William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Constipation facts
- What is constipation?
- What causes constipation?
- Medications that cause constipation
- Other causes of constipation
- What are constipation symptoms?
- How is constipation diagnosed (evaluated)?
- Exams and tests
- Imaging studies and other tests
- What treatments are available for constipation?
- Dietary fiber and bulk-forming laxatives to treat constipation
- Other laxatives to treat constipation
- Other laxatives and OTC products to treat constipation
- Prescription drugs to treat constipation
- Other treatments for constipation
- What is the approach to the evaluation and treatment of constipation?
- When should I seek medical care for chronic constipation?
- What is new in the treatment of constipation?
- Pictures of Constipation Myths and Facts - Slideshow
- Pictures of Irritable Bowel Syndrome (IBS) - Slideshow
- Pictures of What's Causing Your Pelvic Pain - Slideshow
What treatments are available for constipation?
There are many treatments for constipation. The best approach relies on a clear understanding of the underlying cause.
Dietary fiber and bulk-forming laxatives to treat constipation
The best way of adding fiber to the diet is increasing the quantity of fruits and vegetables that are eaten. This means a minimum of five servings of fruits or vegetables every day. For many people, however, the amount of fruits and vegetables that are necessary may be inconveniently large or may not provide adequate relief from constipation. In this case, fiber supplements can be useful.
Fiber is defined as material made by plants that is not digested by the human gastrointestinal tract. Fiber is one of the mainstays in the treatment of constipation. Many types of fiber within the intestine bind to water and keep the water within the intestine. The fiber adds bulk (volume) to the stool and the water softens the stool.
There are different sources of fiber and the type of fiber varies from source to source. Types of fiber can be categorized in several ways, for example, by their source.
The most common sources of fiber include:
- fruits and vegetables,
- wheat or oat bran,
- psyllium seed (for example, Metamucil, Konsyl),
- synthetic methyl cellulose (for example, Citrucel), and
- polycarbophil (for example, Equalactin, Konsyl Fiber).
Polycarbophil often is combined with calcium (for example, Fibercon). However, in some studies, the calcium-containing polycarbophil was not as effective as the polycarbophil without calcium.
A lesser known source of fiber is an extract of malt (for example, Maltsupex). However, this extract may soften stools in ways other than increasing fiber.
Increased gas (flatulence) is a common side effect of high-fiber diets. The gas occurs because the bacteria normally present within the colon are capable of digesting fiber to a small extent. The bacteria produce gas as a byproduct of their digestion of fiber. All fibers, no matter what their source, can cause flatulence. However, since bacteria vary in their ability to digest the various types of fiber, the different sources of fiber may produce different amounts of gas. To complicate the situation, the ability of bacteria to digest one type of fiber can vary from individual to individual. This variability makes the selection of the best type of fiber for each person more difficult.
Different sources of fiber should be tried one by one. The fiber should be started at a low dose and increased every one to two weeks until either the desired effect is achieved or troublesome flatulence interferes. Fiber does not work overnight, so each fiber should be tried over a few weeks, if possible. If flatulence occurs, the dose of fiber can be reduced for a few weeks and the higher dose can then be tried again. It generally is said that the amount of gas that is produced by fiber decreases when the fiber is ingested for a prolonged period of time, although, this has never been studied. If flatulence remains a problem and prevents the dose of fiber from being raised to a level that affects the stool satisfactorily, it is time to move on to a different source of fiber.
When increasing amounts of fiber are used, it is recommended that greater amounts of water be consumed (for example, a full glass with each dose). In theory, the water prevents "hardening" of the fiber and blockage (obstruction) of the intestine. This seems like simple and reasonable advice. However, ingesting larger amounts of water has never been shown to have a beneficial effect on constipation, with or without the addition of fiber. There is already a lot of water in the intestine and any extra water that is digested will be absorbed and excreted in the urine. However, it is reasonable to drink enough fluids to prevent dehydration that would cause reduced intestinal water.
There are reasons not to take fiber or to take specific types of fiber. Due to concern about obstruction, persons with narrowings (strictures) or adhesions (scar tissue from previous surgery) of their intestines should not use fiber unless it has been discussed with their physician. Some fiber laxatives contain sugar, so patients with diabetes may need to select sugar-free products.
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