Article Abstract
Have you ever strained with all your might on the toilet, only to find you still could not have a smooth bowel movement? Constipation is a very common health issue in modern society. According to data from the Taiwan Nutrition Foundation, over 5.25 million people across Taiwan suffer from constipation. Due to changes in lifestyle and dietary culture, modern society is more prone to constipation compared to earlier agricultural societies. Below, we will provide a detailed introduction to the definition, symptoms, causes, prevention, and relief methods of constipation.
Table of Contents
- Symptoms and Definition of Constipation
- Primary Causes of Constipation
- Five Major Classes of Common Ingredients for Relieving Constipation Symptoms
- Main Goals of Constipation Treatment
- Precautions for Taking Constipation Medicines
- Conclusion
- References / Further Reading
1. Symptoms and Definition of Constipation
Medically, constipation is defined as having fewer than three bowel movements per week, or having bowel movements that require straining and result in dry, hard stools. As for how often one should defecate to be considered “normal,” it depends on age, dietary habits, daily activities, and individual constitution. Generally speaking, a normal frequency of bowel movements can range from once every three days to three times a day.
- Due to excessively dry and hard stools, it may lead to difficulty and pain during defecation.
- Still feeling bloated in the abdomen after defecation.
- Having a sensation of incomplete evacuation (feeling like there is still stool left) after defecation.
2. Primary Causes of Constipation
- Insufficient Fiber Intake: Due to changes in modern dietary habits, the dietary fiber obtained from each meal is limited. Coupled with inadequate daily water intake, this causes stools to become too dry and difficult to pass. Straining too hard during defecation can even cause anal fissures. If repeated bleeding persists over a long period, it is highly likely to lead to hemorrhoids.
- Excessive Stress: Stress and depressive emotions can cause the intestinal muscles to remain in a tense state for long periods, worsening gastrointestinal function and affecting bowel movements.
- Insufficient Exercise: Sedentary populations, such as office workers, the middle-aged, and the elderly, as well as long-term bedridden patients, are at high risk for constipation. Lack of adequate exercise causes the intestinal muscles to lose activity, leading to constipation.
- Lifestyle Habits or Medications: Poor lifestyle habits, or taking medications such as pain relievers, tricyclic antidepressants, addictive painkillers (like morphine), psychiatric medications, blood pressure medications, diuretics, or aluminum-containing antacids, can trigger or worsen constipation.
- Age: As age increases, bodily functions begin to decline, resulting in a reduction in gastrointestinal smooth muscle and slower, weaker peristalsis.
3. Five Major Classes of Common Ingredients for Relieving Constipation Symptoms
Constipation usually stems from slowed bowel movements or stools becoming too dry and hard in the intestinal tract. It can be caused by insufficient fiber intake, lack of adequate water, stress, medication, disease, and many other factors. Generally, when facing constipation, besides attempting to adjust our diet and lifestyle, we can also purchase constipation medicines at pharmacies to temporarily relieve symptoms when necessary.
The main common ingredients for stool softening and constipation relief are divided into five major classes:
- Bulk-forming Laxatives: These include drugs containing calcium polycarbophil or psyllium hydrophilic mucilloid (e.g., Konsyl Powder). These medications enter the intestinal tract as fibers, absorbing water and expanding to stimulate intestinal peristalsis and soften stools, thereby achieving a laxative effect. Do not use if you need to restrict water intake, or if you experience gastrointestinal obstruction, abdominal pain, vomiting, nausea, or intestinal ulcers, stenosis, or adhesion.
- Hyperosmotic Laxatives: These include drugs with glycerin. These medications provide intestinal lubrication by softening the stool. When using an enema, be careful not to injure the rectum with the thin tube. After application, wait a few minutes until the urge to defecate is strong and hard to resist before passing stool, so as to avoid premature evacuation which reduces efficacy. Do not use if you have gastrointestinal obstruction, abdominal pain, vomiting, or nausea.
- Saline Laxatives: These include drugs with magnesium salts (such as Magnesium Oxide, Magnesium Hydroxide). These medications prompt the intestines to secrete water, thereby increasing the frequency of bowel movements. If you have renal impairment, consult a doctor before use. Do not use if gastrointestinal obstruction, abdominal pain, vomiting, or nausea occurs.
- Stool Softeners (Emollient Laxatives): These include drugs containing docusate sodium (dioctyl sodium sulfosuccinate, DSS). As a surfactant, it encourages water and fats to mix in the intestinal tract, thereby softening the stool and making it easier to pass. It usually takes 1 to 3 days of use to see results. It is best to increase water intake while taking this medication. Adverse reactions include diarrhea, abdominal pain, skin rash, hepatotoxicity, and changes in urine or stool color.
- Stimulant Laxatives: These include drugs containing ingredients such as bisacodyl, and sennosides A and B (e.g., Dulcolax, Through, Sennoside). These medications stimulate the intestines to accelerate peristalsis. Do not use if you have gastrointestinal obstruction, abdominal pain, vomiting, or nausea.
Comparison Table (Part 1)
| Property | 1. Bulk-forming Laxatives | 2. Hyperosmotic Laxatives (Glycerin) | 3. Saline Laxatives |
| Dosage Form | Oral | Suppository / Enema | Oral |
| Main Ingredients | Psyllium, methylcellulose, polycarbophil, psyllium husk, or other plant mucilages/synthetic fibers. | Normal saline, glycerin, mineral oil | Magnesium oxide, sodium phosphate, magnesium sulfate |
| Mechanism of Action | Absorbs water and expands, stimulating intestinal wall peristalsis. | Localized high osmotic pressure stimulates the intestinal wall, drawing water into the tract to aid evacuation. | Retains intestinal moisture through high osmotic pressure (e.g., Magnesium Oxide tablets), stimulating peristalsis. |
| Onset of Action | Around 2 days | 15–30 minutes | 1–3 hours |
| Precautions | Not suitable for patients requiring fluid restriction, such as those with end-stage renal disease or heart failure; requires high water intake. | Patients with renal impairment, elderly individuals, and children should avoid use. | Patients with poor renal function must be cautious of electrolyte imbalance. |
| Side Effects | Insufficient water intake may cause intestinal obstruction. | Sodium phosphate enemas may lead to hypotension, hyperphosphatemia, renal failure, etc. | Excessive use can easily affect the body’s electrolyte balance. |
| Example | Normacol (e.g., Normacol Granules) | Glycerin Ball (e.g., Enemas) | Magnesium Oxide (e.g., Magnesium Oxide Tablets) |
Comparison Table (Part 2)
| Property | 4. Stool Softeners (Emollient Laxatives) | 5. Stimulant Laxatives |
| Dosage Form | Oral | Oral |
| Main Ingredients | Docusate sodium | Bisacodyl, Sennosides |
| Mechanism of Action | Softens the stool, making it easier to pass. | Increases intestinal peristalsis, stimulates the myenteric plexus of the smooth muscle, or stimulates the secretion of water and electrolytes in the intestine. |
| Onset of Action | 1–3 days | 6–10 hours |
| Precautions | Should not be used for more than 7 days. | Can cause dependency; avoid long-term use. |
| Side Effects | Diarrhea, abdominal pain, rash, hepatotoxicity, discoloration of urine or stool. | Abdominal cramps and loss of water/electrolytes. |
| Example | Mifu (e.g., Mifu Tablets) | Through (e.g., Through Tablets / Sennosides) |
4. Main Goals of Constipation Treatment
Treating constipation requires a careful investigation of its root causes to target the condition effectively. If constipation is drug-induced, consideration should be given to whether the medication can be replaced, or if it is only for short-term use, supplemented with other drugs that can improve the side effects of constipation if necessary. If constipation is caused by an unhealthy lifestyle, treatment should begin with lifestyle improvements, including consuming high-fiber foods, maintaining adequate fluid intake, and engaging in moderate exercise. Short-term use of laxatives is recommended only when the aforementioned methods are ineffective or when rapid relief of constipation symptoms is required.
- Relieve constipation issues and rebuild normal bowel function.
- Establish appropriate dietary and exercise habits to prevent constipation recurrence.
- Use laxatives and stool softeners safely and effectively.
- Avoid the abuse of laxatives and stool softeners.
5. Precautions for Taking Constipation Medicines
Ruisheng Pharmacy often observes that many people suffering from constipation personally visit pharmacies to buy enemas or other laxatives, yet have very little understanding of how these drugs work and their precautions, sometimes even using them incorrectly. Therefore, in this article, we introduce the types, ingredients, mechanisms, and precautions of laxatives.
When choosing a medication to treat constipation, the patient’s age and health status must be considered. Furthermore, drug treatment should be short-term—generally not exceeding seven days—to maintain normal physiological bowel function. Based on their mechanisms of action, laxatives can be categorized into bulk-forming, lubricant, saline, hyperosmotic, and stimulant laxatives.
Elderly Patients
- Acute Constipation: Can be relieved with glycerin or saline enemas.
- First Choice: Bulk-forming laxatives are the preferred choice. Other options like glycerin suppositories and Lactulose are also safe.
- Renal Insufficiency: Patients with renal impairment must be cautious about excessive intake of magnesium-containing laxatives.
Pregnant and Lactating Women
- Pregnancy: Pregnant women can use bulk-forming laxatives.
- Avoid: Avoid mineral oil (which can easily lead to a loss of fat-soluble vitamins) and hyperosmotic laxatives (which easily cause electrolyte imbalance).
- Lactation: Breastfeeding women should avoid using senna-based preparations.
Infants and Children
- Dietary Adjustments: For infants, encourage increased water intake. For children, increase the intake of fiber, vegetables, fruits, and water.
- Under 6 Years Old: Stool softeners and glycerin suppositories can be used for children under six. Other medications are not recommended for children under six without a doctor’s instructions.
- Avoid: Stimulant laxatives should be avoided.
- Saline Laxatives Containing Phosphorus: These must not be given orally to children under 5 years old, or administered rectally to infants under 2 years old.
6. Conclusion
Stool softeners can only provide short-term relief for constipation. To truly resolve this issue, one must start with daily lifestyle and dietary habits. Ruisheng Pharmacy recommends drinking more water, exercising more, and increasing dietary fiber intake. Additionally, you may consider purchasing probiotics, or products rich in dietary fiber and enzymes, which are also helpful in improving constipation symptoms. If you feel unwell, you are welcome to call and consult a pharmacist. Please feel free to share this article to pass beneficial and accurate information to your family and friends, working together to safeguard medication safety for yourself and your loved ones.