Medications included in the treatment of chronic constipation include: herbal preparations, laxatives, IBS-C medications, enemas and/or suppositories. Herbal remedies may be helpful in some patients. There are no published randomized studies in the United States to examine the efficacy of herbal supplements such as aloe in patients with chronic constipation.
Rhubarb and licorice appear to have some improving qualities. Rhubarb acts like senna and cascara as a stimulant. High doses of licorice can result in sodium and water retention which can lead to hypokalemia, increased blood pressure, lethargy, muscle pain, and paralysis. Some other herbals used are basil, cayenne, dandelion, red raspberry, and slippery elm. Honey is also used in treatment of constipation.
There are multiple types of laxatives available. Laxatives are named based on the action or result obtained from their use. Bulk laxatives retain water in the stool and increase fecal mass.
Mechanical obstruction has been reported from their use. Gas and bloating may occur. Bulking laxatives are probably effective in patients with normal transit times. Anaphylactic reactions have been reported with psyllium containing laxatives (Metamucil, Fibercon, and Citrucel). Lubricant laxatives contain mineral oil. They coat the stool and cause water retention in the stool thereby softening the stool. Long-term use can lead to deficiencies of fat-soluble vitamins, decrease absorption of medications like Warfarin and oral contraceptives, and may lead to incontinence of stool. There are also documented issues with aspiration in individuals with swallowing disorders.
Emollient laxatives improve the ability of water within the colon to penetrate and mix with the stool. They are intended for long-term use but are not found to be consistent in the results. Skin rashes may develop. Stool softeners such as Colace are included in this group. Their use in situations such as after surgery, with hemorrhoid flares, anal fissures, after delivery, or post myocardial infarction is warranted.
Hyperosmolar laxatives are indigestible and not absorbable. They remain in the colon and aid in retaining the water already in the colon, thereby softening the stool. Their use causes gas and bloating which is usually dose-related.
Sorbitol, and polyethylene glycol (Miralax and Golytely) are included in this group. Saline laxatives are non-absorbable ions such as magnesium, sulfa, phosphate, and citrate (Magnesium Citrate, Milk of Magnesia, Epsom Salts). They have a stool-softening effect. Stimulant laxatives cause the muscles of the small intestine/colon to propel their contents more rapidly. This prevents the water from being absorbed by the colon, so there are increased amounts of water in the stool. Side effects of use may include abdominal discomfort and melanosis coli.
