Laxatives Fail: Constipation's Next Steps

Laxatives are a common treatment for constipation, but what if they don't work? This is a concern for many people, as constipation can be uncomfortable and even painful. While laxatives are often effective in treating constipation, they are not suitable for everyone, and there are several reasons why they might not always be successful. Firstly, it's important to ensure you are taking the right type of laxative for your specific needs. Different types of laxatives include bulk-forming, osmotic, stool softeners, lubricants, and stimulants. Each type works differently, so consulting a healthcare professional is essential to determine the best option for you. Additionally, laxatives may not be effective if you have an underlying condition causing constipation, such as Crohn's disease or ulcerative colitis. In such cases, it is crucial to seek medical advice, as your doctor can offer alternative treatments or medications.

Try a bulk-forming laxative first

If you're struggling with constipation and laxatives don't seem to be providing relief, it might be time to try a different type of laxative. In many cases, a gentle, bulk-forming laxative can be a good first-line treatment option. These types of laxatives work by increasing the bulk and water content in your stool, which stimulates the intestines and helps to promote a bowel movement. The advantage of starting with a bulk-forming laxative is that they are generally well-tolerated and have a lower risk of side effects compared to other types of laxatives. They are particularly useful for those who experience constipation due to a low-fibre diet or not drinking enough fluids.

Bulk-forming laxatives, also known as fiber supplements, work by adding bulk to your stool, which helps to draw water into the intestines and make the stool softer and easier to pass. They can be particularly effective if your constipation is due to a lack of fiber in your diet. These laxatives are usually made from natural, plant-based sources of fiber, such as psyllium husk, methylcellulose, or calcium polycarbophil. They are typically available in powder or tablet form and are taken once or twice a day, often at breakfast time. It is important to take them with plenty of water to ensure they work effectively and don't cause blockages.

Unlike some other types of laxatives, bulk-forming laxatives are not associated with significant side effects when used correctly. The most common side effect is mild bloating or gas, which usually resolves within a few days as your body adjusts to the increased fiber intake. It is important to start with a low dose and gradually increase it to minimize side effects and determine the correct dose for your body. Additionally, drinking plenty of fluids when taking these laxatives is crucial to ensure they work effectively and safely.

When choosing a bulk-forming laxative, look for products that contain only the fiber source and minimal added ingredients. Some brands may include additional ingredients that can be unnecessary or even cause allergic reactions in some people. It is always a good idea to speak with your pharmacist or healthcare provider for recommendations and to ensure that the product is suitable for your individual needs. They can also advise on potential interactions with any medications you may be taking.

Starting with a gentle, bulk-forming laxative can be an effective and safe way to find relief from constipation. They work in harmony with your body's natural processes and can help to regulate your bowel movements without the risk of dependency or significant side effects. As always, it is important to address any persistent or concerning symptoms of constipation with your healthcare provider to rule out any underlying conditions and determine the best long-term treatment plan for you.

If that doesn't work, try an osmotic laxative

If you're still experiencing constipation after making changes to your diet and lifestyle, it may be time to try a laxative. Laxatives are medicines that help you have a bowel movement if you're constipated. They work by softening hard stools or stimulating your bowels to get moving.

If you've tried a bulk-forming laxative and it hasn't worked, you could try an osmotic laxative. Osmotic laxatives draw water from the rest of the body into your bowel to soften the stool and make it easier to pass. They usually contain polyethylene glycol and glycerin as their active ingredients. Osmotic laxatives take 2-3 days to work and are suitable for long-term use if used correctly. However, it's important to drink plenty of water throughout the day when using osmotic laxatives to avoid dehydration.

Some common osmotic laxatives include:

• Polyethylene glycol (MiraLAX, Gavilax, or a generic version)
• Magnesium hydroxide solution (Dulcolax, Ex-Lax, Phillips' Milk of Magnesia)
• Lactulose (Duphalac, Lactugal)
• Macrogol (Movicol, Laxido, CosmoCol, Molaxole, Molative)
• Glycerin (Colace Glycerin, Fleet Pedia-Lax)

If stools are soft but still difficult to pass, try a stimulant laxative

If your stools are soft but still difficult to pass, it may be time to try a stimulant laxative. This type of laxative is a good option for fast relief from painful constipation. They are fast-acting laxatives that stimulate the intestines to have a bowel movement. They work by activating the nerves that control the muscles in your colon, forcing your colon into motion so that it moves your stool along.

Stimulant laxatives include Bisacodyl (Dulcolax) and Senna (Fletcher's Laxative). They often contain bisacodyl and sennosides as active ingredients. These laxatives are not safe for regular use and should only be used occasionally. If used regularly, they may cause the body to become dependent on them to have a bowel movement. They may also cause cramping and diarrhoea.

It is important to take laxatives exactly as instructed to prevent side effects. It is also important to note that laxatives are not the first option to relieve constipation. It is always best to try to move stool naturally by eating high-fibre foods, getting plenty of water, and exercising. If nothing else works, a gentle laxative may be the next step.

If you're experiencing chronic constipation, see a doctor

Laxatives are a type of medicine that can treat constipation by softening stools or stimulating your bowels. They are available over the counter and on prescription. However, they are not suitable for everyone and should be used with caution. If you are experiencing chronic constipation, it is important to consult a doctor to discuss other treatment options and rule out any underlying conditions.

Constipation can often be relieved through lifestyle changes, such as eating a high-fibre diet, taking probiotics, drinking more fluids, and exercising regularly. If these changes do not help, it may be time to consult a doctor, who can advise on the best course of treatment.

Chronic constipation can be a warning sign of a more serious problem, such as colon cancer, diabetes, or hypothyroidism. A doctor can evaluate your medical history, perform a physical exam and lab tests, and determine the exact cause and solution for your constipation. They may recommend other medications or treatments that are more suitable for long-term relief.

Additionally, some laxatives can interfere with the absorption of certain vitamins and medications. It is important to consult a doctor or pharmacist if you are taking any prescription medications, as laxatives may not be safe for you.

In summary, if you are experiencing chronic constipation, it is important to see a doctor. Laxatives may provide temporary relief, but they are not a cure and can have side effects. A doctor can help determine the underlying cause of your constipation and advise on the best course of treatment.

Drink plenty of water, exercise regularly, and eat more fibre

If you're experiencing constipation, drinking plenty of water, exercising regularly, and eating more fibre can help.

Firstly, drinking water is important for your digestion. It keeps food moving through your intestines and prevents dehydration, a common cause of constipation. Water also keeps your intestines smooth and flexible, helping to ease the passage of stools. Staying well-hydrated softens stools, making them easier to pass.

Exercising regularly is another key factor in preventing and relieving constipation. Inactivity is a leading cause of constipation, so getting up and moving can help speed things up. Aerobic exercise, such as running, jogging, or swimming, stimulates the natural contractions of muscles in your intestines, aiding the quick elimination of stools. Additionally, exercise reduces the time food spends in the large intestine, limiting the amount of water absorbed from the stool, which can make it harder to pass.

Finally, eating more fibre can be an effective way to relieve constipation. Fibre increases stool size and softens them, making them easier to pass. Insoluble fibre, found in wheat bran, vegetables, and whole grains, bulks up the stool and acts like a brush, sweeping through the bowels. Soluble fibre, found in oat bran, nuts, seeds, and legumes, absorbs water and forms a gel-like substance, aiding smooth stool passage and improving its consistency. Fibre also helps maintain a healthy gut by increasing good bacteria, which may reduce the risk of diseases like heart disease, obesity, and diabetes.

However, it's important to note that while increasing fibre intake can be beneficial, it may not work for everyone. Some studies suggest that reducing fibre intake can be helpful, especially if your constipation is not due to a low-fibre diet. Additionally, increasing fibre intake may not improve other constipation symptoms like pain, bloating, and gas. Therefore, it's recommended to determine the cause of your constipation before significantly altering your fibre intake.

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