The best remedies for constipation

Source: Best Health Magazine, October 2012

If your bowel movements are hard and dry, less frequent than usual and difficult to pass, you’re probably constipated. But just because you don’t have a bowel movement every day doesn’t mean you’re constipated: What’s considered ‘normal’ can range from as few as three bowel movements per week to as many as three per day. ‘Constipation is a disturbance in whatever bowel function is regular for you,’ says Dr. Michael Byrne, a clinical professor in the division of gastroenterology at Vancouver General Hospital and the University of British Columbia (UBC).

‘Between 15 and 20 percent of Canadians suffer at any given time, whether it’s short-term or chronic,’ says Byrne. Lifestyle changes are usually to blame for the condition, which most commonly occurs when waste matter moves too slowly through the digestive tract, causing it to become hard and dry. Travel, irregular mealtimes, insufficient water or fibre intake, lack of exercise and altered sleep patterns are the typical causes; less common ones include pregnancy, illness, thyroid disease, diabetes, and certain medications and supplements.

About five percent of sufferers’mostly women’experience constipation that lasts for more than a week. If left untreated, this chronic constipation may contribute to anal fissures, hemorrhoids or ‘lax’ bowels (a loss of tone). Often, stool retention is a factor. ‘Over time, holding in your bowel movements can lead to the bowel becoming stretched,’ explains Dr. Robert Enns, a clinical professor of medicine at St. Paul’s Hospital in Vancouver and UBC.

If you’ve had irregular or non-existent bowel movements for more than a week, or if symptoms are accompanied by rectal bleeding, pain or unexplained weight loss, see your doctor right away. Otherwise, combat constipation by sticking to a schedule. ‘Having regular fibre-rich meals, and getting enough sleep, fluid intake and exercise tends to move the bowels along,’ says Enns. Dietary fibre’which softens and increases the bulk and weight of stools’is essential for preventing, and relieving, constipation (see ‘Your Best Fibre Food Sources,’ below).

In the short term, you could also consider one of these over-the-counter remedies.

Bulk-forming agents

Examples: Metamucil Fibre Orange Smooth Texture; Abundance Naturally Bowel Buddy Bran Wafers; Swiss Natural Sources Psyllium Husk

How they work: ‘Bulk formers add weight and water to stool,’ says Roxy Khosroshahi, a pharmacist at Rexall in Richmond Hill, Ont. The main ingredient in these products is psyllium seed husk, a type of fibre that absorbs water and forms a large mass that stimulates the bowel to move stool.

Need to know: ‘Because fibre is not absorbed, it’s very safe and should be the first line of therapy for constipation,’ says Enns. It’s safe even for the long term. Follow package directions (or speak to your doctor about how much to have), and be sure to always accompany each dose with at least one cup (250 mL) of cool’not warm’water. Be patient; results won’t be immediate. It can take at least 24 hours to stimulate a bowel movement, says Khosroshahi.

Stool softeners; lubricants

Examples: Stool softeners: Rougier Docusate Calcium; Colace Drops; Soflax Syrup. Lubricants: Fleet Mineral Oil Enema; Rougier Mineral Oil Heavy; WellSpring Original Glycerin Suppositories

How they work: Stool softeners contain either docusate calcium (Rougier Docusate Calcium) or docusate sodium (Colace and Soflax); they are taken orally and add fluid to the stool so that it’s easier to have a bowel movement without straining. Lubricants coat the surface of the stool to make it easier to pass, and are available as mineral oil taken either rectally (Fleet) or orally (Rougier Mineral Oil), or as glycerin-based suppositories (WellSpring).

Need to know: While lubricating suppositories and enemas can produce a bowel movement within a few minutes, oral doses of mineral oil need about six hours to work. Take one to three tablespoons (15-45 mL) once a day, but at a different time from any fat-soluble vitamin supplements (such as vitamins A and D) or medications, since mineral oil can interfere with their absorption. For this reason, oral doses of mineral oil are not recommended for long-term use. Stool-softening remedies take longer’about 12 hours’and while they are fairly well tolerated, they may produce minor cramping or nausea. Though they’re considered safe, Khosroshahi recommends stool softeners only for short-term use, usually post-surgery, since long-term use can result in a dependency on them.

Laxatives

Examples: Senokot; Dulcolax Laxative Tablets; Ex-Lax Pills; Fleet Enema; Now Foods Castor Oil; Phillips Milk of Magnesia Tablets; RestoraLax

How they work: Stimulant laxatives are formulated with sennosides (an herb found in Ex-Lax and Senokot), bisacodyl (a chemical compound in Dulcolax) or plain castor oil (Now Foods) to produce contractions that induce a bowel movement. Saline laxatives contain sodium (Fleet) or magnesium (Phillips), while osmotic laxatives contain polyethylene glycol (RestoraLax). Both saline and osmotic types promote contractions by drawing water into the colon from nearby tissues.

Need to know: Stimulant laxatives are safe for short-term use; expect a bowel movement within six to 12 hours. Saline and osmotic formulas are also meant for temporary relief, but work faster (as soon as 15 minutes if taken as a rectal enema, or 30 minutes if taken orally). With all these products, ‘some people may experience a bit of cramping,’ says Khosroshahi. If you have kidney or cardiovascular issues, avoid magnesium-based formulas. Speak to your doctor if you have any concerns.

What about colonics?

Some women are turning to colonics’a non-medical procedure that flushes fecal matter from the large intestine’to manage constipation and other digestive problems. There is no medical need for this procedure, and doctors differ over whether relief of constipation outweighs the risks of colonics, namely electrolyte depletion, and infection if reusable instruments are used. If you are interested in a colonic, be sure to discuss it with your doctor first.

Your Best Fibre Food Sources

Medical experts recommend we get at least 25 grams of fibre a day, but most Canadians average only five to 10 grams a day. Here are some suggestions for foods that are high in fibre and will help you bump up your intake.

‘ Whole grain breads such as rye and pumpernickel
‘ Fresh fruit such as avocado and pears
‘ Legumes such as soy and lima beans
‘ High fibre cereals such as bran
‘ Vegetables such as artichokes, spinach, cauliflower, carrots and broccoli

This article was originally titled "Backup relief" in the October 2012 issue of Best Health. Subscribe today to get the full Best Health experience’and never miss an issue!