Digestion
Constipation
Reaching for a laxative most weeks? The order you try things in matters.
Most constipation can be treated at home with fiber, fluid, movement and routine. Laxatives are meant for short-term use — and some symptoms need a doctor, not a product.
In 30 seconds
The short answer
Constipation can mean fewer than three bowel movements a week, or stools that are hard, painful to pass, or never quite finished.1 Almost everyone has it sometimes, and it is usually short and not serious.4 Most constipation can be treated at home, starting with more fiber and plenty of liquids.14 Laxatives are for a short time, with advice on which type.20
- Normal varies. You don’t need a bowel movement every day; a change in your habits is what to notice.3
- Fiber needs time and water. Add it slowly to avoid bloating and gas, and drink more alongside it.2627
- Laxatives are short-term. Most labels say no more than about a week without your provider.31
- Cleanses are not the answer. Evidence is limited and colon cleansing can have serious side effects.38
What is happening in the body
Constipation is not a disease, but it can be a symptom of another problem.5 The usual causes are slow movement of stool, too little fiber, fluid or activity, and medicines.811
The order to work through
An illustration of the sequence NIDDK and MedlinePlus describe. Give each step a fair trial.
What the research says
- About 16 out of 100 adults have symptoms of constipation — about 33 out of 100 at 60 and older.6
- It is more likely in pregnancy and after giving birth, with little fiber, and with certain medicines or supplements.7
- Bowel habits can change with pregnancy, age, travel, or ignoring the urge to go.10
- Some medicines make it worse, including aluminum and calcium antacids, iron, diuretics, calcium channel blockers, narcotic pain medicines and some antidepressants.9
- If self-care doesn’t work, a doctor may prescribe medicine or recommend biofeedback for muscle problems.23
How common it is
Constipation becomes more common with age.
Adults with symptoms of constipation, out of every 100
Population estimates published by NIDDK — not a description of a ProperHealth or Clarkson service.
The laxative types, side by side
| Type | Example | How it works | What the label says |
|---|---|---|---|
| Bulk-forming (fiber) | Psyllium | Absorbs liquid, swells and forms a bulky stool.32 | Take with at least 8 ounces of liquid; not over 1 week unless your doctor says.32 |
| Osmotic | Polyethylene glycol 3350 | Keeps water in the stool.34 | For occasional constipation; usually up to 2 weeks; 2 to 4 days to work.34 |
| Stimulant | Senna | Increases activity of the intestines.36 | Short-term; not over 1 week without your doctor.37 Only if severe or others failed.21 |
| Stool softener | Docusate | Helps you pass stool more easily.40 | Ask which type suits you.20 |
| Lubricant | Mineral oil | Listed by NIDDK as an over-the-counter option.20 | Ask before combining laxatives. |
Don’t take any laxative with severe stomach pain, nausea or vomiting, or for more than 1 week without your provider.31
Before you buy another box
- Laxatives are for a short time, and a health care professional can tell you which type is best.20
- Psyllium must be taken with plenty of liquid, and kept 3 hours apart from digoxin, aspirin and nitrofurantoin.3233
- Tell your doctor before polyethylene glycol if you have ever had a bowel blockage.35
- If you can’t go without a laxative, talk with your doctor about slowly stopping.22
From the Dr. Majid Ali archive
A historical perspective
“For them, their constipation is not just a colon problem.”— Dr. Majid Ali, 2016-07-28Dr. Ali wrote about constipation that had lasted for years and made life miserable, and he treated it as a real problem rather than a trivial one. His approach began with self-compassion, hydration and fiber.
That food-first ordering matches current guidance, which starts with fiber and plenty of liquids.14 The rest of his list, from colonics to antifungal medicine, is not supported by the sources used here.
Where ProperHealth stops. His programme also included colonics, enemas, antifungal medicine and oil rubs, and much of his constipation writing sits inside bowel-detox material. We do not carry any of it. Evidence for colonic irrigation is limited, and colon cleansing can have serious side effects.38
What to do next
Add one high-fiber food, and more water
Fruit with its skin, beans or lentils.30 Add slowly, and drink more alongside.2627
Try a routine after breakfast
15 to 45 minutes after breakfast, with time and a footstool if it helps.1718
Go when you feel the urge
Don’t wait or hold it in.29
Keep a short diary
Track bowel movements and what they look like for a week or two before your visit.24
Bring your medicine list
Iron, some antacids, diuretics and pain medicines can contribute.9 Don’t stop any on your own.19
Medicines, supplements and safety
A pharmacist can help you choose a laxative type, spot medicines that may be contributing, set timing around other medicines, and tell you when it is time to see a doctor. A pharmacist does not diagnose the cause of constipation.
- Your medicines may be the cause. Aluminum and calcium antacids, iron supplements, diuretics, calcium channel blockers, narcotic pain medicines and some antidepressants can make constipation worse.9 Talk to your doctor before changing any.19
- Read the active ingredient. Psyllium, polyethylene glycol and senna work in different ways and carry different label limits.323436
- Stimulants are for occasional use. Frequent senna use may make you dependent on laxatives.37
- Ask first in pregnancy, while breastfeeding, or for a child under 6.31
- Skip the cleanse. “Detox” programs may include laxatives that cause diarrhea and dehydration.39
Compared
Conventional and integrative care, compared
What laxatives do and how long they are safe, what medicines and habits cause constipation, and the home routine with the strongest evidence.
What conventional treatment does
- A health care professional may recommend a laxative for a short time and tell you which type is best — fiber supplements, osmotic agents, stool softeners, lubricants or stimulants.20 Psyllium absorbs liquid and forms a bulky stool, taken with at least 8 ounces of liquid;32 polyethylene glycol 3350 keeps water in the stool and may take 2 to 4 days to work;34 senna increases intestinal activity and usually works within 6 to 12 hours.36
- If self-care does not work, a doctor may prescribe medicine, or recommend biofeedback for problems with the muscles that control bowel movements.23 A doctor may try treatment before tests; blood tests can look for anemia, an underactive thyroid or celiac disease.25
Limits and adverse effects
- Stimulant laxatives should only be used if constipation is severe or other treatments have not worked;21 senna for more than 1 week needs your doctor, frequent use may make you dependent, and older adults should not usually take it long-term.37 If you have taken laxatives for a long time and cannot go without them, talk with your doctor about slowly stopping.22
- Do not take a laxative with severe stomach pain, nausea or vomiting, or for more than 1 week without your provider; in pregnancy, breastfeeding, or for children under 6, ask first.31 Psyllium should be kept at least 3 hours apart from digoxin, aspirin and nitrofurantoin.33
What contributes to the condition
- Causes include slow movement of stool through the colon, pelvic floor problems that delay emptying, and conditions such as irritable bowel syndrome.8 Medicines that make it worse include aluminum and calcium antacids, calcium channel blockers, diuretics, iron supplements, opioid pain medicines and some antidepressants9 — talk with your doctor rather than changing or stopping them on your own.19
- Not drinking enough, too little physical activity, and hormone conditions such as an underactive thyroid can also cause it,11 as can pregnancy, getting older, travel, or ignoring the urge to go.10 About 16 in 100 adults have symptoms, rising to about 33 in 100 at 60 and older.6
Integrative and naturopathic approaches, by evidence
Evidence levels: EstablishedEmergingHypothesisNot supported
- Established
Most constipation can be treated at home, starting with more fiber and plenty of water alongside it;14 adults need 22 to 34 grams a day.15 Most fruits help — eat the skin when it is edible; beans, chickpeas, lentils and nuts add fiber too.30 Add it slowly, because more fiber can cause bloating and gas.26
- Established
Regular physical activity may help relieve symptoms;16 trying 15 to 45 minutes after breakfast may help, because eating helps the colon move stool,17 and giving yourself time, resting your feet on a footstool18 and going as soon as you feel the need29 complete the routine.
- Not supported
Colon "cleanses" use enemas, laxatives or colon hydrotherapy; evidence for colonic irrigation is limited, and colon cleansing can have side effects, some serious.38 "Detox" programs may include laxatives, which can cause diarrhea — and sudden diarrhea can lead to dehydration.39
Constipation with bleeding, constant belly pain, vomiting, fever, back pain or weight loss is not a fiber problem; see a doctor right away.13
When to get help now
Each warning sign cites the official guidance behind it. The wording still needs pharmacist sign-off.
- Severe belly pain with vomiting, a swollen belly, and no stool or gas — get medical help right away or call 911.4142
- Blood in the stool, bleeding from the rectum, or black, tarry stools — see a doctor right away.4344
- Constipation with new lower back pain — see a doctor right away. Leg weakness, or loss of bladder or bowel control — call 911.4546
- Constipation with weight loss you cannot explain — see a doctor right away. A lasting change in your usual bowel habits — check with your provider.4748
- Needing a laxative for more than a week — talk to your doctor or pharmacist before continuing.49