Constipation is an unpleasant symptom that may affect people for various reasons at times in their lives. We define constipation as difficulty passing bowel movements, rather than as failure to have a bowel movement within a specified number of days. Most people have a regular pattern, and this varies for each individual. In general, it is easier to prevent constipation than to treat it. Our goal is to keep your bowel movements regular and to avoid prolonged constipation, which might lead to fecal impaction.
Factors that tend to make people constipated include diets low in fiber, dehydration, lack of exercise, and narcotic pain medication. Additionally, some chemotherapy medicines, such as vincristine, Velban, cisplatin, VP-16 and Navelbine, may cause constipation. You can maintain regular bowel habits by increasing your intake of whole grains, fruits and vegetables, and fluids of any type that appeal to you. Maintaining a minimal degree of activity is also important.
If your doctor has prescribed a narcotic pain medication, constipation is a predictable side effect, but one which can be managed by you and your caregivers. Frequently, we will recommend a stool softener and/or laxative at the time you begin using these medicines. The following are some over-the-counter (OTC) remedies that you may find helpful. We recommend you start using these when you begin taking pain medicines on a regular basis.
- Senokot or Senokot-Sis a natural vegetable derivative that works very well to counter the constipation caused by narcotics. Generally we recommend that you take 1 tablet twice a day to start, but this may need to be increased up to 2 tablets 4 times a day if needed. Senokot-S 'contains a stool softener, so if you take this, you do not necessarily need to add the next medicine.
- Docusate Sodium (also known as Colace or DSS) helps your stool stay soft by increasing its water content. It is available in 100 mg or 250 mg strengths, and is generally taken twice a day. Again, this may need to be increased at times.
- If you find that you are still constipated despite regular use of the above medicines, you may add one of the following OTC laxatives. These work by increasing the muscular action of your intestines, and may cause temporary abdominal cramps, which usually subside after you have a bowel movement.
- Milk of Magnesia is usually taken at bedtime and works by the following morning. The dose is 2 tablespoons and may be repeated every 8 hours as needed.
- Bisacodyl (also known as Dulcolax)is available in pill or suppository form. Both forms work fairly rapidly. If you use the pills, take 1 or 2 at bedtime. If you prefer the suppository, use 1 rectally; this usually results in a bowel movement within 1 hour.
- Magnesium Citrate (also known as Citroma)is a clear carbonated liquid that may be helpful if the above medications do not work. Generally people begin by drinking Y4 to V2 a bottle, which should work in about 6 hours.
- The above remedies are meant to be guidelines for you, and should prove helpful in countering the constipation resulting from narcotics. If you use these and are still constipated, consult your nurse or physician before making changes. There are also additional prescription medications that may be helpful for you.