Advertising promotes the idea that clockwork bowel movements in some way enhance well-being. Consumers therefore are concerned about what they perceive as constipation. Pharmacists can ask you questions that may help in determining what steps you need to take to ensure good bowel control. Often, only reassurance is needed that daily bowel movements are not necessary to health.
Diet may be the way to treat constipation in which there is no physical abnormality. A high-fiber diet (whole grain, vegetables, fruits), plentiful fluid consumption (four to six 8-ounce glasses of water unless the patient has fluid restrictions), and physical exercise is important in treating constipation.
Should laxative therapy be considered necessary after trying non-drug measures, a bulk-forming laxative containing psyllium, guar gum or carboxymethylcellulose (CMC) should be recommended. However, bulk-forming laxatives generally are inadvisable in fluid-restricted patients because of the danger of intestinal obstruction. If they are taken, a full 8-ounce glass of water should be ingested with each dose.
Stool softeners such as docusate (eg. DSS, Colace) are appropriate short-term therapy for hard stools in acute perianal disease (hemorrhoids, proctitis, etc.), or where avoidance of straining is desirable (following rectal surgery or myocardial infarction). Stool softeners are not as effective in treating long-standing constipation, especially in the elderly.
Mineral oil is a lubricant laxative that is not used much anymore for treating constipation because it is associated with the possible effects of lipoid pneumonia, malabsorption of fat-soluble vitamins and rectal leakage.
Saline laxatives such as magnesium sulfate are indicated only for acute evacuation of the bowel for testing procedures. Glycerin is used most often in the treatment of pediatric constipation. Always consult a pharmacist or physician before using laxatives for small children.
Stimulant laxatives are controversial and abuse is common. Hyperosmotic agents (glycerin) often cause substantial cramping, electrolyte disturbances and dehydration, and they should never be used for more than one week of regular treatment. If stimulant laxatives are used short-term, bisacodyl (Dulcolax) is the agent of choice.
Remember that the oral dosage form is enteric-coated and thus should not be chewed, crushed or taken with antacids. If phenolphthalein is used, the patient should be cautioned about the possibility of skin rash (if this occurs, stop using and contact your pharmacist or physician) and urine discoloration (harmless).
Castor oil should not be used to treat constipation. If you are unsure as to what non-prescription product to purchase, discuss the alternatives with your pharmacist or physician before making your choice.