Constipation

Constipation

Constipation is a chronic condition affecting over 50 million Americans, and is prevalent in 10-20% of the general population and above the age of 65 can affect upto 20-30% of individuals. Constipation however is difficult to define as each person has their own interpretation of what is a normal bowel movement BM. For all practical purposes decreased frequency of bowel movements, less than 3 per week, or difficulty with bowel movements (straining, hard stools), inadequate bowel movements help define this common disorder.

Once ascertained that one has constipation it is important to exclude conditions or medications that may be contributing to this. Medications that may need changing include opioid pain medications, certain antidepressants, certain antihypertensives such as calcium channel blockers, iron supplements, and anticholinergic agents such as cogentin, artane, etc.

Secondary causes include:

Neurologic conditions including central nervous system and peripheral nervous system etiologies. Central etiologies include parkinsons disease, multiple sclerosis, spinal cord injuries. Peripheral nervous system disorders include autonomic neuropathy such as diabetic neuropathy. In addition hypothyroidism, anorexia, hypokalemia can contribute to constipation.

Once a diagnosis is made, treatment options are considered. Patient education, dietary changes and medications are the main stay of treatment.

Patient education on healthy bowel habits including biofeedback, bowel training and the below suggestions:

-trying to adopt a daily morning regimen (to take advantage of the morning increased colonic activity or after meal movement),

-avoidance of straining,

-and understanding that absence of daily motions are not considered abnormal.

Dietary changes for constipated adults include:

-taking prunes or prune juice daily. ( a glass daily should suffice)

-increasing the daily fiber intake (20-35g)or roughage with healthy serving of fruits and vegetables.

-magnesium supplements

-appropriate fluid intake

Medications for constipation should not be overused and can lead to laxative overuse.

-Stool softeners sodium docusate or colace 100mg three times a day helps to some extent.

-Bulk laxatives available include Citrucel ( Methylcellulose), Metamucil ( psyllium), Benefiber ( wheat dextrin), Fibercon (polycarbophil) should be used intermittently.

Many other medications are helpful in managing constipation including

Osmotic agents can increase the fluid content in stools such as Miralax, lactulose (Enulose) and PEG or (golytely 17g powder in 8oz of water daily ) Magnesium citrate ( should be avoided in patients with kidney problems) and Sorbitol are therefore effective in constipation.

Addition of a laxative every other day may be helpful such as Bisacodyl (dulcolax) 10mg tablets or suppositories or Senna or senokot but caution on daily use is recommended as this can cause loss of potassium salts and protein in stool when used for long periods on a daily basis. Glycerin suppositories may also prove helpful.

Other newer FDA approved medications available include amitiza (lubiprostone) 24 mcg twice daily, which can cause nausea, and Linzess (linaclotide) 145mcg daily which can cause diarrhea. Rarely colchicine can be used but can have side effects of renal insufficiency and myopathy.

Rarely to avoid fecal impaction after many days of constipation soap water or sodium phosphate enemas may be an option in adults ( caution in those > 55 and with dehydration or renal dysfunction)

Finally surgery may be appropriate in certain patients who meet certain criteria.

Talk to your doctor regarding prescription medications and trials of above treatment options.