Controlling Constipation

People the world over are concerned about regularity. Aloe was used as a laxative by the ancient Egyptians, and Arab healers in the ninth century used senna for the same purpose. The lasting power of laxatives can be seen by the fact that more than a thousand years later the popular laxative Ex-Lax still contains senna-derived compounds.

Different Strokes for Different Folks

When constipation is defined in terms of regularity, no single standard determines what is normal. Some people do well with two bowel movements a week, while others may visit the bathroom three times a day.

Many folks are concerned about how much effort is required or the consistency of stool. Passing “bricks” can be distressing. If bowel movements suddenly become infrequent or difficult, or if increased fluid and fiber don’t help, it is appropriate to see a doctor. Any underlying medical problem, such as Parkinson’s disease or an underactive thyroid gland, requires treatment.

When there is no apparent medical cause, physicians may dismiss constipation as a minor complaint. Patients don’t see it that way. One man suffering from heart disease, failing vision, and prostate enlargement still rated constipation as one of his most troublesome health problems.

Watch Out for Laxative Overuse

Frequent use of stimulant laxatives can sometimes make the bowels “lazy;” constipation becomes a more chronic problem as a result. Some years ago we heard from an elderly gentleman who cursed his parents for turning him into a laxative addict. From an early age he was warned that a daily bowel movement was essential for good health, so he had used laxatives his entire life. His digestive tract, damaged by harsh cathartics, could no longer work on its own.

Physicians may sometimes contribute to constipation unintentionally and without informing their patients. Quite a few medications may cause constipation as a side effect. Narcotic pain medicines and older antidepressants are especially notorious in this regard, and some anti-cancer medicines and AIDS drugs can also be constipating. If this happens to you, don’t stop taking your medicine. It may be a lifesaver. But do discuss the situation with your doctor. In some cases, there may be an alternative that is less likely to produce this complication.

Fiber and Fluid

The first rule in preventing constipation is to get plenty of fiber and fluid. Here’s how: make sure you drink six to eight 8-ounce glasses of water or juice daily. Eat five to ten servings of vegetables and fruits. One reader found that four ounces of prune juice with pulp daily solved her problem.

For extra fiber, whole bran or bran cereal is useful, and so is psyllium (Metamucil, Per Diem Fiber, Reguloid, Serutan and similar products). Fiber can cause bloating or flatulence, though, so it is best to start with a little and increase the dose gradually. Be sure to wash such products down with plenty of water.

Bulk-Producing Laxatives

Bulk-producing laxatives such as polycarbophil or methylcellulose work in a similar fashion to fiber. Brands such as Citrucel, FiberCon, FiberLax, Konsyl Fiber, or Mitrolan should be taken according to instructions. Neither bulkforming laxatives nor others should be used if a person has nausea, vomiting, fever or serious abdominal pain that might indicate appendicitis or intestinal blockage. Such conditions require urgent medical attention.

Stool Softener

If the principal problem is a hard stool, or when recovery from surgery makes it uncomfortable to strain at all, a stool softener such as docusate (Colace, Dialose and others) may be recommended. Mineral oil is sometimes taken to lubricate the stool and make it easier to pass, but this product interferes with absorption of nutrients, especially fat-soluble vitamins, and its regular use is not recommended.

Osmotic Laxatives

When confronted with especially stubborn constipation, gastroenterologists sometimes resort to osmotic laxatives. These substances attract water into the colon, softening stool and triggering movement. Perhaps the best known are Milk of Magnesia (magnesium hydroxide) and Epsom Salt (magnesium sulfate). Such products may upset the balance of fluid and minerals in the body, and should not be given to children or people with chronic disease except under medical supervision. Certain sugars that are not well absorbed, especially sorbitol and lactulose (Chronulac, Duphalac, etc.) also act as osmotic laxatives. (This is why sugar-free gum or candy containing sorbitol or mannitol can cause diarrhea for some people.)

For people who must take strong pain medicines, constipation can be agony:

“I have used over-the counter harsh laxatives from childhood and have tried just about every herbal laxative known to man. I am on numerous prescription painkillers that cause constipation, so I’m in a lose-lose situation. I’ve gone 14 days without relief, and when I do have a movement, it is too painful to describe.”

Polyethylene glycol 3350 (MiraLAX), which also acts as an osmotic laxative, may be helpful in such a difficult situation. Usually used for short-term relief, it may also be used for chronic constipation. Japanese researchers, noting that most European studies of polyethylene glycol 3350 (PEG3350) lasted six months or less, undertook a year-long study of safety and efficacy (Journal of Gastroenterology, Sep. 2019).  They found that it improved bowel function over the long term without any alarming side effects. Some people did report stomachache, nausea, diarrhea or bloating, however.

Joe & Terry's Ten Tips to Combat Constipation

• Lots of fiber & fluid
• Bran-apple-prune mix
• Flax seed
• Sugarless gum
• Psyllium
• MOM (magnesium)
• Unifiber (cellulose)
• Pumpkin bran muffins
• Vitamin C
• Ginger

Some people refer to this as "nurses' pudding," because nurses used to recommend it for people recovering from abdominal surgery, when straining is uncomfortable and undesirable. Here's the recipe:

Mix: 1 cup coarse unprocessed bran*
1 cup applesauce
3/4 cup prune juice

The mixture will be very thick. Take 1 or 2 tablespoons daily, washed down with plenty of water. Refrigerate unused portion. If there are no results within a week, increase the dose by 1 tablespoon. Do not exceed 6 tablespoons daily. Not drinking lots of water with this remedy could result in an obstruction, so take that part of the instructions very seriously!

*found in the cereal section

All-Bran
apples
bananas
barley
beans
blackberries
bran
Bran Buds
Bran Flakes
broccoli
bulgur
wheat
chickpeas
Fiber One
figskiwifruit
lentils
lima
beans
Mother's Oat Bran
Nabisco 100% Bran
pears
peas
popcorn
prunes
Raisin Bran
raisins
Shredded Wheat’n Bran
split peas
Uncle Sam cereal
winter squash

Warning:

Be aware that using high-fiber foods to fight constipation may cause difficulties. One woman failed to respond to an antidepressant (desipramine) that had worked for her previously. She was extremely depressed by the time her psychiatrist figured out that the bran muffins the woman was eating to counteract constipation she anticipated from the desipramine had blocked the medicine’s absorption. Timing her bran so it no longer interfered with the antidepressant solved the problem.

Digoxin (Lanoxin) is another medicine that is not well absorbed if it is taken at a meal that contains a lot of fiber. One man found that eating a big bowl of oatmeal with Mother’s oat bran interfered with the effectiveness of this heart medicine.