Michael Frey, MD

PRESCRIPTION MEDICATION

A few prescription drugs are available to treat constipation.

These include lubiprostone (Amitiza®), prucalopride (Prudac®, Motegrity®), plecanatide (Trulance®), lactulose (Cephulac®, Kristalose®) and linaclotide (Linzess®).  

SURGERY 

Surgery is rarely needed to treat constipation. However, you may need surgery if constipation is caused by a structural problem in the colon. Examples of these problems include a blockage in the colon (intestinal obstruction), a narrowing in a portion of the intestine (intestinal stricture), tear in the anus (anal fissure) or the collapse of part of the rectum into the vagina (rectal prolapse). Some causes of outlet dysfunction constipation may be treated with surgery. These are all super rare. 


FAQs ABOUT CONSTIPATION

How can I prevent constipation?

• Use the same home-based methods you used to treat constipation to prevent it from becoming a chronic problem:

  • Eat a well-balanced diet with plenty of fiber. Good sources of fiber are fruits, vegetables, legumes, and whole-grain bread and cereals. Fiber and water help the colon pass stool. Most of the fiber in fruits is found in the skins, such as in apples. Fruits with seeds you can eat, like strawberries, have the most fiber. Bran is a great source of fiber. Eat bran cereal or add bran cereal to other foods, like soup and yogurt.  

  • Drink eight 8-ounce glasses of water a day.  

  • Exercise regularly.

Can constipation cause internal damage or lead to other health problems?

• There are a few complications that could happen if you don’t have soft, regular bowel movements. Some complications include:

  • Swollen, inflamed veins in your rectum (a condition called hemorrhoids).

  • Tears in the lining of your anus from hardened stool trying to pass through (called anal fissures).

  • An infection in pouches that sometimes form off the colon wall from stool that has become trapped and infected (a condition called diverticulitis)

  • A pile-up of too much stool/poop in the rectum and anus (a condition called fecal impaction).

  • Damage to your pelvic floor muscles from straining to move your bowels. These muscles help control your bladder. Too much straining for too long a period of time may cause urine to leak from the bladder (a condition called stress urinary incontinence).

What causes constipation?
There are many causes of constipation – lifestyle choices, medications, medical conditions, and pregnancy.
 

Common lifestyle causes of constipation include:

• Eating foods low in fiber.

• Not hydrating.

• Not getting enough exercise.

• Changes in your regular routine, such as traveling or eating or going to bed at different times.

• Eating large amounts of milk or cheese.

• Stress.

• Resisting the urge to have a bowel movement.

• Medications that can cause constipation include:

  • Strong pain medicines, like the narcotics containing codeine, oxycodone (Oxycontin®) and hydromorphone (Dilaudid®).

  • Nonsteroidal anti-inflammatory drugs, like ibuprofen (Advil®, Motrin®) and naproxen (Aleve®).

  • Antidepressants, including the selective serotonin reuptake inhibitors (like fluoxetine [Prozac®]) or tricyclic antidepressants (like amitriptyline [Elavil®]).

  • Antacids containing calcium or aluminum, such as Tums®.

  • Iron pills.

  • Allergy medications, such as antihistamines (like diphenhydramine [Benadryl®]).

  • Certain blood pressure medicines, including calcium channel blockers (like verapamil [Calan SR], diltiazem [Cardizem®] and nifedipine [Procardia®]) and beta-blockers (like atenolol [Tenormin®]).

  • Psychiatric medications, like clozapine (Clozaril®) and olanzapine (Zyprexa®).

  • Anticonvulsant/seizure medications, such as phenytoin and gabapentin.

  • Antinausea medications, like ondansetron (Zofran®).

• Medical and health conditions that can cause constipation include:

  • Endocrine problems, like underactive thyroid gland (hypothyroidism), diabetes, uremia, hypercalcemia.

  • Colorectal cancer.

  • Irritable bowel syndrome (IBS).

  • Diverticular disease.

  • Outlet dysfunction constipation. (A defect in the coordination of pelvic floor muscles. These muscles support the organs within the pelvis and lower abdomen. They are needed to help release stool.)

  • Neurologic disorders including spinal cord injury, multiple sclerosis, Parkinson’s disease, and stroke.

  • Lazy bowel syndrome. The colon contracts poorly and retains stool.

  • Intestinal obstruction.

  • Structural defects in the digestive tract (like fistula, colonic atresia, volvulus, intussusception, imperforate anus, or malrotation.)

  • Pregnancy.