Relieving Medication-Induced Constipation

what is the best laxative for constipation caused by medication

Constipation is a common digestive issue, with doctors receiving at least 2.5 million visits for constipation each year in the US alone. It can be caused by various factors, including certain medications such as opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and antidepressants. Laxatives are often used to treat constipation and can be purchased over the counter or with a prescription. However, it is important to note that not all laxatives are suitable for everyone, and they should be used with caution.

Characteristics Values
Type Bulk-forming, osmotic, stool softener, lubricant, stimulant, prescription-only
How they work Soften stool, stimulate bowel movement, stimulate nerves and muscles in the colon
How to take them Pills, capsules, powders, liquids, gels, suppositories, enemas
Time to work 15 minutes to 3 days, depending on type
Side effects Bloating, gas, stomach cramps, diarrhoea, dehydration, electrolyte imbalance, chronic constipation, intestinal blockage

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Bulk-forming laxatives

Common bulk-forming laxatives include psyllium (Metamucil), polycarbophil (FiberCon), and methylcellulose (Citrucel). These laxatives are generally considered gentle and are the least likely to cause side effects, which is why they are often recommended as the first line of treatment for constipation. They typically take 12 hours to three days to work.

While bulk-forming laxatives are safe for most healthy people, they may cause side effects such as mild stomach pain, bloating, or gas. It is important to take them with at least 8 ounces of water or fruit juice to prevent bowel obstruction and stay well-hydrated throughout the day. People with kidney disease or diabetes should consult a doctor before using bulk-forming laxatives as they are at risk of electrolyte imbalances. Additionally, laxatives may impact how the body absorbs medications, so it is important to leave at least two hours between taking a laxative and any other medication.

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Osmotic laxatives

There are several common osmotic laxatives available:

  • Polyethylene glycol (PEG): An organic compound derived from petroleum. PEG-containing laxatives include Miralax and GlycoLax, which are available over the counter.
  • Lactulose: A type of sugar that is not absorbed by the intestine. It sits and ferments in the intestines, producing fatty acids that draw water into the lumen. Lactulose-containing laxatives include Cephulac, Duphalac, and Kristalose, which are available by prescription.
  • Sorbitol: Another non-absorbable sugar with a similar action to lactulose. Sorbitol is available over the counter and by prescription, including brands such as Arlex and GeriCare.
  • Magnesium citrate: Magnesium in salt form combined with citric acid. The salts help draw water into the lumen. OTC versions include Citrate of Magnesia, Citroma, and LiquiPrep.
  • Magnesium hydroxide: A milder form of magnesium sold under the brand name Milk of Magnesia, which is also used as an antacid.

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Stimulant laxatives

Examples of stimulant laxatives include senna (Senokot, Ex-Lax) and bisacodyl (Dulcolax). Both are available over the counter in a few different oral dosage forms. You can also find bisacodyl as a rectal suppository that works within 15 to 60 minutes.

  • Bisacodyl: Alophen, Carters Little Pills, Correctol, Dulcolax, Ex-lax Ultra, Feen-A-Mint, Fleet Bisacodyl
  • Sodium picosulfate: Dulcolax Pico, Dulcolax Perles
  • Sodium bicarbonate and potassium bitartrate: Ceo-Two Evacuant suppository
  • Senna: Black Draught, ExLax, Fletcher's, Senexon, SennaGen, and Senokot. Senna is also found in herbal stimulant laxatives.

The American College of Gastroenterology recommends sodium picosulfate and bisacodyl over other types due to a lack of sufficient research.

When using stimulant laxatives, carefully read and follow the package directions. Determine if the product is a pill or liquid that should be taken orally or a suppository that is used rectally. Many of these products are recommended for use at bedtime, as this helps them work with your body's natural biorhythms to produce a bowel movement in the morning.

As with all medications, check with your healthcare provider before using stimulant laxatives. They are designed for short-term use only, typically no longer than one week. Overuse may lead to dependency and side effects. Some people experience abdominal pain, cramps, or temporary symptoms of fecal incontinence after using a stimulant laxative. There have also been reports of more serious side effects, including allergic reactions, electrolyte imbalances, and liver damage.

While stimulant laxatives appear to be a safe short-term treatment for constipation, it is important to carefully follow dosing instructions. If you are uncomfortable with the idea of using a stimulant laxative, you can consider using a stool softener as an alternative. If your constipation is chronic, it is best to work with your healthcare provider to develop a long-term management plan.

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Prescription laxatives

If over-the-counter laxatives are not providing relief from constipation caused by medication, a doctor may recommend a prescription medication. There are several prescription medications that a doctor may suggest for chronic constipation, including:

  • Prucalopride (Motegrity)
  • Linaclotide (Linzess)
  • Plecanatide (Trulance)
  • Naldemedine (Symproic)
  • Naloxegol (Movantik)
  • Methylnaltrexone (Relistor)
  • Lubiprostone (Amitiza)

The last four medications are specifically for opioid-induced constipation, as they block opioid effects in the gut.

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Preventative measures

Constipation is a common digestive issue, with doctors receiving at least 2.5 million visits for it annually in the US and other western countries. Medications such as opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and antidepressants are often the culprits behind this discomfort. The good news is that there are preventative measures you can take to stay ahead of the problem. Here are some detailed instructions to help you combat constipation caused by medication:

  • Drink Plenty of Water: Water is essential for maintaining healthy bowel function. Aim for eight glasses of water per day or more if you are physically active or live in a warm climate. Water helps to soften stools and promote more comfortable and regular bowel movements.
  • Eat a High-Fibre Diet: Increase your daily fibre intake by consuming more fruits, vegetables, whole grains, beans, and leafy greens. Fibre adds bulk to stools, making them easier to pass. Aim for 25-30 grams of fibre per day for adults.
  • Exercise Regularly: Physical activity stimulates digestion and can help prevent constipation. Aim for at least 30 minutes of moderate exercise, such as walking, swimming, or cycling, most days of the week.
  • Try to Have a Bowel Movement at the Same Time Each Day: Establishing a routine can help regulate your body's digestive process. Choose a time when you're likely to feel relaxed and not rushed, perhaps after a meal or first thing in the morning.
  • Don't Ignore the Urge to Go: When you feel the need to have a bowel movement, don't delay. Ignoring the urge can lead to constipation.
  • Experiment with Different Toilet Positions: Try raising your feet by using a small stool or squatting instead of sitting. These positions can help align your rectum and make it easier to pass stools.
  • Consider Taking a Daily Preventative Laxative: If dietary and lifestyle changes aren't enough, speak to your healthcare provider about taking a daily laxative to stay ahead of the problem. Bulk-forming laxatives are generally not recommended for medication-induced constipation, as they can make the issue worse. Stimulant laxatives, such as senna or bisacodyl, are often a good first option. Osmotic laxatives, like polyethylene glycol, can also be effective and tend to have fewer side effects.
  • Address the Root Cause: If your constipation is caused by a specific medication, consult your doctor. They may be able to adjust the dosage or prescribe an alternative medication that doesn't cause constipation.

Remember, it's always best to speak with your healthcare provider before starting any new medication, including laxatives. They can advise you on the most suitable treatment plan for your individual needs.

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Frequently asked questions

Medications that can cause constipation include opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, anticholinergics, and allergy medications.

To prevent constipation, it is recommended to drink plenty of water, eat a high-fiber diet, and exercise regularly.

Some common over-the-counter laxatives that can help include stimulant laxatives such as senna (Senokot) and bisacodyl (Dulcolax), and osmotic laxatives such as polyethylene glycol (PEG) or milk of magnesia.

Stimulant laxatives stimulate the muscles in the intestines, helping stool move more quickly. They also reduce water absorption by the body from the intestines.

Some prescription laxatives for medication-induced constipation include prucalopride (Motegrity), linaclotide (Linzess), and lubiprostone (Amitiza).

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