeks.

Sprinkle bran on your breakfast cereal and develop a routine of adding tablespoons of bran to yogurt, Jell-O, cottage cheese, ice cream, or puddings. When cooking, put bran in sauces, muffins, gravies, and soups or make up a batch of the "Special Bran Recipe" and take some each day. Whole, unprocessed, coarse bran is natural to the body and a person cannot take too much of it. In addition to using bran, drink at least six to eight glasses of caffeine-free liquids per day. Fluids aid bowel movements and also help stave off dehydration.

For persons who are bed-bound or who are not able to walk and are sedentary, the "Special Bran Recipe" can be successful. Your family can mix the recipe for you. In nursing homes, I ask the dietary department to make the recipe and give it to the nursing staff to administer to appropriate residents. It can be given similar to the way laxatives are now given.

Exercise: Movement helps bowels stay regular. You need to get out for a walk or do some stretching.

Routine Bowel Schedule: In addition to taking fiber to regulate your bowels, it is helpful to begin a routine bowel schedule. The optimal time is in the morning and after a meal. Sufficient time should be set aside to allow for undisturbed visits to the bathroom. In addition, the urge to have a bowel movement should not be ignored. This is especially important for residents in a nursing home who need assistance to toilet. If a regular toileting time is not set aside for the resident to empty their bowels, they will have bowel "accidents." Try to avoid using a bedpan, if at all possible, with a bedridden person who may be living at home or in a nursing home. Trying to have a bowel movement on a bedpan is not natural. This position causes undue strain if the person is not properly positioned. It forces the extension of legs, pushes the stomach (abdomen) out and does not allow muscles to aid in defecation. Gravity, sitting upright assists in the passage of stool.

What can you do about "gas"? Some foods contain starches that escape digestion in the small bowel and may cause gas in the colon. Here is a list of foods commonly thought to cause gas. Try cutting these foods out of your diet and see if you have less gas!

Apricots
Bananas
Beans
Brussels Sprouts
Cabbage
Carrots
Celery
Dried Beans, Lentils
Milk and Milk Products
Onions
Peas
Pretzels
Prunes
Raisins
Wheat Germ

If for some reason you need to use laxatives, suppositories, or enemas you should become knowledgeable about what you are using . The following table will help educate you about the various products available.

Good Advice!! Remember, laxatives and enemas should be your last resort!

Type of Bowel Product Action Examples

Stool Softeners

Provide moisture to the stool and prevent excessive loss of water. Often recommended after surgery and childbirth. Effective within 24 to 48 hours to produce firm, semisolid stool.

Dioctyl Sodium Succinate (Colace, Pericolace)

Lubricants

Grease the stool allowing it to slip through the intestine more easily. Effects are usually noted within 6 to 8 hours.

Mineral Oil

Bulk-forming Agents

Safest laxatives but can interfere with absorption of some drugs. Should be taken with 8 ounces of water as they absorb water in the intestine to make stool softer. Take 12 hours to 3 days to be effective.

Bran, Psyllium (FiberCon), methylcellulose (Metamucil, Citrucel)

Osmotic cathartics

Cause water to remain in the intestine for easier movement of stool. Produces watery stool in 3 to 6 hours.

Milk of Magnesia, Magnesium sulfate or citrate, lactulose

Stimulants or irritants

Cause rhythmic muscular contractions in the intestines. These can cause dependency and can damage bowel with continual use. Effects are usually noted within 6 to 10 hours.

Cascara, Castor Oil, Senna (Senokot, Fletcher’s Castoria), Bisacodyl (Dulcolax), phenolphthalein (Correctol, Ex-Lax)

Enemas

Instilling fluid into the rectum for removal of stool.

Tap water, saline, Sodium phosphate (Fleets), Milk & Molasses

Suppositories

Suppositories trigger the defecation reflex and assists the rectum to empty any stool contents. Works within 15 minutes.

Oil, Glycerin, Bisacodyl (Dulcolax)

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References

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Last updated February 2003