How is constipation treated?
Treatment for constipation depends on the cause, severity, and duration of the constipation and may include one or more of the following:

• Changes in eating, diet, and nutrition
• Exercise and lifestyle changes
• Medication
• Surgery
• Biofeedback

First-line treatments for constipation include changes in eating, diet, and nutrition; exercise and lifestyle changes; and laxatives. People who do not respond to these first-line treatments should talk with their health care provider about other treatments.

Eating, Diet, and Nutrition
The Academy of Nutrition and Dietetics recommends consuming 20 to 35 grams of fiber a day for adults, but Americans consume only 15 grams a day on average. People prone to constipation should limit foods that have little or no fiber, such as ice cream, cheese, meat, and processed foods. Drinking water and other liquids, such as fruit and vegetable juices and clear soups, may make fiber in the diet more effective in normalizing bowel function and maintaining regularity. A health care provider can give advice about how much a person should drink each day based on the person’s health and activity level and where the person lives.

Exercise and Lifestyle Changes
Engaging in daily exercise can help people with constipation. Another strategy is to try to have a bowel movement at the same time each day. The best time is 15 to 45 minutes after breakfast because eating helps stimulate the colon. People with constipation should reserve enough time to have a bowel movement and be sure not to ignore the urge to have a bowel movement.

Medication
When a medication is causing constipation, the health care provider may suggest the person stop taking the medication or switch to a different medication.

Laxative medications and enemas may be recommended for people who have made diet and lifestyle changes and are still constipated. Laxatives taken by mouth are available in liquid, tablet, powder, and granule forms.

• Bulk-forming agents: Brand names include Metamucil, FiberCon, Citrucel, Konsyl, and Serutan. Bulk-forming agents absorb fluid in the intestines, making stools bulkier, which helps trigger the bowel to contract and push stool out. These supplements should be taken with water or they can cause obstruction. Bulk-forming agents are generally considered the safest laxative, but they can interfere with the absorption of some medications. Many people also report no relief after taking bulk-forming agents and suffer from bloating and abdominal pain.
• Osmotic agents: Brand names include Milk of Magnesia, Fleet Phospho-Soda, Cephulac, Sorbitol, and Miralax. Osmotic agents help stool retain fluid, increasing the number of bowel movements and softening the stool. These laxatives are usually used by people who are bedridden or cannot take bulk-forming agents. Older adults and people with heart or kidney failure should be careful when taking osmotic agents because they can cause dehydration or a mineral imbalance.
• Stool softeners: Brand names include Colace, Docusate, and Surfak. Stool softeners help mix fluid into stools to soften them. Stool softeners may be suggested for people who should avoid straining in order to pass a bowel movement; they are often recommended after childbirth or surgery.
• Lubricants: Brand names include Fleet and Zymenol. Lubricants work by coating the surface of stool, which helps the stool hold in fluid and pass more easily. Lubricants are simple, inexpensive laxatives that may be recommended for people with anorectal blockage.

Other types of laxatives include

• Stimulants: Brand names include Correctol, Dulcolax, Purge, and Senokot. Stimulant laxatives cause the intestines to contract, which moves stool. Stimulants should be reserved for constipation that is severe or has not responded to other treatments. People should not use stimulant laxatives containing phenolphthalein, as phenolphthalein may increase the likelihood of cancer. Most laxatives sold in the United States do not contain phenolphthalein.
• Chloride channel activators: Lubiprostone (Amitiza) is a chloride channel activator available with a prescription. This type of laxative increases fluid in the GI tract. Lubiprostone has been shown to be safe when used for 6 to 12 months.

People who depend on laxatives to have a bowel movement need to talk with Dr. Jones about how to slowly stop using them. For most people, stopping laxatives restores the colon’s natural ability to contract.

Surgery
Surgery may be needed to correct an anorectal blockage caused by rectal prolapse. Surgical removal of the colon may be an option for people whose colon muscles do not work properly, causing severe symptoms that do not respond to treatment. However, the benefits of this surgery should be weighed against possible complications, which include abdominal pain and diarrhea.

Biofeedback
People with chronic constipation caused by problems with the anorectal muscles can use biofeedback to retrain the muscles. Biofeedback uses special sensors to measure bodily functions. The measurements are displayed on a video screen as line graphs and sounds indicate when the person is using the correct muscles. The health care provider uses the information to help the person modify or change abnormal function. The person practices at home. The person may need to continue practicing for 3 months to get the most benefit from the training.