How to Properly Use Laxatives? Overcoming the Frustrations of Constipation!

Constipation is one of the most common digestive issues. Medically, constipation is defined as having fewer than three bowel movements per week, or experiencing difficulty passing stools that are dry and hard. As for “normal” bowel movements, the frequency varies depending on age, dietary habits, daily activity, and individual constitution. Generally, a range from three times a day to once every three days is considered normal. The incidence of constipation increases with age; research shows that over 40% of people aged 65 and older have suffered from constipation. Why do so many people face this frustration?

The 6 Main Causes of Constipation

Based on the underlying causes, constipation can be categorized into primary and secondary types. Primary constipation includes normal transit, slow transit, or defecatory disorders. Secondary constipation may be caused by drug side effects, systemic diseases, or intestinal obstructions.

1. Normal Transit Constipation: As the name suggests, the intestinal motility and defecation functions are normal, yet constipation occurs. This is the most common type for modern people, often caused by a lack of fiber, insufficient water intake, sedentary lifestyles, or high stress.
2. Slow Transit Constipation: Abnormalities in the nerve plexus cells under the colonic mucosa cause the intestines to move too slowly, leading to constipation.
3. Defecatory Disorders (Anorectal Dysfunction): Defecation requires the coordinated control of the puborectalis muscle, internal and external anal sphincters, and pelvic floor muscles. If these muscles fail to coordinate, the rectum cannot empty properly.
4. Drug Side Effects: Common medications that cause constipation include Acetaminophen (using more than 7 tablets a week), drugs with anticholinergic effects (such as antihistamines and antidepressants), calcium channel blockers for high blood pressure, diuretics, and opioids.
5. Systemic Diseases: Conditions that affect intestinal motility include diabetes, hypothyroidism, hypercalcemia, multiple sclerosis, and Parkinson’s disease.
6. Intestinal Obstruction: Structural abnormalities such as anal stenosis, rectal prolapse, or colorectal cancer can cause physical blockages that hinder the passage of stool.

5 Ways to Improve Constipation (Normal Transit Type)

This is the most common form of primary constipation. If it is not severe, it can often be improved through lifestyle adjustments:

1. Adequate Water Intake: The large intestine absorbs water from waste. Insufficient hydration causes stool to become clumped and hard, making it difficult to pass.
2. High-Fiber Diet: The Ministry of Health and Welfare recommends a daily fiber intake of 25–35 grams. Vegetables, fruits, and whole-grain breads are excellent sources. Fiber stimulates intestinal peristalsis (muscle contraction) and reduces the colon’s ability to reabsorb water, keeping stools soft.
3. Regular Exercise: Physical activity stimulates the gastrointestinal tract and promotes smooth bowel movements.
4. Develop Good Bowel Habits: Do not ignore the urge to go. Avoid excessive straining or sitting on the toilet for too long.
5. Proper Fat Intake: Insufficient dietary fat can lead to a lack of lubrication in the stool, contributing to constipation.

Note on Milk and Coffee: Since many Asians are lactose intolerant, drinking milk may trigger diarrhea, which some use to “treat” constipation. While this might work in the short term, relying on it long-term can lead to malnutrition and bloating. Similarly, while coffee promotes motility, it can irritate the stomach and potentially disrupt healthy gut bacteria. Boosting water and fiber intake remains the superior dietary approach.

Types of Laxatives: Consult a Doctor Before Use

If lifestyle changes do not resolve the issue, stool softeners or laxatives may be considered. These are generally divided into four categories:

1. Bulk-producing Laxatives (e.g., Normacol): These are high-fiber preparations that absorb water and expand to increase stool weight, triggering the urge to defecate. They usually come in powder or granule form and must be taken with a large amount of water. Effects occur within 12–24 hours, though some take days. They are contraindicated in patients with intestinal obstruction or intestinal atony (loss of muscle strength). Side effects include bloating and abdominal pain.
2. Stimulant Laxatives (e.g., Bisacodyl/Dulcolax, Sennoside): These increase intestinal motility by stimulating the nerve plexus of the intestinal smooth muscle. Long-term use can reduce nerve activity, leading to “lazy bowel” (habitual constipation) and drug dependency. Due to their irritant nature, they should only be used after a medical diagnosis. Side effects include cramping and electrolyte imbalances.
3. Saline Laxatives (e.g., Magnesium Oxide/MgO): These use non-absorbable ions to increase osmotic pressure in the intestines, drawing in water to promote motility. Magnesium Oxide (MgO) is commonly used for general relief or stool softening. Other saline cathartics are usually reserved for rapid bowel emptying (e.g., before surgery or colonoscopy). Side effects include abdominal pain.
4. Hyperosmotic Agents (e.g., Glycerin enemas, Lactulose): These pull water into the colon to locally stimulate the intestinal wall and nerves. Side effects include bloating and gas. Glycerin enemas are often the first choice for acute constipation to quickly clear hardened stool from the lower rectum.

Warning: While bulk-forming laxatives are generally the safest, they must not be used if an obstruction is suspected, as they can make the blockage worse. Patients with chronic kidney disease should consult a doctor before using saline laxatives due to the risk of electrolyte imbalance. All stimulant-based drugs carry a risk of dependency if used long-term.

When Constipation is More Than “Just Constipation”

While most cases are solved by diet and habit changes, the following “red flags” may indicate a more serious underlying condition:

1. Change in Bowel Habits: Significant changes in frequency, volume, or stool consistency—especially pencil-thin stools lasting more than two weeks—warrant a medical visit.
2. Bloody Stools: While often caused by hemorrhoids, blood in the stool requires an endoscopic exam to rule out inflammation, ulcers, or tumors.
3. Abdominal Pain or Fever: Mild pain that is relieved by defecation is usually not a concern. However, severe pain or pain accompanied by fever requires immediate medical attention to rule out infection or inflammation.
4. Unintentional Weight Loss: Losing more than 5% of body weight in 6–12 months without dieting can be a sign of malabsorption, diabetes, or cancer.