Constipation
PharmDToYou is dedicated to patient care. This week, we will inform our patients about how to treat some ailments/illnesses without medications (non-pharmacological) and if needed, with medications (pharmacologic).
Today we will discuss constipation. Constipation can be caused by many things. There are also times when we would not treat this over the counter. In this post, we will break down who should not treat cough themselves (exclusions), what non-pharmacological treatment can be tried (ideas other than medications), and pharmacological choices that are available over-the-counter (medications you can buy without a prescription).
Causes
- Medications (example):
- NSAIDS (ibuprofen)
- Antacids (calcium carbonate)
- Antihistamines (diphenhydramine [Benadryl])
- Iron (ferrous sulfate)
- Opioids (Norco, Percocet)
- Anticholinergics (benztropine)
- Statins (atorvastatin)
- Benzodiazepines (alprazolam)
- *These are a few examples, this is not all-inclusive*
- Lifestyle – more common if:
- Eat little or no fiber
- Do not drink enough fluid
- Live sedentary lifestyle
- Ignore the urge to use the restroom
Exclusions – DO NOT TREAT YOURSELF AND CONTACT YOUR PROVIDER IF:
- You have severe abdominal pain
- You are experiencing nausea/vomiting
- This issue has lasted more than 2 weeks
- You have been using over the counter medications with no relief for more than 7 days
- You have rectal bleeding or no bowel movements after trying to use laxatives
NON-PHARMACOLOGIC
- TRY THESE FIRST
- Drink lots of water
- Eat more fiber (around 30 grams/day)
- Get lots of exercise to help your gut move along
- If you feel like you need to use the restroom, do not wait, go!
PHARMACOLOGIC – drug types (generic [Brand])
- Bulk-forming laxatives (methylcellulose [Citrucel], psyllium [Metamucol])
- Acts like fiber and helps your gut move
- Can take 12-24 hours to work
- Good in elderly, postpartum women and those with IBS/colostomies
- Emollient laxatives (docusate sodium [Colace])
- Soften feces
- Can take 24-72 hours to work
- Good for postpartum and pregnant women, after surgery and for those with colostomies
- Lubricants (mineral oil)
- Coats feces
- Can take 6-8 hours to work if taken orally and 5-15 minutes if taken rectally
- Good for postpartum and pregnant women, after surgery and for those with colostomies
- Saline (magnesium citrate, magnesium hydroxide [Milk of Magnesia], dibasic sodium phosphate [Fleet enema]
- Stimulates intestine to MOVE
- Can take 30 minutes – 3 hours to work if taken orally, 2-5 minutes if taken rectally
- Avoid use if you have a sodium-restricted diet, are dehydrated or are on anticoagulants (like warfarin) or digoxin
- Hyperosmotics (glycerin [Fleet Pedia-Lax], polyethylene glycol [Miralax])
- *polyethylene glycol is the go-to for short term constipation!*
- Can take 30 minutes for suppositories to work and 2-4 days for polyethylene glycol to work (DO NOT USE IN LESS THAN 18 YEARS OLD WITHOUT TALKING TO YOUR PROVIDER)
- Stimulants (senna [Senakot], bisacodyl [Dulcolax], castor oil)
- Makes your intestines PUSH
- Can take 6-12 hours for oral senna and bisacodyl to work, 15-60 minutes for rectal bisacodyl and 2-6 hours for castor oil to work
- Avoid using more than a week unless directed by a provider
- Can lower electrolytes
TIPS
- Constipation can be a side effect of other underlying issues. If you try to treat this yourself and have no relief, contact your provider. There could be more to this.
- Some laxatives are combination drugs. For instance, there is a senna-docusate combination that helps make your feces soft and helps your intestesting to push (“mush and push”). This is helpful for preventing constipation especially when taking short term pain medications.
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