Constipation is the difficulty in bowel movement, scarce and hard stool, most commonly three times a week. Constipation is usually connected with cramps, defecation pain and the incomplete vacation of the colon sensation.

What can cause constipation?

• Inadequate diet (fiber poor food, insufficient liquids intake)
• Insufficient physical activity
• Long lying and inaction (due to disease for example)
• Psychological factors (stress)
• Change of surroundings (moves, travels)
• Delaying defecation (bowel vacation) after natural instinct
• Taking of iron or calcium supplements
• Side effect of certain medicines (some diuretics, antidepressants and antacids)
• Long-term laxatives use
• Some diseases (hemorrhoids, colon cancer, thyroid conditions – hyperthyroidism)
• Pregnancy

When should you visit your doctor?

• When you notice the presence of blood in the stool
• When mild to moderate pain interchanges with sudden sharp pain for longer than 48 hours
• When you start losing weight uncontrollably
• When, in addition to constipation, you feel nausea and vomit
• When constipation and diarrhea occur one after the other
• When constipation lasts long and is recurrent

What can you do to prevent or treat constipation?

Enrich your diet with fibers (wholegrain what, fruit, vegetables). It is particularly useful to ingest a couple of ripe, sweet fruits in the morning (fig, plum, kiwi) after which a couple of glasses of warm water is recommended
Take plenty of liquid during the day (2 to 3 liters)
Increase physical activity (1/2 hour to 1 hour of walks during the day stimulates bowel function)
Go to the toilet as soon as you feel the need to defecate and ensure plenty of time for relaxation
Use laxatives only if the listed methods prove ineffective

Laxatives

Laxatives are medicines in the form of pills, syrup, suppositories or granulate which stimulate defecation by altering the stool consistence. They are usually used uncontrolled and without doctor or pharmacist counseling. The use of laxatives can help only timely and short-term. Long-term and regular use of laxatives causes “lazy” intestines, prevents the formation of normal stool rhythm. All laxatives are effective and differ on intensity and speed of effect to the intensity of side effects. The choice of laxatives depends primarily on the indication (the intended use): preparation for a surgical or diagnostic interventions, acute constipation treatment, chronic constipation, digestion stabilization…

Types of laxatives:

1. Hydrophilic agents which cause swelling (increase the volume of the intestines): bran, psyllium, linseed, calcium polycarbophil, methyl and carboxymethyl cellulose.

They swell in the intestine and cause slime which softens the stool and increase its total volume. They are recommended in chronic constipation. The laxative effect is visible within 24 hours, while the total effect is expected 2-3 days after use. The treatment starts with smaller doses which are gradually increased until the desired effect is achieved. It is important to take plenty of liquids when using these laxatives. Possible side effects of these laxatives are flatulence, stomach pains and gasses.

2. Osmotic laxatives

1. Saline laxatives

• Magnesium sulfide (“Epsom salt”), magnesium citrate and hydroxide
• Sodium phosphate and sulfide
• Potassium, sodium tartrate

Osmotic laxatives reduce the absorption of liquid in the intestine and increase the content of water in the stool. Saline laxatives may disrupt the electrolyte balance and cause dehydration in kidney patients. Their laxative effect is seen very quickly (in ½ to 3 hours) and is mainly used on doctor recommendation and in diagnostic examination.

Sugars and alcohols

• lactulose

Lactulose manifests its laxative effect after 24 hours so use before breakfast is recommended. As is the case in all osmotic laxatives, for its proper effect and dehydration prevention, plenty of liquids should be taken. It is suitable for children and pregnant women while caution is recommended for diabetics use because of its sugar content. Lactulose also has a probiotics effect, meaning, it is used as a substratum (food) for the good bacteria whose presence is of vital importance for proper intestine function.

• sorbitol  and manitol

Glicerol

It irritates the colon with it local effect, the end part of the intestine, and so softens the stool and stimulates vacation. It effect is manifested after 15 to 30 minutes so it is used in acute constipation. It comes in the form of suppositories for children and adults and its use mustn’t be longer than one week.

3. Lubricants or slippery laxatives

• minelar oils

These laxatives stimulate bowel vacation by softening the stool and by forming a slimy-sticky wrapper around it. They are not suitable for long-term use; they prevent the absorption of water dissolvable vitamins and are therefore used segregated from food.

4. Contact laxatives

1. Anthraquinones (Seine, aloe, kaskar, buckthorn)

2. Castor oil

3. Biphenyl (bisacodyl, sodium picosulphate)

Contact laxatives increase contractions frequency and intestine motility. The effect is manifested after 6 – 12 hours in pills or tea, and after 15 minutes to one hour in suppositories. They are used for preparation (bowel vacation) before diagnostic examinations or surgical interventions and for the treatment of narcotics caused constipation. Excessive use of these laxatives may lead to “Lazy bowels syndrome” and can cause serious health problems. Bisacodyl pills musn’t be crushed or taken with antacids or milk. In self-medication, they mustn’t be used longer than a week without medical supervision. Their use for weight loss is in no case justified because they do not prevent calorie absorption and may cause physical addictiveness and metabolic problems. They are also unsuitable for children, pregnant or breastfeeding women and intestine inflammation.

5. Other

• probiotics, prebiotics

They do not belong to the group of laxatives, but help regulate digestion and are a valuable addition to any laxative. Probiotics are living microorganisms (so called “good” bacteria) have a healthy effect on the host if used in appropriate doses. Probiotics help establish a balance between the so called “good and bad” bacteria in our intestine and normalize the stool.

Prebiotics (inulin for example) are indigestible food ingredients (mostly oligosaccharides) which have a positive effect on the host by stimulating the growth and activity of probiotics, mainly Bifidobacteria, and enter a synergy with them. The most famous prebiotics is inulin.

Remember: Most people are mildly constipated and no laxative use is necessary. However, is certain cases, their use may be recommended if no diet-hygiene measure have proven effective. Be sure to consult your pharmacist on their use.

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