What is constipation?
Constipation occurs when your bowel movements are less frequent than usual or you have stool that’s dry and hard, or difficult to pass. Constipation is different for everyone, but it’s often defined as having fewer than three bowel movements per week.
Most people have constipation occasionally, but people who have symptoms that last for a long time, or that go away and come back, have chronic constipation. Sometimes, constipation is related to an underlying disease, such as irritable bowel syndrome. It can also be caused by the use of opioids, a class of strong pain-relieving drugs.
Exercise and changes to your diet are often helpful to prevent or treat mild constipation. However, if these approaches don’t work, many over-the-counter (OTC) and prescription medications are available.
Over-the-counter constipation medications
Milder cases of constipation can often be treated using OTC medications, which are called laxatives. These include:
- bulk-forming laxatives
- osmotic laxatives
- stimulant laxatives
- stool softeners
- combination medications
Each type of laxative works in a slightly different way to relieve constipation. The main types of laxatives are listed below. All of these laxatives are available as generics, and most are available as brand-name products as well.
When looking for an OTC laxative, it’s helpful to be familiar with the generic name of the medication. This is because with brand-name products, the manufacturer may sell different products containing different laxatives under the same brand name. These products may differ in how fast they work and what side effects they may cause.
Bulk-forming laxatives are also known as fiber supplements. They work by pulling fluid into the intestines to make the stool softer and bulkier. This can help to produce muscle contractions in the intestines, which means the muscles tighten or squeeze. The contractions push the stool through your system.
Bulk-forming laxatives may take a few days to work, but they are safe for long-term use.
Types of bulk-forming laxatives include:
Bulk-forming laxatives often come in the form of powder or granules, which you mix with water or other liquid and take by mouth. However, bulk-forming laxatives also come in a number of other forms, such as liquid, tablets, packets, and wafers.
All forms of bulk-forming laxatives should be taken with plenty of water or other liquid. This helps to avoid fecal impaction, which is when stool becomes stuck in the intestine.
The more common side effects of bulk-forming laxatives are bloating or abdominal pain.
Lubricant laxatives coat the stool to allow it to pass more easily through your intestines. These laxatives may begin working within 6 to 8 hours of when you take them.
Lubricant laxatives should not be used long-term. This is because long-term use could lead to dependence, which means you would need lubricant laxatives to pass stool. In addition, long-term use could make you deficient in certain vitamins, including vitamins A, D, E, and K.
Mineral oil is the most common lubricant laxative. It comes as an enema, which is available as a generic and as the brand-name product Fleet Mineral Oil Enema. Mineral oil also comes as a liquid you take by mouth. You can find the liquid as a generic called a “mineral oil lubricant laxative solution.”
The more common side effects of lubricant laxatives include stomach pain and cramping. These lubricants may also make your body absorb less of certain medications and vitamins. Ask your doctor if this effect should be a concern for you.
Osmotic laxatives help keep water within the intestines, which softens stool and can cause more frequent bowel movements. Some of these products are also known as saline laxatives, including magnesium hydroxide, magnesium citrate, and sodium phosphate.
Osmotic laxatives come as enemas, suppositories, or in forms you take by mouth. These laxatives act quickly. The oral forms may work within 30 minutes, and the suppositories and enemas may work even faster.
Osmotic laxatives include:
- magnesium hydroxide (Phillips Milk of Magnesia)
- magnesium citrate (Citroma)
- polyethylene glycol (Miralax)
- sodium phosphate* (Fleet Saline Enema)
- glycerin (Fleet Glycerin Suppository)
Osmotic laxatives are generally safe to use long-term, but you should be sure to drink plenty of water to avoid becoming dehydrated. Also, some people have reported that osmotic laxatives stop working if used too often.
The more common side effects of osmotic laxatives include stomach cramping and diarrhea. In some cases, the diarrhea can result in dehydration.
*The U.S. Food and Drug Administration (FDA) has warned that in rare cases, using excessive amounts of sodium phosphate products can cause serious kidney and heart damage and even death. The FDA recommends that you talk to a doctor before giving these medications to older adults, children, or people with heart or kidney problems.
Stimulant laxatives trigger the muscles in your intestines to contract, which moves the stool through the intestines. Typically, oral stimulant laxatives work within 6 to 10 hours.
Stimulant laxatives come as oral liquids or capsules as well as enemas and suppositories. Types of stimulant laxatives include:
One of the more common side effects of stimulant laxatives is stomach cramping. In fact, these products are more likely than other laxatives to cause this effect.
You should not use stimulant laxatives as a long-term treatment. This is because your body may become tolerant to this type of medication. If that happens, your constipation will worsen when you stop taking the laxative.
Stool softeners add water and fats into the stool, creating softer bowel movements. These products are often recommended to prevent straining during bowel movements, which might be important if you’ve recently had surgery or given birth.
Typically, stool softeners take 1 to 3 days to take effect.
Docusate (Colace, DulcoEase, Surfak) is a commonly used stool softener. It comes in forms you take by mouth, including tablet, capsule, and liquid. It also comes as an enema and a suppository.
Stool softeners have few side effects and are safe for long-term use.
Sometimes, two different OTC laxatives are combined into one product. Most combination products contain a stool softener and a stimulant laxative. An example of a common combination product is docusate-sodium-senna (Senokot-S and Peri-Colace).
|Type||Generic and brand names||Forms||How fast?||Safe to use long-term?||Available as a generic?|
|bulk-forming||psyllium (Metamucil, Konsyl), calcium polycarbophil (FiberCon), methylcellulose fiber (Citrucel)||powder, granules, liquid, tablet, packet, wafer||a few days||yes||yes|
|lubricant||mineral oil (Fleet Mineral Oil Enema)||enema, oral liquid||6 to 8 hours||no||yes|
|osmotic||magnesium hydroxide (Phillips Milk of Magnesia), magnesium citrate, polyethylene glycol (Miralax), sodium phosphate (Fleet Saline Enema), glycerin (Fleet Glycerin Suppository)||enema, suppository, oral liquid||30 minutes or less||yes||yes|
|stimulant||bisacodyl (Dulcolax), senna/sennoside (Senokot)||enema, suppository, oral liquid or capsule||6 to 10 hours||no||yes|
|stool softener||docusate (Colace, DulcoEase, Surfak)||Enema, suppository, oral tablet, capsule, or liquid||1 to 3 days||yes||yes|
Prescription medications for constipation
If you try OTC products and they don’t resolve your constipation, talk to your doctor. They may recommend a prescription medication. These medications are generally safe for long-term use.
Prescription constipation medications are typically recommended for people with chronic constipation or irritable bowel syndrome with constipation (IBS-C). Some are also recommended for people with opioid-induced constipation.
These medications aren’t meant to provide immediate relief. They don’t necessarily lead to a bowel movement within minutes to hours, as many of the OTC laxatives do. Instead, when you take a prescription product daily, your number of weekly bowel movements should increase.
Most people taking these medications have a bowel movement within the first 24 hours, with more frequent bowel movements seen within the first week or two of treatment.
The only types of prescription constipation medications available in the United States are:
Linaclotide (Linzess) and plecanatide (Trulance)
Linaclotide (Linzess) and plecanatide (Trulance) regulate the amount of fluid in the intestines. They also speed up the movement of stool through the intestines. Both of these drugs are used to treat chronic constipation. Linaclotide is also used to treat IBS-C.
Both products are only available as brand-name medications, which means they don’t have generic forms. Trulance comes as an oral tablet, and Linzess comes as an oral capsule.
Common side effects of these medications include diarrhea, gas, bloating, and abdominal pain. Diarrhea may be severe and require you to stop using the medication.
These medications should not be used in children younger than 6 years, and they’re not recommended for use in older children, either.
Lubiprostone (Amitiza) helps increase fluid secretion in the intestines. This helps pass stool through the intestines. Lubiprostone is used to treat chronic constipation, IBS-C, and opioid-induced constipation.
This medication comes as a capsule you take by mouth. Common side effects include diarrhea, nausea, and abdominal pain.
Methylnaltrexone (Relistor) works by blocking certain effects of opioids to treat opioid-induced constipation.
Opioids work by binding to pain receptors in your brain. However, they may also bind to receptors in your gut or intestines. When this happens, it can cause constipation.
Methylnaltrexone blocks opioids from binding to the receptors in your gut or intestines. However, it does not block opioids from binding to pain receptors in your brain. This action helps relieve constipation while still allowing for pain relief.
Methylnaltrexone comes as a tablet you take by mouth and as an injectable form. Common side effects include nausea, diarrhea, and abdominal pain.
Naloxegol (Movantik) works in the same way as methylnaltrexone to treat opioid-induced constipation. It blocks certain effects of opioids that can cause constipation without blocking their pain-relieving effects.
Movantik comes as a tablet you take by mouth. Common side effects include diarrhea, nausea, and abdominal pain.
|Generic name||Brand name||Forms||How fast?||Safe to use long-term?||Available as a generic?|
|linaclotide||Linzess||oral capsule||within 24 hours for most people||yes||no|
|plecanatide||Trulance||oral tablet||within 24 hours for most people||yes||no|
|lubiprostone||Amitiza||oral capsule||within 24 hours for most people||yes||no|
|methylnaltrexone||Relistor||oral tablet, injection||within 24 hours for most people||yes||no|
|naloxegol||Movantik||oral tablet||within 24 hours for most people||yes||no|
Making a choice
Constipation occurs for different reasons, so medications used to treat it work in different ways. The choice of treatment for you may depend on the cause of your constipation, how long you have been constipated, and the severity of your constipation. You may need to try more than one medication before you find the one that’s best for you.
Constipation medications may be covered by your insurance plan, but they may not be. Many plans don’t cover OTC laxatives. Your insurance plan is more likely to cover prescription drugs, but they may require that you try OTC medications first.
When to call your doctor
The availability of OTC laxatives can make it easy to treat your constipation on your own. However, in some cases, a call to your doctor is essential. Be sure to call your doctor if you’re constipated and you:
- go more than three days without a bowel movement
- have been using laxatives for more than a week and are still constipated
- have had recent, unexplained weight loss of 10 pounds or more
- have severe abdominal pain or cramps, blood in your stool, or weakness, dizziness, or fatigue
- are pregnant or breastfeeding
You should also contact your doctor before giving a laxative to an infant or young child.
Talk with your doctor
Almost everyone experiences constipation at some point in their life, but it’s usually a minor inconvenience. However, if you have constipation, you should be sure to treat it for two reasons.
First, you’ll feel better when you have normal bowel movements again. Second, in rare cases, serious complications can result from untreated constipation. These complications can include:
- hemorrhoids (swollen veins in your anus)
- anal fissures (skin tears around the anus)
- rectal prolapse (intestine that protrudes through the anus)
- fecal impaction (stool stuck in the intestine)
If you have concerns about your bowel habits, talk with your doctor. They can help you relieve your constipation and get back to feeling good — regularly.