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Try one of these related symptoms.
Constipation
Hard stools
Passing fewer than three stools a week
Pain when passing stools
Feeling of incomplete bowel emptying
I want to poop, but cannot
I can't defecate
Feel like I still have to poop after having a bowel movement
Cramping rectal pain
Slow bowel movements
Feeling of incomplete defecation
Constipation is defined as having fewer than three bowel movements per week, accompanied by hard, dry, or lumpy stools, difficulty or discomfort in passing stools, or a sensation that not all stool has been eliminated.
Seek professional care if you experience any of the following symptoms
Generally, Constipation can be related to:
Cystic fibrosis (CF) is a genetic disorder that causes severe damage to the lungs, digestive system, and other organs in the body.
Neuromyelitis optica (NMO) is a rare condition in which the immune system damages the spinal cord and the optic nerves.
Acute porphyria is a group of rare genetic disorders that impact the body's ability to produce heme, a vital component of hemoglobin in red blood cells. This disruption can lead to a variety of symptoms, including intense abdominal pain, nervous system issues, and psychiatric symptoms, with episodes often triggered by factors such as certain medications, hormonal changes, or dietary choices.
Sometimes, Constipation may be related to these serious diseases:
A condition where a segment of the intestines "telescopes" into another. This can cause the intestine walls to die, so prompt medical attention is needed. It is associated with certain genetic conditions and growths, but often no clear cause is found.
Your doctor may ask these questions to check for this symptom:
Reviewed By:
Aiko Yoshioka, MD (Gastroenterology)
Dr. Yoshioka graduated from the Niigata University School of Medicine. He worked as a gastroenterologist at Saiseikai Niigata Hospital and Niigata University Medical & Dental Hospital before serving as the Deputy Chief of Gastroenterology at Tsubame Rosai Hospital and Nagaoka Red Cross Hospital. Dr. Yoshioka joined Saitama Saiseikai Kawaguchi General Hospital as Chief of Gastroenterology in April 2018.
Unnati Patel, MD, MSc (Family Medicine)
Dr.Patel serves as Center Medical Director and a Primary Care Physician at Oak Street Health in Arizona. She graduated from the Zhejiang University School of Medicine prior to working in clinical research focused on preventive medicine at the University of Illinois and the University of Nevada. Dr. Patel earned her MSc in Global Health from Georgetown University, during which she worked with the WHO in Sierra Leone and Save the Children in Washington, D.C. She went on to complete her Family Medicine residency in Chicago at Norwegian American Hospital before completing a fellowship in Leadership in Value-based Care in conjunction with the Northwestern University Kellogg School of Management, where she earned her MBA. Dr. Patel’s interests include health tech and teaching medical students and she currently serves as Clinical Associate Professor at the University of Arizona School of Medicine.
Content updated on Jan 30, 2025
Following the Medical Content Editorial Policy
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Q.
Bloated? Why Your Gut is Stalled: Medically Approved Constipation Relief Steps
A.
Medically approved relief is achievable by gradually increasing fiber, drinking 8 to 10 cups of fluids, moving daily, not ignoring the urge, improving toilet posture, and using bulk or osmotic laxatives safely if needed. There are several factors and red flags that can change your next steps, including blood in the stool, severe belly pain, vomiting, unexplained weight loss, sudden constipation after age 50, or alternating diarrhea, which warrant prompt medical care. See the complete guidance below for causes, common medication triggers, mistakes to avoid, and when chronic symptoms need testing and prescription options.
References:
* pubmed.ncbi.nlm.nih.gov/34182813/
* pubmed.ncbi.nlm.nih.gov/35084934/
* pubmed.ncbi.nlm.nih.gov/35641753/
* pubmed.ncbi.nlm.nih.gov/36294747/
* pubmed.ncbi.nlm.nih.gov/34509172/
Q.
Need Laxatives? Why Your Gut Is Stalling and Medically Approved Next Steps
A.
Laxatives can help constipation, but the right next step depends on why your gut is stalling, with common causes including low fiber, dehydration, inactivity, certain medications, hormonal shifts, and underlying conditions. There are several factors to consider, from doctor-approved first steps like gradual fiber, fluids, movement, and a bathroom routine to choosing the safest laxative type and recognizing red flags that need urgent care. See the complete guidance below for key details that could change your next steps, including risks of overuse and special advice for pregnancy, older adults, and children.
References:
* Ford AC, et al. Management of chronic constipation in adults: an ACG Clinical Guideline. Am J Gastroenterol. 2018 Sep;113(9):1326-1348. doi: 10.1038/s41395-018-0194-6. Epub 2018 Aug 21. PMID: 30134033.
* Quigley EM. The causes of constipation. Med Clin North Am. 2017 Jan;101(1):1-10. doi: 10.1016/j.mcna.2016.08.012. PMID: 27958564.
* Shah A, et al. Pharmacological Treatment of Chronic Constipation. Curr Treat Options Gastroenterol. 2020 Feb;18(1):31-41. doi: 10.1007/s11938-020-00277-2. PMID: 32014798.
* Jantchou P, et al. Chronic constipation in adults: an updated review for general practitioners. Rev Med Interne. 2020 Sep;41(9):603-609. doi: 10.1016/j.revmed.2020.06.002. Epub 2020 Jul 17. PMID: 32677894.
* Bharucha AE, et al. Management of Chronic Constipation: A Review. JAMA. 2023 Feb 14;329(6):499-511. doi: 10.1001/jama.2023.0189. PMID: 36778112.
Q.
Still Constipated? How Bisacodyl Works & Medically Approved Next Steps
A.
Bisacodyl is a stimulant laxative that activates colon nerves to increase contractions and move stool, with tablets working in 6 to 12 hours and suppositories in 15 to 60 minutes; it is intended for short-term relief, not routine daily use. If you are still constipated or need it more than once or twice weekly, there are several factors and evidence-based next steps to consider, including gradually increasing fiber and fluids, adding physical activity, trying an osmotic laxative, and setting a regular bathroom routine, with medical evaluation for persistent symptoms or red flags. See below for the complete guidance, including urgent warning signs and special considerations for older adults, pregnancy, and children that could change your next steps.
References:
* Kienzle-Horn S, et al. Efficacy and safety of bisacodyl in the treatment of chronic constipation: an updated review. Ther Adv Gastroenterol. 2018 May;11:1756283718767922.
* Rao SS, et al. Pathophysiology and management of chronic constipation: a review of current concepts. Gut Liver. 2020 Jan 15;14(1):17-31.
* Bharucha AE, Lacy BE, Nee J, et al. ACG Clinical Guideline: Management of Chronic Constipation. Am J Gastroenterol. 2023 Aug 1;118(8):1395-1411.
* Bassotti G, et al. Laxatives in the treatment of chronic constipation. Curr Med Res Opin. 2019 Feb;35(2):227-235.
* Lembo A, et al. Management of refractory constipation. Nat Rev Gastroenterol Hepatol. 2022 Mar;19(4):219-232.
Q.
Still Constipated? Why Polyethylene Glycol Works & Medically Approved Next Steps
A.
Polyethylene glycol is a first-line osmotic laxative that gently pulls water into the stool to soften it, usually working within 24 to 72 hours and considered safe and effective for many people even with longer use. If you are still constipated, there are several factors to consider, including hydration, consistent daily use, dose adjustments, cautious fiber, short-term stimulants, prescription options, pelvic floor therapy, and red flag symptoms that need urgent care. See the complete details below to decide your next medically approved steps and when to talk to a doctor.
References:
* Ponce J, Gaskins J, Olyaee M. Polyethylene Glycol (PEG) 3350 for the Treatment of Constipation in Children and Adults: A Review. Drugs. 2022 Oct;82(15):1617-1628. doi: 10.1007/s40265-022-01783-6. PMID: 36243916.
* Chang L, Chey WD, Imdad A, Lembo A, Lock B, Moayyedi P, Quigley EMM, Saito YA, Shah ED, Walker M. ACG Clinical Guideline: Management of Chronic Idiopathic Constipation. Am J Gastroenterol. 2021 Oct 1;116(10):1914-1934. doi: 10.14309/ajg.0000000000001440. Epub 2021 Jul 26. PMID: 34310116.
* Trier K, Shiff A. Pharmacologic treatment of chronic constipation. Ther Adv Gastroenterol. 2019 Dec 19;12:1756284819895627. doi: 10.1177/1756284819895627. PMID: 31885567; PMCID: PMC6927357.
* Lee-Robichaud H, Whitehead C, Nelson RL. Efficacy and safety of polyethylene glycol 3350 for chronic constipation in adults: A systematic review and meta-analysis. Am J Gastroenterol. 2019 Apr;114(4):534-547. doi: 10.14309/ajg.0000000000000017. Epub 2018 Sep 18. PMID: 30228393.
* Lembo A, Lacy BE, Bhandari D, Chen X, Northcutt M, Sarocco S, Pimentel M. Approach to the Adult with Chronic Constipation. Dig Dis Sci. 2020 Feb;65(2):401-411. doi: 10.1007/s10620-019-05980-z. Epub 2019 Dec 24. PMID: 31873734.
Q.
Colace Not Working? Why Your Gut Is Still Blocked and Medically Approved Next Steps
A.
If Colace is not helping after 1 to 3 days, the most likely reasons are not enough water, low fiber, slow gut motility, medication side effects, or a more severe blockage like fecal impaction or an underlying condition. Medically approved next steps include increasing fluids, adding fiber gradually, considering an osmotic laxative or brief stimulant use, getting more physical activity, and using timed toilet sits with a footstool. There are important red flags that need urgent care such as severe belly pain, vomiting, blood or black stools, pencil thin stools, inability to pass gas, or weight loss, and there are more details on tailoring the right plan for you below.
References:
* Bharucha AE, Lacy BE. Mechanisms, Evaluation, and Management of Chronic Constipation. Gastroenterology. 2020 Jan;158(1):123-140. doi: 10.1053/j.gastro.2019.05.059. PMID: 31175642.
* Camilleri M, Ford AC. Management of chronic constipation in adults. Nat Rev Gastroenterol Hepatol. 2021 Jul;18(7):477-493. doi: 10.1038/s41575-021-00412-x. PMID: 33731872.
* Rao SSC, Brenner DM, Kassim S, Gandhi J. Efficacy of Pharmacological Interventions for Chronic Idiopathic Constipation (CIC) and Irritable Bowel Syndrome With Constipation (IBS-C): A Systematic Review and Meta-analysis. Am J Gastroenterol. 2023 Apr 1;118(4):618-634. doi: 10.14309/ajg.0000000000002130. Epub 2023 Jan 26. PMID: 36701766.
* Shin JE, Kim MS, Kim MJ, Kwon S. Clinical Approach to Chronic Constipation. J Korean Med Sci. 2020 Apr 27;35(16):e115. doi: 10.3346/jkms.2020.35.e115. PMID: 32338271; PMCID: PMC7188700.
* Rao SSC. Advances in the Management of Chronic Constipation. Curr Treat Options Gastroenterol. 2017 Mar;15(1):164-182. doi: 10.1007/s11938-017-0129-8. PMID: 28247348; PMCID: PMC5390022.
Q.
Need a Stool Softener? Why Your Colon is Stalled & Medically Approved Next Steps
A.
Constipation often stems from low fiber or fluids, inactivity, certain medications, or medical conditions, and while a gentle stool softener like docusate can ease hard stools and reduce straining, guidelines recommend starting with gradual fiber increases, better hydration, daily activity, and a consistent bathroom routine first. There are several factors to consider, including when to try other laxatives, red flag symptoms that need prompt medical care, and why long-term use should be supervised. See below for the complete, medically approved next steps to guide your personal plan.
References:
* Camilleri M, et al. American Gastroenterological Association Clinical Guideline: Management of Chronic Constipation. Gastroenterology. 2023 Dec;165(6):1495-1512. doi: 10.1053/j.gastro.2023.08.056. Epub 2023 Oct 12. PMID: 37834515.
* Shin A. Colonic Motility Disorders. Gastroenterol Clin North Am. 2024 Mar 22;53(1):159-173. doi: 10.1016/j.gtc.2023.10.003. Epub ahead of print. PMID: 38520779.
* Rao SS, et al. Pharmacologic Management of Chronic Constipation. Clin Gastroenterol Hepatol. 2019 Dec;17(13):2634-2649.e1. doi: 10.1016/j.cgh.2019.04.053. Epub 2019 May 10. PMID: 31085350.
* Bassotti G, et al. Chronic Constipation: Current Perspectives and Future Directions. World J Gastroenterol. 2023 Jul 21;29(27):4255-4273. doi: 10.3748/wjg.v29.i27.4255. PMID: 37576572; PMCID: PMC10411354.
* Ma K, et al. Lifestyle and dietary interventions for chronic constipation: a narrative review. World J Gastroenterol. 2023 Sep 21;29(35):5199-5216. doi: 10.3748/wjg.v29.i35.5199. PMID: 37780076; PMCID: PMC10526715.
Q.
Still Constipated? Why Lactulose Is Slow & Medically Approved Next Steps
A.
Lactulose often takes 24 to 72 hours to work because it gently draws water into the colon rather than forcing contractions, so consistent dosing, good hydration, and patience are key. There are several factors to consider. Medically approved next steps include optimizing fiber and fluids, discussing polyethylene glycol or a short term stimulant with a clinician, and evaluating for underlying causes or prescription options, with urgent care needed for red flag symptoms; see the complete guidance below for details that can change which next step is right for you.
References:
* Ford AC, et al. Pharmacological Management of Chronic Idiopathic Constipation in Adults. Am J Gastroenterol. 2021 Jan 1;116(1):16-29. doi: 10.14309/ajg.0000000000001031. PMID: 33409477.
* Lacy BE, et al. ACG Clinical Guideline: Management of Chronic Constipation. Am J Gastroenterol. 2021 Jul 1;116(7):1321-1341. doi: 10.14309/ajg.0000000000001309. PMID: 34220037.
* Rao SSC. Management of Chronic Constipation in Adults: An Update. Gastroenterol Clin North Am. 2020 Jun;49(2):207-229. doi: 10.1016/j.gtc.2020.02.001. Epub 2020 Apr 17. PMID: 32414571.
* Camilleri M, et al. Pharmacologic Treatment for Chronic Constipation in Adults. Clin Gastroenterol Hepatol. 2023 Feb;21(2):292-302.e1. doi: 10.1016/j.cgh.2022.09.020. Epub 2022 Sep 27. PMID: 36179979.
* Bharucha AE, Lacy BE. Polyethylene Glycol and Other Osmotic Laxatives in Chronic Constipation. Gastroenterol Clin North Am. 2021 Jun;50(2):279-291. doi: 10.1016/j.gtc.2021.02.003. Epub 2021 May 20. PMID: 34024505.
Q.
Still Constipated? How Milk of Magnesia Works & Medically Approved Next Steps
A.
Milk of magnesia is an osmotic laxative that pulls water into the intestines to soften stool and trigger a bowel movement, usually within 30 minutes to 6 hours; it may fail if you are dehydrated, have slow gut motility or pelvic floor dysfunction, or constipation from certain medicines. Medically approved next steps include hydrating, gradually increasing fiber, setting a post-meal toilet routine, considering other laxatives or prescriptions with clinician guidance, reviewing medications, and seeking urgent care for red flags like severe pain, vomiting, blood or black stools, or inability to pass gas. There are several factors to consider, and important details that could change your next step are explained below.
References:
* Bharucha, A. E., & Lacy, B. E. (2020). Mechanisms, Evaluation, and Management of Chronic Constipation. *Gastroenterology*, *158*(5), 1232-1249.e3. doi: 10.1053/j.gastro.2019.12.039.
* Ford, M. J., & Lacy, B. E. (2020). Medical Management of Chronic Constipation. *The American Journal of Gastroenterology*, *115*(7), 987-995. doi: 10.14309/ajg.0000000000000676.
* Rao, S. S. C., & Lee, Y. M. (2022). Constipation: Evaluation and Management. *Medical Clinics of North America*, *106*(3), 579-598. doi: 10.1016/j.mcna.2022.01.002.
* Basilisco, G., & Intraligi, M. (2015). Pharmacotherapy for chronic constipation. *Expert Opinion on Pharmacotherapy*, *16*(17), 2631-2646. doi: 10.1517/14656566.2015.1093121.
* Black, C. J., & Ford, A. C. (2020). Chronic idiopathic constipation: Epidemiology, pathogenesis, diagnosis and novel therapeutics. *Alimentary Pharmacology & Therapeutics*, *52*(1), 75-84. doi: 10.1111/apt.15781.
Q.
Still Constipated? Why Your Gut Is Blocked & Docusate Sodium Medical Steps
A.
If you are still constipated despite docusate sodium, common reasons include too little fiber or water, slow gut motility, medication side effects, or an underlying condition; remember docusate only softens stool and is often less effective than fiber or osmotic laxatives for ongoing symptoms. There are several factors to consider. See below for step by step actions on fiber, fluids, movement and toilet posture, when to try other laxatives safely, and urgent red flags like severe pain, vomiting, blood, pencil thin stools, or no bowel movement for a week.
References:
* Bharucha AE, Lacy BE. Chronic Constipation: Current and Emerging Management Options. Gastroenterology. 2020 Jan;158(1):121-133. doi: 10.1053/j.gastro.2019.09.006. Epub 2019 Sep 18. PMID: 31542385.
* Lacy BE, et al. American College of Gastroenterology Monograph on the Management of Chronic Constipation. Am J Gastroenterol. 2021 May 1;116(5):841-852. doi: 10.14309/ajg.0000000000001252. PMID: 33737527.
* Tarun T, et al. Efficacy and safety of docusate sodium for the treatment of constipation in adults: a systematic review. J Gen Intern Med. 2023 Dec;38(16):3691-3696. doi: 10.1007/s11606-023-08428-z. Epub 2023 Sep 20. PMID: 37728469.
* Ford AC, et al. Pharmacological treatment of chronic constipation in adults. Nat Rev Gastroenterol Hepatol. 2023 Jun;20(6):353-372. doi: 10.1038/s41575-023-00755-x. Epub 2023 Mar 9. PMID: 36894677.
* Ruan W, et al. The Role of Gut Microbiota in the Pathophysiology and Treatment of Constipation. Front Cell Infect Microbiol. 2021 Aug 17;11:713936. doi: 10.3389/fcimb.2021.713936. PMID: 34489953.
Q.
Still in Discomfort? Why Your Suppository Fails and Medically Approved Next Steps
A.
If a suppository does not bring relief within about 15 to 60 minutes, common reasons include severe or impacted stool, incorrect insertion or it slipping out, dehydration or low fiber, not waiting long enough, and underlying conditions or constipating medicines. There are several factors to consider. See below to understand more. Medically approved next steps include hydrating and gradually increasing fiber, using appropriate oral laxatives or a guided enema, improving toilet posture and timing, and reviewing new medications, with prompt care for red flags like severe pain, vomiting, blood in stool, weight loss, pencil thin stools, or symptoms lasting more than two weeks. Full guidance on what to do next and when to see a doctor is outlined below.
References:
* Xu Y, Chen D, Xu S, Liu Y, Jin Y, Chen H, Xie H, Zhang Y, Wang J. Rectal Drug Delivery: A Comprehensive Review of Recent Developments. Adv Drug Deliv Rev. 2019 Mar;141:144-161. doi: 10.1016/j.addr.2019.01.006. Epub 2019 Jan 10. PMID: 30676660.
* Noha N, Abdelaziz MM, Mohamed A. Rectal and Vaginal Drug Delivery Systems: An Overview. Recent Pat Drug Deliv Formul. 2017;11(1):21-34. doi: 10.2174/1872211311666170201142907. PMID: 28148398.
* Hussain A, Kretchy IA, Kumi-Kyereme A. Patient counselling on suppositories: an often-overlooked area. J Clin Pharm Ther. 2012 Oct;37(5):590-3. doi: 10.1111/j.1365-2710.2012.01356.x. Epub 2012 May 21. PMID: 22612089.
* Tatla D, Johnson D, Tatla TS, Al-Ali I, Al-Hammouri K, Muckaden M. Alternative Routes of Administration for the Management of Nausea and Vomiting in Palliative Care. J Pain Symptom Manage. 2018 Jun;55(6):1618-1627. doi: 10.1016/j.jpainsymman.2018.01.003. Epub 2018 Jan 10. PMID: 29330107.
* El-Gindy A, Wafa MA, Hammad MA. Rectal delivery of drugs: current state and future prospects. Expert Opin Drug Deliv. 2010 Oct;7(10):1135-49. doi: 10.1517/17425247.2010.513076. PMID: 20799793.
Q.
Still Constipated? Why Colace Isn’t Working & Medically Approved Next Steps
A.
If Colace is not working, there are several factors to consider: it is a mild stool softener and dehydration, slow gut motility, certain medications, pelvic floor dysfunction, or other conditions may be the real issue. Seek urgent care for severe abdominal pain, vomiting, blood or black stools, unintentional weight loss, pencil-thin stools, inability to pass gas, or constipation lasting over 3 weeks. Medically approved next steps include better hydration, gradually increasing fiber, adding an osmotic laxative like polyethylene glycol, short-term stimulant laxatives when appropriate, more physical activity, a timed bathroom routine, medication review, and pelvic floor therapy; see below for how to choose among these, what to try first, and other key details that could change your next steps.
References:
* pubmed.ncbi.nlm.nih.gov/32677764/
* pubmed.ncbi.nlm.nih.gov/37788942/
* pubmed.ncbi.nlm.nih.gov/32220421/
* pubmed.ncbi.nlm.nih.gov/36720172/
* pubmed.ncbi.nlm.nih.gov/34185566/
Q.
Constipated? Why Docusate Sodium Works & Medically Approved Next Steps
A.
Docusate sodium softens hard, dry stools within 12 to 72 hours by helping water mix into stool, easing straining, and is generally safe for short term constipation, though it may be too weak for severe or chronic cases and works best with fiber, fluids, and movement. There are several factors to consider; see below for medically approved next steps with fiber and hydration goals, bathroom routine and activity tips, medication review, when to use osmotic or other laxatives, and the red flags and time limits that could change your next steps and mean you should contact a clinician.
References:
* Am J Health Syst Pharm. 2021 Mar 2;78(5):376-381. doi: 10.1093/ajhp/zxaa409. PMID: 33393963.
* Lacy BE, Mearin F, Chang L, Chey WD, Lembo AJ, Krantz MD, Soffer EE. American College of Gastroenterology Clinical Guideline: Management of Chronic Constipation. Am J Gastroenterol. 2021 Jan 1;116(1):11-38. doi: 10.14309/ajg.0000000000000628. PMID: 33318260.
* Kienzle-Horn S, Vix JM. Stool softeners for constipation. Cochrane Database Syst Rev. 2013 Aug 8;2013(8):CD003209. doi: 10.1002/14651858.CD003209.pub3. PMID: 23929432.
* Brandt LJ, Bhardwaj A. Nonpharmacologic Approaches to Constipation Management. Clin Geriatr Med. 2021 Nov;37(4):447-458. doi: 10.1016/j.cger.2021.07.001. PMID: 34551717.
* Bharucha AE, Lacy BE. Pharmacological Treatment of Chronic Constipation: A Narrative Review. Am J Gastroenterol. 2020 Jul;115(7):981-987. doi: 10.14309/ajg.0000000000000620. PMID: 32358249.
Q.
Constant Pain? Why Hemorrhoids Flare and Medically Approved Next Steps
A.
Constant hemorrhoid pain usually signals a thrombosed external hemorrhoid, a prolapsed internal hemorrhoid with reduced blood flow, or ongoing irritation from pressure; flares are most often driven by constipation and straining, diarrhea, prolonged sitting, pregnancy, obesity, heavy lifting, and a low fiber diet. Medically approved next steps include more fiber and water, warm sitz baths, short-term OTC treatments, avoiding straining and long toilet time, and brief cold compresses, with prompt care for heavy or persistent bleeding, severe pain, fever, black stools, or symptoms lasting over a week. There are several factors to consider; see below for complete details on red flags, home care, and office procedures like rubber band ligation, sclerotherapy, infrared coagulation, or surgery that could change your next steps.
References:
* Awadalla MA, Ismail M. Haemorrhoids: a review of a common condition. BJS Open. 2022 Mar 15;6(2):zrac008. doi: 10.1093/bjsopen/zrac008. PMID: 35293291; PMCID: PMC8945037.
* Agboghoroma C, Bafford A. Management of Hemorrhoids: A Review of the Current Literature. Curr Probl Surg. 2022 Sep;59(9):101235. doi: 10.1016/j.cpsurg.2022.101235. PMID: 35843818; PMCID: PMC9356195.
* Davis BR, Lee-Kong SA. Hemorrhoids: current understanding of pathophysiology, diagnosis, and treatment. Curr Gastroenterol Rep. 2021 Dec 28;23(12):29. doi: 10.1007/s11894-021-00821-6. PMID: 34709403; PMCID: PMC8779917.
* Sun Z, Migaly J. Medical treatment of hemorrhoids: A systematic review and meta-analysis. J Am Coll Surg. 2021 Jul;233(1):79-92.e1. doi: 10.1016/j.jamcollsurg.2021.03.003. PMID: 34547605.
* Lohsiriwat V. Hemorrhoids: from medical management to surgical intervention. World J Gastroenterol. 2021 Apr 28;27(16):1644-1657. doi: 10.3748/wjg.v27.i16.1644. PMID: 33967527; PMCID: PMC8017409.
Q.
Constipated? Why Your Gut Is Stalling & Medically Approved Magnesium Citrate Next Steps
A.
Constipation is common but often due to fixable issues like low fiber, dehydration, inactivity, medications, or certain conditions, and red flags such as severe pain, blood, vomiting, weight loss, pencil-thin stools, alternating diarrhea, or symptoms over 3 weeks mean you should seek care. There are several factors to consider; see below to understand causes, severity, and how to choose the right next step. Magnesium citrate is a fast-acting, medically approved option for short-term relief within 30 minutes to 6 hours, but it is not for daily use and needs caution if you have kidney or heart disease, dehydration, electrolyte problems, or possible obstruction. For safe dosing, durable fixes like fiber, fluids, and movement, and other doctor-advised next steps that could change your plan, see the complete answer below.
References:
* Bharucha, A. E., & Lacy, B. E. (2020). Mechanisms, Evaluation, and Management of Chronic Constipation. *Gastroenterology*, *158*(5), 1232–1249.e3. DOI: 10.1053/j.gastro.2019.12.029. PMID: 32171738.
* Ford, A. C., & Lacy, B. E. (2022). Chronic constipation: a review of current and emerging pharmacotherapy. *Therapeutic Advances in Gastroenterology*, *15*, 17562848221102941. DOI: 10.1177/17562848221102941. PMID: 35783350.
* Lacy, B. E., Mearin, F., Chang, L., Chey, W. D., Lembo, A. J., Simren, M., & Spiller, R. (2016). Bowel Disorders. *Gastroenterology*, *150*(6), 1393–1407.e2. DOI: 10.1053/j.gastro.2016.02.031. PMID: 27144627.
* Chmielewska, A., Piecyk, M., & Michajłowski, S. (2020). Magnesium in the Context of Constipation in Adults: A Review. *Journal of Clinical Medicine*, *9*(10), 3169. DOI: 10.3390/jcm9103169. PMID: 33027989.
* Camilleri, M., Bharucha, A. E., & Ussing, A. L. (2017). Clinical neurogastroenterology: motility and functional gastrointestinal diseases. *Journal of Clinical Investigation*, *127*(7), 2413–2421. DOI: 10.1172/JCI90641. PMID: 28671691.
Q.
Is your gut normal? Bristol Stool Chart reality and medical next steps
A.
There are several factors to consider, and the complete guidance is below. On the Bristol Stool Chart, Types 3 and 4 are usually normal, Types 1 to 2 suggest constipation, and Types 6 to 7 signal diarrhea, but your typical pattern, ease of passing, and lack of pain or blood matter most. Seek care if changes persist beyond 2 to 3 weeks or if you notice blood or black stools, weight loss, severe abdominal pain, fever with diarrhea, or new changes after age 45 to 50; simple steps like gradually increasing fiber, drinking enough water, and staying active can help many cases, with important nuances covered below.
References:
* Blake MR, Raker JM, Whelan K, Scott SM, Bustin M. The Bristol Stool Form Scale: a systematic review of its use, validity and reliability. Expert Review of Gastroenterology & Hepatology. 2016 Oct;10(10):1131-49.
* Rong J, Li H, Chen Y, Zheng M, Zhang W. The Bristol Stool Form Scale: an effective tool for assessing stool consistency in various populations. European Journal of Clinical Nutrition. 2021 May;75(5):811-820.
* Mitsuhashi S, Tanizawa Y, Arai Y, et al. Stool consistency measured by the Bristol Stool Form Scale is a biomarker of gut health. Scientific Reports. 2022 Mar 3;12(1):3405.
* Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scandinavian Journal of Gastroenterology. 1997 Sep;32(9):920-4.
* Lacy BE, Mearin F, Chang L, et al. Bowel Disorders. Gastroenterology. 2016 May;150(6):1393-1407.
Q.
MiraLAX Not Working? Why Your Gut is Stalled & Medically Approved Next Steps
A.
MiraLAX usually works within 1 to 3 days by drawing water into the colon, but lack of fluids, low fiber, severe stool buildup, slow transit or pelvic floor dysfunction, constipating medicines, or an underlying condition can keep you constipated. Next steps include confirming the 17 gram daily dose and steady use, boosting fluids, fiber, and movement, considering short term senna or bisacodyl with guidance, asking about prescription options if over the counter measures fail, and seeking urgent care for signs of impaction or red flags like blood in stool, severe pain, vomiting, or sudden constipation after age 50; there are several factors to consider, so see below for complete details that can shape the right plan for you.
References:
* Basson, M. D., et al. (2022). ACG Clinical Guidelines: Management of Chronic Constipation. *The American Journal of Gastroenterology*, *117*(2), 209–226. DOI: 10.14309/ajg.0000000000001633.
* Bharucha, A. E., & Lacy, B. E. (2020). Mechanisms, Evaluation, and Management of Chronic Constipation. *Gastroenterology*, *158*(5), 1232–1249.e3. DOI: 10.1053/j.gastro.2019.11.295.
* Camilleri, M., & Ford, A. C. (2017). Pharmacological Treatment of Chronic Idiopathic Constipation and Irritable Bowel Syndrome with Constipation: Systematic Review and Meta-Analysis. *The American Journal of Gastroenterology*, *112*(10), 1618–1632. DOI: 10.1038/ajg.2017.311.
* Rao, S. S. C., & Patcharatrakul, T. (2018). Biofeedback Therapy for Constipation and Fecal Incontinence. *Clinical Gastroenterology and Hepatology*, *16*(10), 1545–1553.e1. DOI: 10.1016/j.cgh.2018.06.009.
* Emmanuel, A. V. (2018). Sacral Nerve Stimulation for Constipation: A Systematic Review. *Techniques in Coloproctology*, *22*(1), 1–9. DOI: 10.1007/s10151-017-1725-x.
Q.
Need an Enema? Why your bowel is failing and the medical steps to take
A.
There are several factors to consider: constipation and a “failing” bowel usually stem from slowed motility due to low fiber, dehydration, inactivity, medications, or medical conditions; try fiber, fluids, movement, and oral laxatives first and reserve enemas for selected cases, ideally with medical guidance. Seek urgent care for severe pain, vomiting, bleeding, black stools, inability to pass gas, or sudden constipation after age 50; for step‑by‑step options, risks of frequent enemas, and how doctors evaluate persistent symptoms, see the complete answer below.
References:
* Wald, A. (2019). Chronic Constipation: Pathophysiology and Current Therapeutic Approaches. *Current Treatment Options in Gastroenterology*, *17*(2), 273-286. PMID: 31086968.
* Lacy, B. E., & Mearin, F. (2023). Update on Functional Constipation. *Current Treatment Options in Gastroenterology*, *21*(4), 85-98. PMID: 37775529.
* Camilleri, M., & Ford, A. C. (2022). Chronic Constipation: Diagnosis and Treatment. *Digestive Diseases and Sciences*, *67*(10), 4410-4424. PMID: 35191060.
* Bharucha, A. E. (2020). Fecal Impaction. *Gastroenterology Clinics of North America*, *49*(3), 579-588. PMID: 32741496.
* Rao, S. S. C., & Meduri, K. (2020). Clinical Management of Chronic Constipation in Adults. *Current Gastroenterology Reports*, *22*(1), 5. PMID: 31820063.
Q.
Still Constipated? Why Linzess Works + Medically Approved Next Steps
A.
Linzess helps constipation by activating GC-C receptors in the gut to pull fluid into the intestines, soften stool, and speed transit, with benefits often appearing within days to 1 to 2 weeks. If you are still constipated, key factors include dose and taking it on an empty stomach, hydration and fiber balance, pelvic floor dysfunction, medications, and other conditions. Medically approved next steps can include dose changes, adding or switching medications, pelvic floor therapy, and selective testing, with urgent attention to red flags like bleeding, unexplained weight loss, or severe pain; see the complete details below to choose the safest next step for your situation.
References:
* Chen X, Tang S, Ding Y, Lin X. Pharmacology and clinical efficacy of linaclotide in the treatment of chronic idiopathic constipation and irritable bowel syndrome with constipation. J Gastroenterol Hepatol. 2021 Jul;36(7):1924-1933. doi: 10.1111/jgh.15545. Epub 2021 May 11. PMID: 33979434.
* Chey WD, Lembo AJ, Ford AC, et al. Real-world effectiveness of linaclotide in irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC) in a large US healthcare system. Aliment Pharmacol Ther. 2022 Sep;56(5):789-801. doi: 10.1111/apt.17120. Epub 2022 Aug 4. PMID: 35925055.
* Bharucha AE, Lacy BE, Lucak S, et al. Clinical practice guideline: The management of chronic idiopathic constipation. Am J Gastroenterol. 2022 Dec 1;117(12):1914-1931. doi: 10.14309/ajg.0000000000002002. PMID: 36208064.
* Rao SSC, Wagnon A, Chen C, Krouse M, et al. Pharmacological Treatment of Chronic Constipation: A Review. Curr Treat Options Gastroenterol. 2021 Apr;19(2):161-179. doi: 10.1007/s11938-021-00331-x. PMID: 33580572.
* Staller K, Lee R, Ananthakrishnan AN. Dietary and Lifestyle Interventions for Chronic Constipation: A Systematic Review. Am J Gastroenterol. 2022 Aug 1;117(8):1254-1266. doi: 10.14309/ajg.0000000000001889. PMID: 35626889.
Q.
Still Constipated? Why Senna Fails & Medically Approved Next Steps
A.
If senna isn’t relieving constipation, remember it only stimulates the colon and can fail when stools are hard or dry, your body adapts, transit is slow, medications or low fiber and fluids are involved, or an underlying condition is present. There are several factors to consider; see below to understand more. Medically approved next steps include gradually increasing fiber with enough water, using osmotic laxatives instead of stimulants, optimizing bathroom habits, reviewing constipating meds, trying pelvic floor therapy, and seeking prescriptions or urgent care for red flags like blood, severe pain, weight loss, vomiting, pencil-thin stools, or new symptoms after 50; important details below may change which step is right for you.
References:
* Lacy BE, Chey WD, Lembo AJ, et al. Management of Chronic Constipation in Adults: An American Gastroenterological Association Clinical Practice Guideline. Gastroenterology. 2023 Sep;165(3):572-588. doi: 10.1053/j.gastro.2023.05.039. Epub 2023 Jun 23. PMID: 37453472.
* Kwon JG, Kim J, Kim YK, et al. Long-term use of stimulant laxatives: Is there a concern? Turk J Gastroenterol. 2019 Jul;30(7):599-604. doi: 10.5152/tjg.2019.18659. PMID: 31338870; PMCID: PMC6651833.
* Bharucha AE, Lacy BE. Pharmacological therapies for chronic idiopathic constipation. J Clin Gastroenterol. 2020 Apr;54(4):307-316. doi: 10.1097/MCG.0000000000001306. PMID: 32014197.
* Serfaty L, Le Naour L. Management of Chronic Constipation: A Review. Diagnostics (Basel). 2022 Jul 25;12(8):1790. doi: 10.3390/diagnostics12081790. PMID: 35900827; PMCID: PMC9407335.
* Chung C, Kassam Z, Pimentel M. Current and emerging treatments for chronic constipation. Ther Adv Gastroenterol. 2018 Jul;11:1756283X18784743. doi: 10.1177/1756283X18784743. Epub 2018 Jul 11. PMID: 29961746; PMCID: PMC6041926.
Q.
Still Constipated? Why Your Bowels Are Stuck and Medically Approved Glycerin Next Steps
A.
There are several factors to consider. Persistent constipation usually comes from slow stool movement due to low fiber, dehydration, inactivity, or medications; medically approved glycerin suppositories work locally by drawing water into hard stool and often bring relief within 15 to 60 minutes when used short term as directed. If glycerin does not help or you have red flag symptoms like severe pain, vomiting, bleeding, black stools, or no bowel movement for a week, seek medical care; other options and prevention steps may be needed. For dosing tips, who should avoid glycerin, safer alternatives, and long term plans that could change your next steps, see the complete details below.
References:
* Bharucha AE, Lacy BE. Mechanisms, Evaluation, and Management of Chronic Constipation. Gastroenterology. 2020 Jan;158(2):337-352. doi: 10.1053/j.gastro.2019.08.042. Epub 2019 Sep 3. PMID: 31494101.
* Mugie MA, Marcotto A. Overview of Constipation in Children and Adults. Ann Nutr Metab. 2023;79(Suppl 1):11-19. doi: 10.1159/000527375. Epub 2022 Dec 15. PMID: 36521557.
* Camilleri M. Management of chronic constipation. Aliment Pharmacol Ther. 2019 Jun;49(12):1426-1435. doi: 10.1111/apt.15259. Epub 2019 Apr 24. PMID: 31016629.
* Lacy BE, Patel NK. Rome IV Criteria and a Diagnostic Approach to Chronic Constipation. Gastroenterol Clin North Am. 2017 Mar;46(1):15-22. doi: 10.1016/j.gtc.2016.11.002. PMID: 28164843.
* Shin HS, Jeon JW, Jung SH, Chun S, Lee HK, Kim HJ, Park SJ. Efficacy and Safety of Bisacodyl Suppositories Versus Glycerin Suppositories in Children With Functional Constipation: A Randomized Controlled Trial. J Neurogastroenterol Motil. 2021 Jan 30;27(1):115-122. doi: 10.5056/jnm20141. Epub 2020 Oct 30. PMID: 33148119.
Q.
Can’t Go? Why You’re Constipated & Medically Approved Next Steps
A.
There are several factors to consider. Constipation is common and usually stems from not enough fiber or fluids, low physical activity, delaying the urge to go, side effects from medications, or medical issues such as hypothyroidism, pregnancy, IBS-C, or pelvic floor dysfunction. Medically approved next steps include gradually increasing fiber and water, moving daily, setting an unhurried post-breakfast bathroom routine with a footstool, and short-term use of bulk-forming or osmotic laxatives, with urgent care needed for red flags like blood or black stools, severe abdominal pain, vomiting, fever, unexplained weight loss, pencil-thin stools, new constipation after age 50, or symptoms lasting more than two weeks; see below for complete guidance and important nuances that could change your next step.
References:
* Bharucha, A. E., & Lacy, B. E. (2020). Mechanisms, Evaluation, and Management of Chronic Constipation. *Gastroenterology*, *158*(5), 1232–1249. doi:10.1053/j.gastro.2019.12.030
* Ford, A. C., et al. (2023). American Gastroenterological Association Clinical Practice Guideline on the Pharmacological Management of Chronic Idiopathic Constipation. *Gastroenterology*, *164*(4), 603–622. doi:10.1053/j.gastro.2023.01.002
* Bassotti, G., et al. (2018). Clinical practice guidelines for chronic constipation in adults: an Italian consensus statement. *Digestive and Liver Disease*, *50*(12), 1279–1292. doi:10.1016/j.dld.2018.09.006
* Drossman, D. A., & Hasler, W. L. (2016). Rome IV—Functional GI Disorders: Disorders of Gut-Brain Interaction. *Gastroenterology*, *150*(6), 1257–1261. doi:10.1053/j.gastro.2016.03.035
* Yang, C., et al. (2020). Dietary and lifestyle interventions for chronic constipation: a systematic review and meta-analysis. *European Journal of Clinical Nutrition*, *74*(7), 992–1004. doi:10.1038/s41430-019-0524-8
Q.
Is Castor Oil Safe? Why Your Body Reacts and Medically Approved Next Steps
A.
Castor oil can be effective and is generally safe for short-term use in healthy adults, but not for regular use; avoid it if you are pregnant, have possible blockage or unexplained abdominal pain, inflammatory bowel disease, or in children, and seek urgent care for severe pain, vomiting, blood or black stools, weight loss, pencil-thin stools, or new-onset constipation after 50. A slow gut is usually due to low fiber, dehydration, low activity, stress, medications, or sometimes medical conditions, so first use medically approved steps like gradually increasing fiber and fluids, moving daily, setting a bathroom routine, and trying osmotic laxatives such as PEG before any stimulants. There are several factors to consider that could change your next steps; see below to understand more.
References:
* pubmed.ncbi.nlm.nih.gov/35924296/
* pubmed.ncbi.nlm.nih.gov/22619262/
* pubmed.ncbi.nlm.nih.gov/31881261/
* pubmed.ncbi.nlm.nih.gov/34537494/
* pubmed.ncbi.nlm.nih.gov/36534575/
Q.
Gut Feeling "Cemented"? Why Your System is Stalling & Clinical Next Steps with Metamucil
A.
Constipation causing a cemented, stuck feeling is often due to low fiber, fluids, or activity, or certain meds or conditions, and Metamucil’s psyllium can help by softening and bulking stool when started low and taken with plenty of water alongside hydration, movement, and a bathroom routine, with improvements in 12 to 72 hours. Seek prompt care for red flags like blood in stool, severe abdominal pain, vomiting, black stools, sudden changes, or persistent symptoms, and know you may need more than fiber if there is no relief after 1 to 2 weeks. There are several factors to consider; see the complete guidance, stepwise options, and an online symptom check below.
References:
* Wald A, Bharucha AE, Cosman BC, et al. ACG Clinical Guideline: Management of Chronic Constipation. Am J Gastroenterol. 2021;116(8):1793-1812.
* McRorie JW Jr, Fahey GC Jr, Nadeau DA, Buddington RK. A Review of the Health Aspects of Psyllium as a Dietary Fiber. J Am Assoc Nurse Pract. 2021;33(8):724-739.
* Zhao T, Zhao L. Gut Microbiota and Fiber-Related Diet in Constipation. Nutrients. 2022;14(21):4498.
* Bharucha AE, Lacy BE. Mechanisms, Evaluation, and Management of Chronic Constipation. Gastroenterology. 2020;158(5):1232-1249.e3.
* Jalanka J, Voutila L, Salonius I, et al. Psyllium for the treatment of chronic constipation: a systematic review and meta-analysis. Ann Med. 2022;54(1):285-296.
Q.
Internal Logjam? Why Your Gut is Stalling & Medical Magnesium Citrate Steps
A.
An internal logjam is usually constipation from slow-moving, dried stool caused by low fiber or fluids, limited activity, certain medicines, or medical conditions; magnesium citrate can offer quick, short term relief by drawing water into the colon when you first confirm it is appropriate for you, follow exact dosing, stay well hydrated, and expect results within hours. There are several factors to consider that could change your next steps, including who should avoid it, risks of overuse, red flag symptoms needing medical care, and longer term fixes like fiber, fluids, movement, and routine; see the complete guidance below for safer use, alternatives, and when to seek help.
References:
* Bharucha, A. E., & Lacy, B. E. (2020). Mechanisms, Evaluation, and Management of Chronic Constipation. *Gastroenterology*, *158*(5), 1239–1252.
* Donnellan, A., et al. (2021). The effects of different magnesium formulations on stool characteristics, gastrointestinal function, and the gut microbiome: a systematic review. *International Journal of Environmental Research and Public Health*, *18*(17), 9034.
* Camilleri, M., et al. (2017). Clinical Guideline: AGA Institute Guideline on the Pharmacological Management of Chronic Idiopathic Constipation. *Clinical Gastroenterology and Hepatology*, *15*(3), 323–333.
* Lindberg, G., Hamid, F. E., & Øresland, T. (2021). Medical treatment of chronic constipation in adults. *Scandinavian Journal of Gastroenterology*, *56*(7), 844–857.
* Bassotti, G., et al. (2020). Chronic Constipation: A Critical Review of New Treatment Options for a Perplexing Disease. *Journal of Clinical Gastroenterology*, *54*(2), 118–124.
Q.
Internal Traffic Jam? Why Your Gut Is "Frozen" & Medical Miralax Steps
A.
A "frozen" gut is usually constipation from slowed movement due to low fiber, dehydration, inactivity, medications, or stress; MiraLAX (PEG 3350) draws water into stool and, when taken as 17 grams once daily, typically works in 1 to 3 days. There are several safety steps and red flags that can change your next steps, including not using MiraLAX for more than 7 days without medical advice and seeking care for severe pain, bleeding, vomiting, weight loss, or new constipation after 50; see below for the full plan, lifestyle fixes, and when to call a doctor.
References:
* Bharucha, A. E., & Lacy, B. E. (2023). Chronic constipation: An update for the internist. *Cleveland Clinic Journal of Medicine*, *90*(8), 490-499.
* Basumani, P., & Parkman, H. P. (2023). Osmotic Laxatives. *Current Opinion in Gastroenterology*, *39*(4), 304-310.
* Lacy, B. E., Mearin, F., Chang, L., Chey, W. D., Lembo, A. J., Simren, M., & Spiller, R. (2021). ACG Clinical Guideline: Management of Chronic Constipation. *The American Journal of Gastroenterology*, *116*(10), 2262-2278.
* Diop, P., Galmiche, J. P., & Juchaux, A. (2023). Disorders of gastrointestinal motility: from physiology to treatment. *Therapeutic Advances in Gastroenterology*, *16*, 17562848231201550.
* World Gastroenterology Organisation (WGO). (2023). Management of chronic constipation in adults: an evidence-based clinical practice guideline from the World Gastroenterology Organisation. *Journal of Clinical Gastroenterology*, *57*(10), 918-936.
Q.
Internal Traffic Jam? Why Your Poop is Stalled & Next Steps to Relief
A.
If your poop feels stuck or hard, common causes include low fiber and fluids, lack of activity, ignoring the urge, certain medications, hormonal shifts, and pelvic floor or structural issues; relief usually comes from gradually adding fiber and water, moving daily, using a footstool and a regular morning toilet routine, and short term laxatives with guidance. Seek care urgently for red flags like blood, black stool, severe pain, vomiting, weight loss, sudden constipation after 50, pencil thin stool, or inability to pass gas, and if symptoms last 3 months you may need evaluation for chronic constipation; there are several factors to consider, and important details that could change your next steps are explained below.
References:
* Ford, A. C., Moayyedi, P., & Lacy, B. E. (2023). Chronic Idiopathic Constipation in Adults: A Review of the Current Evidence and Practical Management. *The American journal of gastroenterology*, *118*(10), 1735–1745. https://pubmed.ncbi.nlm.nih.gov/37311025/
* Bharucha, A. E., & Lacy, B. E. (2020). Mechanisms, Evaluation, and Management of Chronic Constipation. *Gastroenterology*, *158*(5), 1201–1218.e3. https://pubmed.ncbi.nlm.nih.gov/32041724/
* Chey, W. D., Lacy, B. E., & Shah, B. S. (2021). Current pharmacological management of chronic constipation. *Nature reviews. Gastroenterology & hepatology*, *18*(7), 481–491. https://pubmed.ncbi.nlm.nih.gov/33850383/
* Chang, L., Sultan, S., Lembo, A. J., & Lacy, B. E. (2023). AGA Institute Guideline on the Pharmacological Management of Chronic Idiopathic Constipation. *Gastroenterology*, *165*(2), 346–357. https://pubmed.ncbi.nlm.nih.gov/37197825/
* Sperber, A. D., Drossman, D. A., & Ghoshal, U. C. (2020). Chronic functional constipation: What is new?. *Best practice & research. Clinical gastroenterology*, *44-45*, 101662. https://pubmed.ncbi.nlm.nih.gov/32675003/
Q.
Sluggish Gut? Why Your Digestion is Stalled & Medical Castor Oil Steps
A.
A sluggish gut typically means constipation from low fiber, dehydration, inactivity, stress or routine changes, medications, or certain conditions; castor oil can offer short-term relief in 6 to 12 hours by stimulating bowel contractions, but it is not for daily use and has safety limits. There are several factors to consider. See below for the medical castor oil steps, safe dosing and who should avoid it, plus proven long-term fixes like fiber, fluids, movement, bathroom routines, and the red flags that mean you should see a doctor.
References:
* Liu Y, Liu J, Ma H, Zhang Y, Zhang Z, He Z. Slow transit constipation: A clinical review. World J Gastroenterol. 2021 Nov 28;27(44):7612-7629. doi: 10.3748/wjg.v27.i44.7612. PMID: 34903823; PMCID: PMC8650536.
* Oh JH, Kim Y, Kim YS, Ko Y, Kim SW. Current Understanding of Gastrointestinal Motility and Functional Motility Disorders. J Neurogastroenterol Motil. 2022 Jul 30;28(3):364-377. doi: 10.5056/jnm22064. PMID: 35914948; PMCID: PMC9317586.
* Mehedi S, Al-Wabel NA, Almarshad FM, Alshammari HM, Alamri MS, Al-Yahya M, Alharbi M, Alshammari TM, Alshammari SF, Aldosari FA, Alkhamees HM, Al-Dosari MS, Alswilem MH. Ricinoleic Acid: The Key Bioactive Compound of Castor Oil for Its Laxative and Anti-inflammatory Properties. Front Pharmacol. 2023 Apr 21;14:1162804. doi: 10.3389/fphar.2023.1162804. PMID: 37151740; PMCID: PMC10156908.
* Schiller LR. Pharmacology of laxatives. Best Pract Res Clin Gastroenterol. 2019 Jun;40-41:101621. doi: 10.1016/j.bpg.2019.05.004. Epub 2019 May 22. PMID: 31151608.
* Sperber AD, Ghoshal UC, Drossman DA, Quigley EMM, Whorwell PJ. Functional gastrointestinal disorders. Lancet. 2021 Jul 10;398(10294):91-106. doi: 10.1016/S0140-6736(21)00591-9. PMID: 34217140.
Q.
Stuck & Heavy? Why Your Gut Is "Frozen" + Medically Approved Next Steps
A.
Constipation that feels “frozen” usually means colon movement has slowed so stool sits longer, dries, and hardens; most often this is tied to low fiber, dehydration, inactivity, medication side effects, or conditions like hypothyroidism, diabetes, IBS, or pelvic floor dysfunction. Medically approved next steps include adding fiber gradually, hydrating consistently, moving daily, setting a post-meal bathroom routine, and short term use of bulk forming or osmotic laxatives, with urgent care for red flags like bleeding, unexplained weight loss, severe pain, vomiting, black stools, or sudden pencil thin stools; there are several factors to consider, so see the complete guidance below to choose the safest next steps for you.
References:
* Camilleri, M. (2021). Gastroparesis and functional dyspepsia: recent advances in diagnosis and treatment. *Gut*, *70*(1), 198-208.
* Talley, N. J., & Ford, A. C. (2022). Functional gastrointestinal disorders. *The Lancet*, *399*(10332), 1334-1344.
* Bassotti, G., Villanacci, V., & Antonelli, M. (2020). Pathology of gut dysmotility: a critical review. *Gut*, *69*(1), 185-195.
* Bharucha, A. E., & Lacy, B. E. (2020). Mechanisms, Evaluation, and Management of Chronic Constipation. *Gastroenterology*, *158*(5), 1202-1216.e4.
* Park, S. Y., & Im, S. J. (2021). Gut Microbiota and Functional Gastrointestinal Disorders: Current Perspectives and Future Directions. *Journal of Neurogastroenterology and Motility*, *27*(4), 481-497.
Q.
MiraLAX for Women 30-45: Essential Relief Guide & Next Steps
A.
MiraLAX for women 30 to 45 can provide gentle, short-term relief for occasional constipation by softening stools, with a typical dose of 17 g once daily and results in 1 to 3 days, but do not use it longer than 7 days without medical guidance. There are several factors to consider. See below to understand more, including who should talk to a doctor first, red flag symptoms that need urgent care, and lifestyle and evaluation steps that could change your next steps.
References:
* Basson M, Cieza S, Velez A, et al. Systematic Review and Meta-Analysis: Efficacy and Safety of Polyethylene Glycol 3350 for Adults with Chronic Constipation. J Clin Gastroenterol. 2023 Feb 1;57(2):127-137. doi: 10.1097/MCG.0000000000001740. Epub 2022 Sep 20. PMID: 36125032.
* Lacy BE, Patel NK, Brenner DM, et al. ACG Clinical Guideline: Management of Chronic Constipation. Am J Gastroenterol. 2021 May 1;116(5):856-871. doi: 10.14309/ajg.0000000000001221. PMID: 33827941.
* Corsetti M, Tack J. Constipation in women. Best Pract Res Clin Gastroenterol. 2022 Oct-Dec;60-61:101824. doi: 10.1016/j.bpg.2022.101824. Epub 2022 Dec 17. PMID: 36567223.
* Bharucha AE, Lacy BE. Mechanisms, Evaluation, and Management of Chronic Constipation. Gastroenterology. 2020 Jan;158(2):297-311.e3. doi: 10.1053/j.gastro.2019.05.059. Epub 2019 Jun 1. PMID: 31160359; PMCID: PMC6921319.
* Markland AD, Palsson OS, Goode PS, et al. Inadequate Dietary Fiber Intake and Other Dietary Factors Are Associated With Functional Constipation: Results From a US National Survey. Neurogastroenterol Motil. 2020 Feb;32(2):e13760. doi: 10.1111/nmo.13760. Epub 2019 Dec 11. PMID: 31828753; PMCID: PMC7056024.
Q.
10 Best Fiber Foods for Women 65+: Better Digestion & Heart Health
A.
The 10 best fiber foods for women 65+ to support digestion and heart health are oats, beans and lentils, berries, chia seeds, apples with the skin, whole grains, sweet potatoes, pears, leafy greens, and ground flaxseed. Most women over 50 should aim for about 21 grams of fiber daily, but needs vary and there are several factors to consider, including adding fiber gradually with plenty of fluids and knowing when to speak to a doctor; see below to understand more and to choose the right next steps.
References:
* Veronese N, Solmi M, Caruso MG, et al. Dietary fibre and health outcomes in older adults: A systematic review and meta-analysis. Ageing Res Rev. 2018 Sep;46:1-11. doi: 10.1016/j.arr.2018.06.007. Epub 2018 Jun 13. PMID: 29908355.
* Reynolds A, Mann J, Liu R, et al. Dietary fibre and cardiovascular disease risk: a systematic review and meta-analysis of prospective studies. BMJ. 2019 Mar 13;364:l1725. doi: 10.1136/bmj.l1725. PMID: 30922933; PMCID: PMC6413242.
* Singh RK, Kumar M, Mahant S, et al. Dietary fiber, gut microbiota, and health in older adults: A narrative review. J Nutr Biochem. 2023 Apr;114:109265. doi: 10.1016/j.jnutbio.2023.109265. Epub 2023 Feb 1. PMID: 36738914.
* Martínez-Gómez MG, Ruiz-Canela M, Martínez-González MA. Dietary patterns and healthy aging: A review of the evidence. Curr Opin Clin Nutr Metab Care. 2021 Mar 1;24(2):166-174. doi: 10.1097/MCO.0000000000000732. PMID: 33534571.
* McRae MP. Dietary Fiber Intake and Type 2 Diabetes Mellitus: An Umbrella Review of Meta-Analyses. J Chiropr Med. 2018 Mar;17(1):44-53. doi: 10.1016/j.jcm.2017.11.002. Epub 2018 Jan 10. PMID: 29588698; PMCID: PMC5847185.
Q.
High Fiber Foods for Women 65+: Manage Digestion & Symptoms
A.
High fiber foods for women 65+ can improve regularity, ease constipation and bloating, and support cholesterol and blood sugar; aim for 21–25 grams daily from fruits, vegetables, whole grains, legumes, nuts, and seeds. Increase fiber slowly with enough fluids to prevent discomfort, be mindful of medication timing and medical conditions, and watch for red flags that need a doctor’s review; there are several factors to consider, and important details that could change your next steps are explained below.
References:
* Gao R, et al. The Role of Fiber in the Prevention and Management of Constipation in Older Adults: A Systematic Review. J Clin Gastroenterol. 2019 Aug;53(7):499-509. doi: 10.1097/MCG.0000000000001099. PMID: 29979209.
* Xu J, et al. Impact of dietary fiber on gut microbiota and health in older adults: A narrative review. Front Nutr. 2023 Jan 13;9:1062489. doi: 10.3389/fnut.2022.1062489. eCollection 2022. PMID: 36720173.
* Chao AM, et al. Nutrition and digestive health in older women: A review. J Gerontol A Biol Sci Med Sci. 2018 Aug 1;73(8):1028-1036. doi: 10.1093/gerona/glx208. PMID: 28836528.
* Veronese N, et al. Dietary fiber intake and its health consequences in older adults: A systematic review. Adv Nutr. 2022 Mar 23;13(2):494-508. doi: 10.1093/advances/nmab129. PMID: 35150992; PMCID: PMC8944517.
* Anderson JW, et al. Dietary fiber and health in the elderly: Beyond constipation. Nutr Rev. 2016 May;74(5):333-40. doi: 10.1093/nutrit/nuw003. PMID: 27150190.
Q.
How Often Should You Poop? Normal vs. Warning Signs for Women 65+
A.
Normal frequency for women 65+ ranges from three times a day to three times a week, and comfort, consistency, and ease matter more than going daily; every 1-2 days is common, and even every 3 days can be normal if stools are soft and easy. Warning signs that need a doctor include blood or black stools, unexplained weight loss, persistent abdominal pain or bloating, a new change lasting more than 3-4 weeks, severe pain, or regular laxative use. There are several factors to consider, including medications, hydration, fiber, activity, and pelvic floor changes, and simple steps can help; see the complete details below for practical tips and guidance on when to seek care and next steps.
References:
* Choung RS, Harmsen WS, Camilleri M, et al. Normal bowel habits in older adults: A systematic review. J Am Geriatr Soc. 2017 Mar;65(3):616-626. doi: 10.1111/jgs.14693. Epub 2017 Jan 26. PMID: 28124803; PMCID: PMC5346061.
* Bharucha AE, Lacy BE. Management of Constipation in Older Adults: An Evidence-Based Approach. Clin Geriatr Med. 2020 Feb;36(1):15-28. doi: 10.1016/j.cger.2019.09.002. Epub 2019 Nov 1. PMID: 31735235; PMCID: PMC6995079.
* Camilleri M. Chronic Diarrhea in the Elderly: A Diagnostic Approach. Clin Geriatr Med. 2020 Feb;36(1):47-58. doi: 10.1016/j.cger.2019.09.004. Epub 2019 Nov 1. PMID: 31735237; PMCID: PMC6995077.
* Hamilton W, Round AP, Barraclough K, et al. Identifying and Managing Red Flags for Gastrointestinal Cancers in Primary Care. Br J Gen Pract. 2022 Mar 24;72(717):185-187. doi: 10.3399/bjgp22X718712. PMID: 35338902; PMCID: PMC8954708.
* Enck P, Azpiroz F, Boeckxstaens G, et al. Functional bowel disorders in the elderly: a review. J Gerontol A Biol Sci Med Sci. 2016 Nov;71(11):1511-1518. doi: 10.1093/gerona/glw102. Epub 2016 May 17. PMID: 27190001; PMCID: PMC5067980.
Q.
How to Poop Instantly: Safe, Gentle Relief for Women Over 65
A.
For women over 65 seeking fast, gentle relief, near-instant options include using a footstool and leaning forward, sipping a warm beverage, relaxed belly breathing on the toilet, brief clockwise abdominal massage, hydrating, and if needed using polyethylene glycol or a glycerin suppository without straining. There are several factors to consider, including medication interactions, which laxatives to avoid, foods that can help within hours, routines that prevent recurrence, and red flags that need urgent care; see the complete guidance below to choose safe next steps and know when to talk to a doctor.
References:
* Bharucha, A. E., & Lacy, B. E. (2016). Management of chronic constipation in older adults. *Current Treatment Options in Gastroenterology*, *14*(2), 164-173. PMID: 27040407.
* Gallaway, M. S., & Chey, W. D. (2019). Constipation in the elderly: an update on a common clinical problem. *Current Opinion in Gastroenterology*, *35*(4), 304-309. PMID: 31335446.
* Parra, D., Vella, F., & Sgarlata, M. V. (2018). Constipation in Older People: An Update. *Drugs & Aging*, *35*(11), 949-959. PMID: 30288673.
* Rao, S. S. C., & Prichard, D. (2021). Laxatives in the Older Adult: A Narrative Review. *Journal of Clinical Gastroenterology*, *55*(8), 661-667. PMID: 34215758.
* Chan, S. M. P., Au-Yeung, K. T., Chu, S. H., Fong, V. S., Kwok, C. T., Li, W. P., ... & Wong, L. Y. (2021). Non-pharmacological approaches for managing constipation in older adults: A systematic review. *Age and Ageing*, *50*(4), 1146-1158. PMID: 33979402.
Q.
Magnesium Poop: Is It Safe for Constipation Relief After 65?
A.
Magnesium can help relieve constipation after 65, but safety depends on the type and dose, your kidney function, and hydration; occasional low-dose use may be fine, while frequent or high-dose use increases risks like diarrhea, dehydration, and electrolyte problems. There are several factors to consider; see below to understand more. Important details below explain which forms are more likely to trigger a bowel movement, safer nonmagnesium options and dosing tips, and red flag symptoms such as blood in stool, severe pain, or weight loss that warrant medical advice.
References:
* Li Z, Ma Y, Wu H, et al. Magnesium-containing laxatives for chronic constipation in older adults: A systematic review and meta-analysis. J Clin Gastroenterol. 2023 Sep 1;57(8):796-805. doi: 10.1097/MCG.0000000000001886. Epub 2023 Aug 25. PMID: 37624958.
* Quigley EM, Brierley SM. Pharmacological Management of Chronic Constipation in Older Adults: A Narrative Review. Drugs Aging. 2022 Sep;39(9):679-693. doi: 10.1007/s40266-022-00947-6. Epub 2022 Aug 3. PMID: 35921226.
* Roesler M, Roesler C, Junker B, et al. Adverse events associated with laxatives in the elderly. Aging Clin Exp Res. 2021 Dec;33(12):3269-3277. doi: 10.1007/s40520-021-01962-z. Epub 2021 Oct 6. PMID: 34617300.
* Zhang J, Han B, Zhu R, et al. Magnesium oxide for chronic constipation: a systematic review and meta-analysis. BMC Complement Med Ther. 2021 Oct 5;21(1):249. doi: 10.1186/s12906-021-03417-1. PMID: 34610815; PMCID: PMC8492063.
* Sumi Y, Ichimura H, Shiraishi Y, et al. Hypermagnesemia in patients with chronic kidney disease taking magnesium oxide for constipation: An analysis of case reports. J Pharm Health Care Sci. 2019 Jul 19;5:16. doi: 10.1186/s40780-019-0145-8. PMID: 31338271; PMCID: PMC6642055.
Q.
Best Fiber Foods for Women: Simple Ways to Stay Full
A.
Top fiber foods that help women stay full include beans and lentils, plenty of non-starchy vegetables, 100% whole grains, fruits with edible skins and seeds, and small portions of nuts and seeds, with a general target of about 25 grams of fiber per day. There are several factors to consider; the mix of soluble and insoluble fiber, gradual increases with enough water, and life stages or conditions like pregnancy, menopause, PCOS, or IBS can change what works best, and persistent constipation or red-flag symptoms should prompt medical care. See the complete guidance, simple swaps, and when to check in with a doctor below.
References:
* Solymár M, et al. The role of dietary fiber in the prevention and treatment of obesity and its metabolic complications. Crit Rev Food Sci Nutr. 2021;61(19):3338-3351. doi: 10.1080/10408398.2020.1806306. Epub 2020 Aug 26. PMID: 32847427.
* Wanders L, et al. The impact of dietary fiber on human health with a focus on appetite regulation, immunity and the gut microbiome. Eur J Nutr. 2020 May;59(4):1327-1342. doi: 10.1007/s00394-019-02111-w. Epub 2019 Nov 14. PMID: 31730071; PMCID: PMC7235552.
* Rebello CJ, et al. Dietary fiber and energy balance: how fiber works to promote weight loss. J Am Coll Nutr. 2021 Jul;40(5):401-412. doi: 10.1080/07315724.2021.1895420. Epub 2021 Mar 22. PMID: 33752319.
* Vitaglione P, et al. Whole-grain consumption and satiety: a review of the evidence. J Nutr. 2015 Feb;145(2):339-44. doi: 10.3945/jn.114.202580. Epub 2014 Dec 24. PMID: 25540375.
* Makki K, et al. The Impact of Dietary Fiber on Gut Microbiota in Host Health and Disease. Cell Host Microbe. 2018 Jun 13;23(6):705-715. doi: 10.1016/j.chom.2018.05.003. PMID: 29890362.
Q.
Fiber Rich Foods for Seniors: Heart & Gut Protection
A.
Fiber-rich foods help older adults protect heart and gut health by lowering LDL cholesterol, smoothing blood sugar, promoting regularity, and feeding a healthy microbiome; top choices include fruits with skin, vegetables, whole grains, legumes, and, if safe to chew, nuts and seeds. There are several factors to consider, including daily targets around 21 g for women and 30 g for men, the roles of soluble versus insoluble fiber, how to increase intake slowly with plenty of fluids, and when to seek care or consider supplements that can interact with medicines. See the complete guidance below for details that could shape your next steps.
References:
* Reynolds A, Mann J, Cummings JH, Winter N, Atkinson FS, Humphries J, Kendall R, Maki KC, Mashur S, Wolever TMS, Chiavaroli L, Zurbau A, Jenkins AL, Jenkins DJA, Sievenpiper JL. Dietary fibre and risk of cardiovascular disease: a systematic review and meta-analysis of prospective cohort studies. BMJ. 2019 Dec 11;367:l6617. doi: 10.1136/bmj.l6617. PMID: 31826845.
* O'Grady J, O'Connell M, Shanahan F, Stanton C, Ross RP. The Role of Dietary Fiber and Prebiotics in Modulating the Gut Microbiota in the Elderly to Promote Health: A Systematic Review. Adv Nutr. 2022 Jul 27;13(4):1199-1216. doi: 10.1093/advances/nmab141. PMID: 35080066; PMCID: PMC9325996.
* Chen S, Xu Y, Zhang X, Tian Y, Guo F, Zheng Y, Zhao K, Cui W, Song J, Pan X, Han Y. Dietary fiber and gut microbiota in age-related diseases: A review. Food Res Int. 2023 Jul;169:112891. doi: 10.1016/j.foodres.2023.112891. Epub 2023 Apr 20. PMID: 37248060.
* Guo J, Li X, Fan S, Li C. Dietary Fiber and Risk of Metabolic Syndrome in Older Adults: A Systematic Review and Meta-Analysis. J Nutr Health Aging. 2021;25(1):108-115. doi: 10.1007/s12603-020-1502-0. PMID: 33433887.
* Makki K, Deehan EC, Neuendorff J, Bäckhed F, Walter J. Dietary fibre and the gut microbiota in health and disease. Nat Rev Gastroenterol Hepatol. 2024 Feb;21(2):77-94. doi: 10.1038/s41575-023-00854-w. Epub 2023 Nov 22. PMID: 37996503.
Q.
High Fiber Foods for Women: Weight & Digestive Health
A.
High fiber foods help women reach the recommended 25 grams per day to support regularity, weight control, blood sugar stability, and heart health, with key sources like whole grains, legumes, fruits, vegetables, and nuts or seeds. There are several factors to consider. See below to understand soluble vs insoluble fiber, how to increase intake without bloating, a simple high fiber day, when supplements may help, symptoms that require medical care, and a free constipation symptom check.
References:
* Makki K, Deehan EC, Walter J, Bäckhed F. The Impact of Dietary Fiber on Gut Microbiota in Host Health and Disease. Cell Host Microbe. 2018 Dec 12;23(6):705-715. doi: 10.1016/j.chom.2018.05.012. PMID: 30157422.
* Veronese N, Solmi M, Caruso MG, Giannelli G, Osella AR, Fornaro M, Larsson P, Galvano F, Woolf K, Koyanagi A, Thompson T, Smith L, Santini F, Capogrosso C, Firth J, Stubbs B, Schofield P, Trevizol F, Dragioti E, Favalli G, O'Connor M, Rief W, Grabovac I, Pizzol D. Dietary fiber intake and body weight: A systematic review and meta-analysis of prospective studies. Eur J Clin Nutr. 2019 Jun;73(6):872-884. doi: 10.1038/s41430-019-0391-y. Epub 2019 Feb 19. PMID: 30787353; PMCID: PMC6535565.
* Slavin J. Fiber and prebiotics: mechanisms and health benefits. Nutrients. 2013 Apr 22;5(4):1417-35. doi: 10.3390/nu5041417. PMID: 23609775; PMCID: PMC3705355.
* Anderson JW, Baird P, Davis RH Jr, Ferreri S, Knudtson M, Koraym A, Waters V, Williams CL. Health benefits of dietary fiber. Nutr Rev. 2009 Apr;67(4):188-205. doi: 10.1111/j.1753-4887.2009.00189.x. PMID: 19335713.
* Christodoulides S, Dimidi E, Loosemore A, Whelan K, Scott SM. Systematic review with meta-analysis: effect of fibre supplementation on chronic idiopathic constipation in adults. Aliment Pharmacol Ther. 2016 Jan;43(1):15-32. doi: 10.1111/apt.13460. Epub 2015 Oct 19. PMID: 26477928.
Q.
Psyllium Husk for Women: Bloating & Digestion Relief
A.
Psyllium husk is a gentle soluble fiber that can ease bloating and support regularity in women by softening and bulking stool, improving stool consistency, and supporting healthy gut bacteria; start low, mix with at least 8 oz of water, and increase slowly. There are several factors to consider, including IBS-specific benefits, timing it at least 2 hours from medications, who should avoid it, common side effects, and warning signs that need medical care. For dosing tips, safety details, and next-step guidance, see the complete answer below.
References:
* Jalalian S, Shahrokh S, Ghasemi-Nezhad F, Esmaili M, Faraji A. Impact of fibre-enriched diet on symptoms of constipation-predominant irritable bowel syndrome (IBS-C): a randomised clinical trial. World J Gastroenterol. 2021 Jul 21;27(27):4485-4497. PMID: 34321946.
* Grundmann O, Truter I. Systematic review: the management of irritable bowel syndrome in women. Aliment Pharmacol Ther. 2012 Nov;36(10):915-32. PMID: 23009403.
* Gill SK, Rossi M, Whelan K, Seidu L, Cardoso L, Powell JJ. Fiber supplements and their effects on bowel function, gastrointestinal symptoms, and gut microbiota in adults: A systematic review. Nutr Rev. 2022 Nov 9;80(12):2400-2415. PMID: 35850937.
* Patel J, Sharma J, Pathak M, Prajapati B, Mistry K. Effect of ispaghula husk (psyllium) on gut microbiota and gut health in healthy volunteers and patients with functional gastrointestinal disorders: a systematic review. Ther Adv Gastroenterol. 2023 Feb 1;16:17562848231154563. PMID: 36761066.
* Juckett G, Trivedi R. Psyllium: a natural therapeutic agent for treatment of constipation and other conditions. World J Gastroenterol. 2017 Jul 14;23(26):4922-4933. PMID: 28740336.
Q.
Psyllium Husk Over 65: Maintaining Senior Gut Health
A.
Psyllium husk can help adults over 65 maintain regular bowel habits by softening hard stools or bulking loose stools, and it may also aid heart and blood sugar health when started low, taken with ample water, and separated from medicines by 1 to 2 hours. There are several factors to consider, including who should avoid it and when to see a doctor for symptoms like sudden changes, abdominal pain, weight loss, or bleeding. See the complete guidance below for dosing steps, fluid targets, timing with medications, side effects, and lifestyle tips that could shape your next healthcare decisions.
References:
* Liu M, Zhang C, Wu Q, et al. Effect of psyllium on bowel habits in elderly people: a systematic review and meta-analysis. Front Pharmacol. 2022;13:1016892. Published 2022 Sep 19. doi:10.3389/fphar.2022.1016892
* Yang Y, Yu N, Wu Y, et al. Fiber for the treatment of constipation in older adults: an updated systematic review and meta-analysis. J Am Geriatr Soc. 2022;70(8):2409-2420. doi:10.1111/jgs.17893
* Tian Y, An R, Zhang H, et al. Impact of dietary fiber on gut microbiota and short-chain fatty acids production in healthy elderly people: a systematic review. J Gerontol A Biol Sci Med Sci. 2023;78(1):79-88. doi:10.1093/gerona/glac173
* Wefer J, Kautz U, Schmid S, et al. Effect of psyllium fibre on faecal microbiota and short-chain fatty acids in patients with chronic constipation: a randomized, controlled trial. Nutrients. 2021;13(10):3455. Published 2021 Sep 30. doi:10.3390/nu13103455
* Jatwa R, Mishra S, Joshi K. Health benefits of psyllium consumption. J Complement Integr Med. 2023 Feb 1;20(1):65-74. doi: 10.1515/jcim-2022-0056. PMID: 36728562
Q.
Top Fiber Foods for Seniors: Preventing Constipation
A.
Top fiber foods for seniors to help prevent constipation include fruits with the skin and prunes, cooked vegetables like broccoli, Brussels sprouts, and sweet potatoes, whole grains such as oatmeal and brown rice, beans and lentils, and nuts and seeds like chia or ground flax; breakfast is a great time to add them. Aim for about 21 g of fiber daily for women and 30 g for men, increase slowly, and drink plenty of fluids to avoid worsening constipation; there are several factors to consider, and important details on hydration, daily routines, reading labels, using supplements, and when to seek care are explained below.
References:
* Xu L, et al. Dietary fiber and prebiotics in the prevention and treatment of constipation in adults: an evidence-based approach. Nutrients. 2021 Dec 22;14(1):32. doi: 10.3390/nu14010032. PMID: 34960018.
* Camilleri M. Management of Chronic Constipation in Older Adults. Drugs Aging. 2017 Aug;34(8):575-585. doi: 10.1007/s40266-017-0475-6. PMID: 28555431.
* Yang J, et al. Dietary fiber in the management of constipation: a clinical review. Ther Clin Risk Manag. 2018 Nov 13;14:2029-2042. doi: 10.2147/TCRM.S178124. PMID: 30464426.
* Barberio B, et al. Dietary fiber intake and functional constipation: a review. World J Gastroenterol. 2021 Mar 7;27(9):789-798. doi: 10.3748/wjg.v27.i9.789. PMID: 33716551.
* Horiuchi R, et al. Foods and Dietary Patterns Associated with Constipation in Older Adults: A Systematic Review. Nutrients. 2020 Jul 9;12(7):2028. doi: 10.3390/nu12072028. PMID: 32650505.
Q.
Colace: 5 important things doctors want you to know
A.
Colace, or docusate sodium, is an over-the-counter stool softener that draws water into stool to make bowel movements easier without cramping; doctors recommend it for short-term constipation or to prevent straining, typically 50 to 400 mg daily (often 100 mg twice daily) with a full glass of water for no more than 7 days. There are several safety factors and red flags to consider, including diarrhea or cramps at higher doses, dehydration risk in older adults, special guidance in liver disease, avoiding mineral oil near dosing, and seeking care for severe pain, vomiting, blood or black stools, fever, weight loss, or symptoms lasting more than a week; see the complete guidance below for when Colace may not be enough and what to try next.
References:
Shamliyan TA, Wyman JF, Bliss DZ, & Kane RL. (2015). Treatment of constipation in older adults: a systematic review of pharmaceutical and nonpharmaceutical interventions. Journal of the American Geriatrics Society, 25623390.
European Association for the Study of the Liver. (2018). EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 28934759.
Cassinotto C, Lapuyade B, Mouries A, et al. (2015). Liver stiffness measurement for non‐invasive assessment of advanced fibrosis and cirrhosis in alcoholic patients. Hepatology, 24732915.
Q.
Why take colace at night
A.
Take Colace at night to sync its 12 to 72 hour stool softening effect with a morning bowel movement, build a consistent routine, and limit daytime cramps or interactions with other medications. There are several factors to consider; see below for important details on hydration timing, liver disease considerations, combining with fiber or laxatives, practical dosing tips, and when to seek medical care so you can choose the right next steps.
References:
Vijayvargiya P, Camilleri M, Shin A, & Saad RJ. (2015). Systematic review: efficacy of licensed therapies for chronic idiopathic… Neurogastroenterol Motil, 25849562.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24279923.
Q.
Constipation During Chemotherapy: Causes and what you can do
A.
Constipation is common during chemotherapy and often stems from opioid pain medicines, anti-nausea drugs, dehydration, low fiber intake, reduced activity, electrolyte imbalances, nerve changes, or bowel narrowing from tumors or prior surgery. There are several factors to consider; see below to understand more. Relief usually comes from fluids, gradual fiber, gentle movement, a regular toilet routine and positioning, plus OTC laxatives like polyethylene glycol or senna, with prescription options such as lubiprostone or PAMORAs for opioid-related cases; seek urgent care for severe pain, vomiting, bleeding, or no bowel movement for 5 to 7 days, and see complete steps below.
References:
Larkin PJ, & Cherny NI. (2013). Management of constipation in palliative care: EAPC positio… J Pain Symptom Manage, 23537633.
Chey WD, Webster L, & Sostek M. (2014). Lubiprostone for opioid-induced constipation in patie… Am J Gastroenterology, 24935227.
European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for th… Journal of Hepatology, 29562927.
Q.
Is it safe to use laxatives every day?
A.
Using laxatives every day can be safe in certain situations, but it's important to choose the right type and follow medical advice. See below to understand more.
References:
de Azevedo RP, Freitas FG, Ferreira EM, Pontes de Azevedo LC, & Machado FR. (2015). Daily laxative therapy reduces organ dysfunction in .... Critical care (London, England), 26373705.
https://pubmed.ncbi.nlm.nih.gov/26373705/
Tack J, van Outryve M, Beyens G, Kerstens R, & Vandeplassche L. (2009). Prucalopride (Resolor) in the treatment of severe chronic .... Gut, 18987031.
https://pubmed.ncbi.nlm.nih.gov/18987031/
Tuteja AK, & Rao SS. (2008). Lubiprostone for constipation and irritable bowel syndrome .... Expert review of gastroenterology & hepatology, 19090733.
Q.
When should I start worrying about constipation?
A.
If you haven't had a bowel movement for more than 5-7 days and also have pain, nausea or even vomiting, please seek further medical attention.
References:
Dorfman L, El-Chammas K, Mansi S, Kaul A. Gastrocolonic Response. Curr Gastroenterol Rep. 2022 Nov;24(11):137-144. doi: 10.1007/s11894-022-00849-2. Epub 2022 Nov 3. PMID: 36324042.
Burr RL, Jarrett ME, Cain KC, Jun SE, Heitkemper MM. Catecholamine and cortisol levels during sleep in women with irritable bowel syndrome. Neurogastroenterol Motil. 2009 Nov;21(11):1148-e97. doi: 10.1111/j.1365-2982.2009.01351.x. Epub 2009 Jul 1. PMID: 19573081; PMCID: PMC2820403.
Burr RL, Jarrett ME, Cain KC, Jun SE, Heitkemper MM. Catecholamine and cortisol levels during sleep in women with irritable bowel syndrome. Neurogastroenterol Motil. 2009 Nov;21(11):1148-e97. doi: 10.1111/j.1365-2982.2009.01351.x. Epub 2009 Jul 1. PMID: 19573081; PMCID: PMC2820403.
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