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This is a condition that is characterized by infrequent bowel movements that are painful or difficult, or stools that are hard in consistency. Infrequent bowel movements alone are not a reliable indicator of constipation because bowel frequency can vary between three times a day to three times a week among normal individuals. Therefore, hard stools that are difficult to pass or infrequent stools accompanied by abdominal pain, back pain, and abdominal bloating define important constipation.

There are many causes of Laxatives Constipation including:

• Diets that are low in fiber. Fiber is vegetable material that is resistant to digestion. It promotes soft stools by adding bulk to the stool and causing water to be retained in stool
• Side effects of medications such as narcotic pain killers, antidepressants, iron supplements, calcium channel blockers (a class of medications for high blood pressure), and certain types of antacids.
• Narrowing or blockage of the large intestine (colon) due to colon cancer or advanced diverticulosis.
• Ineffective contraction or spasm of the colon's muscles due to irritable bowel syndrome or other diseases of the colon's muscles.
• Hormonal (endocrine) disturbances such as an under- active thyroid gland and diabetes mellitus with nerve damage.
• Parkinson's disease, multiple sclerosis, and other neurologic conditions.

Examples of common medications that can cause constipation:

• narcotic pain medications: codeine (Tylenol #3), oxycodone (Percocet), and hydromorphone (Dilaudid)
• antidepressants: amitriptyline (Elavil), fluoxetine (Prozac), and imipramine (Tofranil)
• anticonvulsants: phenytoin (Dilantin) and carbamazepine (Tegretol)
• iron supplements
• calcium channel blockers: diltiazem (Cardizem) and nifedipine (Procardia)
• antacids: Amphojel and Basaljel

When should a doctor be consulted for Laxatives Constipation ?
Many people have a life-long tendency toward constipation while others tend to have occasional constipation alternating with a normal bowel pattern or even diarrhea. While mild and intermittent constipation in these individuals is usually not a cause for concern, a doctor should be consulted under the following circumstances:

• A new onset of constipation or recent change in bowel habits;
• Moderate to severe constipation, or constipation that does not respond to self-treatment with simple bulking agents that provide fiber;
• Constipation that is accompanied by rectal bleeding, abdominal pain and cramps, nausea and vomiting, and involuntary weight loss; and
• Constipation during pregnancy or while breast- feeding.

What non-drug measures can you take for Laxatives Constipation ?
Mild constipation that does not have an underlying cause (such as medications, an under-active thyroid, or colon obstruction) can often improve with life-style modifications that include:

1. Increasing fiber in the diet. Fiber improves bowel function by adding bulk and softening the stool. Examples of foods that are high in fiber content include vegetables, fruits (include the skin), whole grain breads, whole grain cereals, prunes, corn, whole beans (such as kidney beans and pinto beans), oat bran, corn, and barley.
2. Increasing fluid intake.
3. Regular exercise such as walking, swimming, or running.

What over-the-counter preparations can be used for Laxatives Constipation ?
Laxatives are medicines that increase the frequency and ease of passing bowel movements. Many types of laxatives are available over-the-counter (OTC) for the relief of mild, occasional constipation. If the constipation becomes moderate to severe or does not respond to OTC products, a doctor should be consulted.

Most OTC laxatives are safe, effective, and well tolerated. There are distinct classes of laxatives, which function differently and have varying degrees of effectiveness and potential side effects.

Bulk-Forming Laxatives
They are the most commonly recommended initial treatments for constipation. Bulk-forming laxatives may work as quickly as twelve hours or take as long as three days to be effective. Some-bulk-forming laxatives are derived from natural sources such as agar, psyllium, kelp (alginates), and plant gum. Others are synthetic cellulose compounds such as methylcellulose and carboxymethylcellulose. Natural and synthetic bulk-forming laxatives act similarly. They dissolve or swell in the intestines, lubricate and soften the stool, and make the passage of bowel movements easier and more frequent.

Examples of bulk-forming laxatives are methylcellulose (Citrucel), polycarbophil (Fiberco), psyllium hydrophilic mucilloid (Metamucil), and malt soup extract (Maltsupex). Many of these agents are available as powders and are mixed with fluids. Fruit drinks, fruit juice, and soft drinks mask the gritty taste of these laxatives better than water. Some are available as wafers, which are designed to be eaten with a separate beverage.

The benefits of bulk-forming laxatives are:

• Bulk-forming laxatives are not absorbed from the intestines into the body and are safe for long-term use. They are also safe for elderly patients with constipation.
• They are helpful in patients with irritable bowel syndrome, diverticulosis, and colostomies.
• Some bulk-forming laxatives (such as Metamucil) are used as fiber supplements in patients whose diets contain insufficient fiber. High fiber consumption can help control weight gain and sometimes modestly lower the level of cholesterol in the blood.

Precautions for using bulk-forming laxatives.

• Each dose of a bulk-forming laxative should be taken with at least a full glass (8 ounces) of fluid to be safe and effective. Therefore, bulk-forming laxatives may not be appropriate for patients who must restrict oral fluid intake (such as patients with kidney failure).
• Patients with narrowing of the digestive tract (including esophageal stricture, intestinal stricture, or severe adhesions) should not use bulk-forming agents without their doctors' approval due to the risk of blockage of the intestine or the esophagus.
• Some patients may be allergic to the laxative or other substances contained in the product, such as coloring or artificial sweeteners.
• Abdominal bloating, discomfort, and flatulence can be bothersome to some patients using bulk-forming laxatives.
• Some of these products contain sugar. Diabetes mellitus patients may need to select sugar-free bulk-forming laxatives. By trying different types of bulk-forming laxatives, it usually is possible to find one that does not cause discomfort.

Stool Softeners (Emollient laxatives)
Stool softeners, also called emollient laxatives, prevent hardening of the feces by adding moisture to the stool. The active ingredient in most stool softeners is a medicine called docusate. Agents containing docusate do not by themselves stimulate or increase the number of bowel movements. Therefore, they are more for use in preventing constipation than in treating it. Stool softeners are commonly recommended for patients who should avoid straining while defecating, including:

• Patients who are recovering from abdominal, pelvic, or rectal surgery, childbirth, or a heart attack; persons with severe high blood pressure or abdominal hernias; and
• patients with painful hemorrhoids and/or anal fissures. Softening the stool in these patients can help reduce pain during defecation.

Stool softeners that are available OTC include Colace, Surfak, and pharmacy or store-branded products containing docusate. Some preparations (for example, Peri-Colace) combine a stool softener with a stimulant laxative to activate bowel movements.

Precautions for using stool softeners
Stool softeners are generally safe and well tolerated. They should not be combined with mineral oil, a lubricant laxative, because stool softeners may increase the absorption and toxicity of mineral oil. Mineral oil droplets that are absorbed into the body can deposit and cause inflammation in the lymph glands, liver, and spleen.

Lubricant Laxatives
Mineral oil (liquid petrolatum) coats and softens stool. Like stool softeners, mineral oil is used by patients who need to avoid straining (for example, after hernia repair, hemorrhoid surgery, heart attacks, and childbirth).

Precautions for using lubricant laxatives

• Mineral oil should be avoided in patients taking blood thinners, such as Coumadin. Mineral oil decreases the absorption of vitamin K (important in forming clotting factors in the blood) from the intestines. The decreased assimilation of vitamin K in patients taking Coumadin can potentially lead to "over-thinning" of the blood and increasing the risk of excessive bleeding.
• Mineral oil should not be taken during pregnancy since it may inhibit vitamin absorption and decrease the availability of vitamin K to the fetus.
• Mineral oil can cause pneumonia if it leaks into the lungs. Leakage of secretions and other contents from the mouth and the esophagus into the lungs is called aspiration. Certain individuals (for example, the very young, the elderly, stroke victims, and those with swallowing difficulties) are prone to aspirate, especially while lying down. Therefore, mineral oil should not be given at bedtime or to individuals who are prone to aspirate.
• Mineral oil should only be used for short periods of time. A significant absorption of mineral oil into the body can occur if used repeatedly over prolonged periods.

Stimulant Laxatives
Stimulant laxatives induce bowel movements by increasing the contraction of muscles in the intestines. Stimulant laxatives are effective when used on a short term basis. Examples of stimulant laxatives include aloe, cascara, senna compounds, casanthranol, bisacodyl, and castor oil.

Bisacodyl is available OTC as Dulcolax and Correctol. It is available in oral pill form and as a suppository or enema. The oral form takes six to ten hours to work. Bisacodyl is commonly used in cleansing the colon for colonoscopies, barium enemas, and intestinal surgeries. While effective for occasional constipation, bisacodyl should not be taken for more than a week, and a doctor should supervise repeated use.

Other stimulant laxatives include senna (an active ingredient in Ex-Lax and Senacot), cascara sagrada (Nature's Remedy), and casanthranol. These laxatives are converted by the bacteria in the colon into active compounds. The active compounds then stimulate the contraction of colon muscles. After taking these products orally, bowel movements occur after eight to twenty-four hours. Prolonged, chronic use of these laxatives can cause the lining of the colon to become darker than normal (melanosis coli) due to the accumulation of a pigment (melanin).

Castor oil (an ingredient of Purge Concentrate) is a liquid stimulant laxative that works in the small intestine. It causes the accumulation of fluid in the small intestine and promotes evacuation of the bowels. Castor oil should not be taken with food, although juice or other flavored liquids can help hide its unpleasant taste. This laxative works rather quickly, usually within two to six hours. Castor oil is usually used to cleanse the colon for surgery, barium enema, or colonoscopy. The absorption of nutrients and minerals by the small intestine can be impaired by the frequent use of castor oil. Therefore, this medicine is not recommended for the repeated treatment for constipation.

Precautions

• The intensity of the action of stimulant laxatives is dose related. A large enough dose of any stimulant laxative can produce serious adverse effects.
• Side effects include severe cramps, excess fluid loss and dehydration, blood electrolyte disturbances such as low levels of blood potassium, and malnutrition with chronic use.
• Chronic, long-term use of stimulant laxatives can lead to loss of colon function (cathartic colon). After years to decades of frequent use of stimulant laxatives, the nerves of the colon slowly disappear, the colon muscles wither, and the colon becomes dilated. Consequently, constipation becomes increasingly worse and unresponsive to laxatives.

Saline Laxatives
The active ingredients in saline laxatives are mostly magnesium, sulfate, citrate, and phosphate ions. These ions draw water into the intestines. The additional water softens the stool, increases pressure within the intestines, and increases intestinal contractions. The result is the discharge of softer stool. Fleet Phosphosoda, milk of magnesia, and magnesium citrate are examples of saline laxatives.

Oral doses of saline laxatives should be taken with one to two glasses of water. The onset of bowel response is usually one-half to three hours after consuming the laxative. Small doses are sometimes recommended for the treatment of occasional constipation, while larger doses can produce complete evacuation of the intestine. Complete cleansing of the bowel is useful in preparing for colonoscopy, sigmoidoscopy, and barium enema.

Precautions
Since there may be some absorption of the active ingredients from the intestines into the blood circulation, saline laxatives should not be used in certain patients. For example, patients who have impaired kidney function should not use laxatives that contain magnesium or phosphate salts. Excess accumulation of magnesium and phosphate in the blood of these patients can lead to toxicity. Patients who need to limit their sodium intake, such as those with congestive heart failure, kidney disease, and high blood pressure, should not use laxatives that contain sodium.

Enemas and Suppositories
Rectally administered enemas and suppositories are commonly used to cleanse the rectum and the sigmoid colon (the part of the colon closest to the rectum) prior to surgery, child delivery, and flexible sigmoidoscopy. Enemas and suppositories are also used to relieve constipation and rectal fecal impaction (blockage of the rectum by hard, compacted stool). They can also be used in conjunction with oral laxatives in cleansing the colon in preparation for barium enema studies.

Examples of enemas and suppositories include Microenema, which contains docusate, Ducolax Suppository, which contains bisacodyl, and Fleet Enema, which contains sodium phosphate. These products are intended for occasional use and are not recommended as a chronic laxative regimen unless directed by a physician.

Patients should carefully follow instructions in using enemas. The patient should lie on the left side with the knees bent. The enema solution should be inserted slowly into the rectum. The person should retain the solution in the rectum until definite lower abdominal cramps are felt. Evacuation usually occurs within minutes to an hour.

Precautions

• Soapsud enemas can cause rectal irritation and sometimes rectal gangrene. Therefore, soapsud enemas are not recommended.
• Enema solutions can cause fluid and electrolyte disturbances in the blood if used on a chronic basis.