Laxatives And Constipation: What To Do When They Fail?

Laxatives are a common go-to for relieving constipation, but what happens if they don't work? Constipation is characterised by having fewer than three bowel movements a week, straining during bowel movements, and passing small, hard stools. While laxatives are often effective in treating constipation, they don't always work, and there could be several reasons for this. For instance, chronic constipation could be due to pelvic floor issues, which diet, lifestyle, and laxatives may not help with. In such cases, a specialist healthcare provider that administers pelvic floor therapy might be needed. Additionally, if constipation is caused by an underlying condition, laxatives may not be effective in providing relief. It is important to consult a doctor if constipation persists despite trying different types of laxatives, as it could indicate a more serious issue.

Laxatives don't always work

One possible reason for the ineffectiveness of laxatives is that they may not be the right choice for your specific situation. For example, if you have a chronic condition like Crohn's disease or ulcerative colitis, a prescription laxative specifically targeted to your condition may be necessary. Additionally, if you are taking opioids, you may require a prescription laxative to address opioid-induced constipation.

Another factor to consider is that not all laxatives are created equal. Different types of laxatives work in different ways and have varying levels of effectiveness. Bulk-forming laxatives, for instance, are known to be gentle and safe for daily use, but they can take up to several days to provide relief. On the other hand, enemas and suppositories work much faster, typically within minutes to an hour, but they come with a higher risk of side effects like diarrhoea and stomach cramps.

If you've tried different types of laxatives without success, it's essential to consult a healthcare provider. They can help rule out any serious underlying conditions, such as a bowel obstruction or colon cancer, which could be causing your constipation. Additionally, your healthcare provider can prescribe other medications that may be more effective than over-the-counter laxatives.

It's important to remember that laxatives should not be the first option for treating constipation. Lifestyle changes, such as eating high-fibre foods, taking probiotics, staying hydrated, and exercising, are typically recommended as the initial approach to addressing constipation. If these changes don't provide relief, then laxatives may be considered as a "plan B". However, even with laxatives, it's crucial to follow the instructions carefully to avoid unpleasant side effects and potential overdose.

You may have chronic constipation

If you are experiencing chronic constipation, it is important to address the issue and seek appropriate treatment. Chronic constipation refers to persistent and recurring constipation that interferes with your daily life. Here are some detailed instructions and suggestions to help you manage this condition:

Firstly, it is important to understand the underlying causes of chronic constipation. This condition can be caused by a variety of factors, including lifestyle choices, medical conditions, and certain medications. Some common causes include a low-fibre diet, inadequate water intake, lack of exercise, changes in routine, and consumption of dairy products. Certain medications, such as antidepressants, antacids, and painkillers, can also lead to chronic constipation. Understanding the specific causes contributing to your condition will help guide your treatment approach.

To alleviate chronic constipation, consider making dietary and lifestyle changes. Increase your fibre intake by incorporating more high-fibre foods into your diet, such as fruits, vegetables, whole grains, and bran cereal. Stay hydrated by drinking plenty of water throughout the day, aiming for at least eight 8-ounce glasses of water. Engage in regular physical activity, as exercise helps stimulate your digestive system. Develop a consistent daily routine, including a dedicated time for bowel movements, such as after breakfast each morning. Avoid ignoring the urge to defecate, as suppressing this urge can contribute to constipation.

In addition to dietary and lifestyle modifications, there are other strategies that can help. Try incorporating probiotics into your diet by consuming yogurt and kefir, which promote digestive health. Consider taking a fibre supplement, such as Metamucil or Citrucel, to bulk up your stool and facilitate easier passage. Over-the-counter stool softeners can also be effective in making stools softer and easier to pass. However, it is important to use these products as directed by your doctor or pharmacist.

If these self-care measures do not provide sufficient relief, it is important to consult your healthcare provider. They can recommend or prescribe stronger laxatives or other medications to treat chronic constipation. Bulk-forming laxatives, for example, draw water into the stool to soften it and are generally safe for daily use. Osmotic laxatives, such as polyethylene glycol, hold water in the stool to soften it and increase bowel movements. Stimulant laxatives trigger contractions in the bowels to facilitate stool passage, but they should be used with caution to avoid dependency.

In summary, chronic constipation can be effectively managed through a combination of dietary and lifestyle changes, over-the-counter treatments, and prescription medications. It is important to be patient and persistent in finding the right treatment approach, as different individuals may respond differently to various interventions. Remember to seek professional advice if self-care measures do not provide relief, as your healthcare provider can offer additional guidance and treatment options.

Severe constipation may require intensive methods

If you are severely constipated and laxatives are not working, you may need to seek help from a healthcare provider, as more intensive methods may be required to resolve the issue. Here are some options for intensive methods to treat severe constipation:

Prescription Laxatives:

If over-the-counter laxatives are not effective, your healthcare provider may prescribe a prescription laxative. These are typically recommended for individuals with chronic constipation or those with a long-term condition causing constipation, such as irritable bowel syndrome (IBS). Prescription laxatives include medications such as lactulose, linaclotide, lubiprostone, prucalopride, and plecanatide.

Tap Water Enema:

A tap water enema is a method where you inject water into your rectum using a small squeezable tube. This can help stimulate bowel movements and provide relief from constipation. However, it is important to follow the product directions carefully, as enemas can be habit-forming and are not meant for long-term use.

Pelvic Floor Therapy:

In some cases, chronic constipation may be related to issues with the muscles in the pelvis. If diet, lifestyle changes, and laxatives have not helped, it may be worth consulting a specialist in pelvic floor therapy. They can evaluate and treat any pelvic floor disorders that could be contributing to constipation.

Changes in Medication:

If you are taking medications that are known to cause constipation, such as opioids, antacids containing aluminum and calcium, or anticholinergics, consult your healthcare provider. They may adjust your medication or recommend ways to minimise the constipating effects.

Dietary and Lifestyle Changes:

While this may seem like a basic recommendation, it is crucial to ensure that you are implementing these changes correctly and consistently. Drink plenty of water, aim for a high-fibre diet (22-34 grams per day), and include physical activity in your routine. These measures are essential for preventing and managing constipation.

Remember, it is important to consult a healthcare provider if you are experiencing severe constipation that is not responding to initial treatments. They can help determine the underlying cause and provide guidance on the most appropriate course of action.

Laxatives can cause side effects

Bulk-forming laxatives are considered the gentlest type and are usually the best option to try first. They work by increasing the bulk or weight of the stool, which stimulates the bowel. These laxatives can take a few days to work and are generally safe to use daily. However, they may cause side effects such as flatulence and bloating.

Osmotic laxatives, including polyethylene glycol (MiraLAX) and magnesium-based laxatives (milk of magnesia, magnesium citrate), draw water into the bowels to soften the stool and trigger bowel movements. These laxatives can cause side effects such as gas, bloating, and nausea.

Stool softeners, such as mineral oil, add moisture to the stool to make it softer and easier to pass. While generally safe, they should not be taken with other stool softeners or for extended periods, as they can interfere with vitamin absorption and cause pneumonia if inhaled.

Lubricant laxatives, like mineral oil, coat the colon, making it slippery and preventing water absorption from the stool.

Stimulant laxatives, such as senna and bisacodyl, trigger contractions in the bowels to push the stool along. However, overuse of stimulant laxatives can lead to dependence, as the bowel may stop functioning normally without them.

Common side effects of most laxatives include dehydration, which can manifest as dizziness, headaches, and dark-coloured urine. Overuse or prolonged use of laxatives can also cause diarrhoea, intestinal obstruction, and electrolyte imbalances. Therefore, it is important to follow the instructions and not exceed the recommended dosage. If you experience troublesome or persistent side effects, consult a healthcare professional.

Laxatives can be habit-forming

The potential for laxative dependency underscores the importance of using these medications judiciously and only as directed. It is advisable to opt for the gentlest and safest laxative option, such as bulk-forming laxatives, which are safe for daily use. Bulk-forming laxatives work by drawing water into the stool, making it softer and easier to pass. They can take some time to provide relief, typically from half a day to several days.

If you find yourself frequently relying on laxatives or trying different types of laxatives without success, it is important to consult a doctor. A doctor can provide guidance on alternative treatments and rule out any underlying health issues. They may recommend other medications that are more effective than over-the-counter laxatives in treating constipation.

To maintain regular bowel function, it is essential to adopt healthy lifestyle habits. Ensuring adequate fiber intake, staying hydrated, and engaging in regular physical activity are key components of promoting digestive health and preventing constipation. Natural laxatives, such as dietary fiber, can also be incorporated into the diet as a safe and inexpensive alternative to over-the-counter products.

While laxatives can provide relief from constipation, their overuse should be avoided to prevent dependency and potential harm to bowel function. It is crucial to prioritize lifestyle modifications and, if needed, consult a healthcare professional for personalized advice and treatment options.

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