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What are the treatment options to cure constipation?

The first treatment for constipation is to eat a high fiber diet to provide natural bulk in daily food intake. Dietary fiber, often called roughage, is a portion of food that passes through the intestine and colon almost unchanged. Undigested fiber holds water to keep the stool soft and adds bulk which helps move stool to the rectum. Most Americans eat very little roughage and this is often a major factor in the cause of constipation. An increase in dietary fiber generally results in a softer and bulkier

stool which can be passed more easily. Ask to see a dietitian for complete instructions. The best way of adding fiber to the diet is increasing the quantity of fruits and vegetables that are eaten. This means a minimum of five servings of fruits or vegetables every day. For many people, however, the amount of fruits and vegetables that are necessary may be inconveniently large or may not provide adequate relief from constipation. In this case, fiber supplements can be useful.

Many people use laxatives to relieve constipation. Some laxatives are safe for long-term use; others should be used only occasionally. Some are good for preventing constipation; others can be used to treat it. Bulk-forming laxatives generally are considered the safest but can interfere with absorption of some medicines. These laxatives, also known as fiber supplements, are taken with water. They absorb water in the intestine and make the stool softer. Stool softeners provide moisture to the stool and prevent dehydration. These laxatives are often recommended after childbirth or surgery. Lubricants grease the stool enabling it to move through the intestine more easily. Mineral oil is the most common lubricant. Osmotic agents pull large amounts of water into the large intestine, making the stool soft and loose. The excess fluid also stretches the walls of the large intestine, stimulating contractions. Stimulant laxatives contain irritating substances, such as senna and cascara, that directly stimulate the walls of the large intestine, causing them to contract and move the stool. People who are dependent on laxatives need to slowly stop using the medications. A physician can assist in this process.

Enemas mechanically flush stool from the rectum and lower part of the large intestine. Small-volume enemas can be purchased in squeeze bottles at a pharmacy. They can also be administered with a reusable squeeze-ball device. However, small-volume enemas are often inadequate, especially in older people, whose rectal capacity increases as advancing age makes the rectum more easily stretched. Larger-volume enemas are administered with an enema bag. There are many different types of enemas. By distending the rectum, all enemas (even the simplest type, the tap water enema) stimulate the colon to contract and eliminate stool. Other types of enemas have additional mechanisms of action. Enemas are particularly useful when there is impaction, which is hardening of stool in the rectum.

Several prescribed drugs that are used to treat medical diseases consistently cause (as a side effect) loose stools, even diarrhea. There actually are several small studies that have examined these drugs for the treatment of constipation. Colchicine is a drug that has been used for decades to treat gout. Most patients who take colchicine note a loosening of their stools. Colchicine has also been demonstrated to relieve constipation effectively in patients without gout. Misoprostil (Cytotec) is a drug used primarily for preventing stomach ulcers caused by non-steroidal anti-inflammatory drugs such as ibuprofen. Diarrhea is one of its consistent side-effects. Orlistat (Xenical) is a drug that is used primarily for reducing weight. It works by blocking the enzymes within the intestine that digest fat.

Changes in your lifestyle are the best and safest way to manage constipation. People who lead sedentary lives are more frequently constipated than people who are active. Nevertheless, limited studies of exercise on bowel habit have shown that exercise has minimal or no effect on the frequency of bowel movements. Thus, exercise can be recommended for its many other health benefits, but not for its effect on constipation. It is extremely important to have regular habits to reestablish normal bowel function. Establish a regular routine based on your own schedule. Try to have a bowel movement at the same time every day. The activity of the colon increases after waking up in the morning and after eating, so the urge to have a bowel movement is usually greatest after breakfast. Get up early enough in the morning to eat breakfast, exercise, and sit on the toilet. This should become a daily routine.

For individuals with problematic constipation that is due to diseases of the colon or laxative abuse, surgery is the ultimate treatment. Surgical removal of the colon may be an option for people with severe symptoms caused by colonic inertia. These patients must be carefully selected or optimal benefit of this surgery will not be achieved. Electrical pacing may be done using electrodes implanted into the muscular wall of the colon. The electrodes exit the colon and are attached to an electrical stimulator. Alternatively, stimulation of the sacral skin can be used to stimulate nerves going to the colon. These techniques are promising, but much more work lies ahead before their role in treating constipation, if any, has been defined.

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