What are the unexpected factors that can lead to constipation. How do common medications contribute to bowel issues. Can certain health conditions cause chronic constipation. Which lifestyle changes can help alleviate constipation symptoms.

Understanding Constipation: More Than Just Diet

Constipation is a common digestive issue that affects people of all ages. While many associate it primarily with dietary factors, the truth is that numerous unexpected causes can lead to this uncomfortable condition. From medications to underlying health conditions, understanding these factors is crucial for effective management and prevention.

The Impact of Thyroid Disorders on Bowel Function

Thyroid disorders can significantly affect digestive health, often in ways that may surprise many individuals. How exactly do thyroid issues relate to constipation?

Hypothyroidism and Constipation

Hypothyroidism, a condition where the thyroid gland doesn’t produce enough hormones, can slow down many bodily functions, including digestion. This sluggishness often results in chronic constipation. Dr. Benjamin Krevsky, a gastroenterologist at Temple University, explains that the thyroid acts as a general regulator, influencing organs throughout the body, including the bowels.

Hyperparathyroidism: An Overlooked Cause

While less common than hypothyroidism, hyperparathyroidism – an overactive parathyroid gland – can also lead to constipation. This condition often goes undiagnosed, but a gastroenterologist familiar with its effects can identify and treat it, potentially resolving persistent constipation issues.

Medications and Their Role in Causing Constipation

Many people are unaware that certain medications can cause or exacerbate constipation. Which common drugs are the most likely culprits?

• Prescription painkillers (opioids)
• Certain antidepressants
• Some antacids
• Specific high blood pressure medications

Opioids and Bowel Function

Opioid painkillers, often prescribed for post-surgical recovery or chronic pain management, are notorious for causing constipation. This side effect can significantly impact a patient’s quality of life and even delay hospital discharge in some cases. Healthcare providers are actively researching new pain management options that don’t lead to constipation.

The Antidepressant-Constipation Connection

Certain antidepressants, particularly older tricyclic medications, can interfere with nerve transmissions that stimulate bowel movement. While modern SSRI antidepressants are less likely to cause this issue, constipation remains a possible side effect. Patients experiencing this problem should consult their doctor about alternative medications or adding a laxative to their regimen.

The Paradox of Laxatives and Chronic Constipation

Is it possible for laxatives to actually contribute to chronic constipation? Surprisingly, the answer is yes. How does this paradox occur?

Certain types of laxatives, particularly stimulant laxatives like castor oil, can lead to tolerance over time. This means that the body becomes less responsive to their effects, potentially resulting in chronic constipation. Dr. Krevsky clarifies that these laxatives aren’t directly causing constipation but rather failing to provide relief over time.

For those seeking long-term solutions, alternatives such as milk of magnesia or polyethylene glycol (Miralax) are less likely to lead to tolerance issues.

Digestive Disorders and Their Link to Constipation

While many digestive disorders are associated with diarrhea, some can surprisingly lead to constipation. Which conditions should people be aware of?

Irritable Bowel Disease (IBD) and Constipation

Although diarrhea is more commonly associated with IBD, some individuals with Crohn’s disease affecting the small bowel may experience chronic constipation. In such cases, more aggressive therapy for IBD or even surgery might be necessary to address the issue.

Pregnancy and Constipation: A Common but Manageable Issue

Pregnancy often brings about various physical changes, and constipation is a common complaint among expectant mothers. What factors contribute to pregnancy-related constipation?

• Hormonal changes, especially in early pregnancy
• Dietary adjustments
• Pressure on organs from the growing fetus in later months

It’s crucial for pregnant women to address constipation carefully. Straining can lead to hemorrhoids, compounding discomfort. Always consult with an obstetrician before taking any laxatives during pregnancy.

The Role of Chronic Conditions in Constipation

Certain long-term health conditions can have a significant impact on digestive function, including bowel movements. Which chronic conditions are most commonly associated with constipation?

Diabetes and Digestive Health

People with diabetes often face various digestive issues, including constipation. This can be due to nerve damage affecting the digestive system, medications used to manage diabetes, or changes in diet and fluid intake. Managing blood sugar levels and working closely with healthcare providers can help address these concerns.

Neurological Disorders and Bowel Function

Conditions affecting the nervous system, such as multiple sclerosis or Parkinson’s disease, can impact the muscles and nerves responsible for bowel movements. This can lead to chronic constipation that requires specialized management strategies.

Lifestyle Factors Contributing to Constipation

While medical conditions and medications play a significant role in constipation, lifestyle factors shouldn’t be overlooked. Which daily habits can influence bowel regularity?

1. Lack of physical activity
2. Insufficient fiber intake
3. Inadequate hydration
4. Ignoring the urge to have a bowel movement
5. Stress and anxiety

Addressing these factors through lifestyle modifications can often provide significant relief from constipation symptoms. Incorporating regular exercise, increasing fiber-rich foods in the diet, staying well-hydrated, and managing stress levels are all effective strategies for promoting healthy bowel function.

When to Seek Medical Attention for Constipation

While occasional constipation is common, certain symptoms warrant prompt medical attention. When should individuals be concerned about their constipation?

• Constipation that is new, different, or persistent
• Constipation accompanied by bleeding
• Unexplained weight loss along with constipation
• Severe abdominal pain
• Constipation lasting more than a few days despite home remedies

Dr. Krevsky emphasizes that new or unusual constipation, especially when associated with bleeding or weight loss, could potentially be a sign of colon cancer. While this is not the most common cause, it’s important to have such symptoms evaluated by a healthcare professional to rule out serious conditions.

Diagnosing the Root Cause of Chronic Constipation

Given the wide range of potential causes, diagnosing the underlying reason for chronic constipation often requires a comprehensive approach. How do healthcare providers determine the cause of persistent constipation?

Medical History and Physical Examination

The first step in diagnosis typically involves a thorough review of the patient’s medical history, including current medications, dietary habits, and lifestyle factors. A physical examination may also be conducted to check for any obvious abnormalities.

Diagnostic Tests and Procedures

Depending on the initial assessment, various tests may be recommended, including:

• Blood tests to check thyroid function and rule out other conditions
• Imaging studies such as X-rays or CT scans to examine the abdominal area
• Colonoscopy to inspect the colon for any abnormalities or obstructions
• Transit time studies to assess how quickly food moves through the digestive system

These diagnostic tools help healthcare providers identify the specific cause of constipation, allowing for more targeted and effective treatment approaches.

Treatment Strategies for Chronic Constipation

Once the underlying cause of constipation is identified, treatment can be tailored to address the specific issue. What are some common approaches to managing chronic constipation?

Lifestyle Modifications

For many individuals, simple lifestyle changes can make a significant difference:

• Increasing dietary fiber intake
• Staying well-hydrated
• Engaging in regular physical activity
• Establishing a consistent bathroom routine

Medication Adjustments

If constipation is linked to a specific medication, healthcare providers may consider:

• Switching to an alternative medication with fewer digestive side effects
• Adjusting dosages to minimize constipation
• Adding a laxative or stool softener to counteract the constipating effects

Treating Underlying Conditions

When constipation is a symptom of an underlying health condition, addressing the primary issue often resolves the digestive problems. This might involve:

• Thyroid hormone replacement for hypothyroidism
• Improved blood sugar management for diabetes
• Targeted treatments for IBD or other digestive disorders

Over-the-Counter and Prescription Treatments

Various medications can provide relief from constipation:

• Bulk-forming agents
• Osmotic laxatives
• Stool softeners
• Lubricants
• Prescription medications for severe or chronic cases

It’s important to use these treatments under the guidance of a healthcare provider, as long-term use of certain laxatives can lead to dependence or other complications.

Preventing Constipation: Proactive Measures

While treatment is important, prevention is often the best approach to managing constipation. What steps can individuals take to reduce their risk of developing constipation?

Dietary Considerations

A diet rich in fiber is crucial for maintaining regular bowel movements. Aim to include:

• Whole grains
• Fresh fruits and vegetables
• Legumes
• Nuts and seeds

Gradually increasing fiber intake can help prevent the bloating and gas that sometimes occur with sudden dietary changes.

Hydration Habits

Proper hydration is essential for preventing constipation. Aim to drink plenty of water throughout the day, and consider limiting beverages that can contribute to dehydration, such as alcohol and caffeinated drinks.

Regular Exercise

Physical activity stimulates bowel function. Incorporate regular exercise into your routine, even if it’s just a daily walk. This not only aids digestion but also provides numerous other health benefits.

Stress Management

Chronic stress can disrupt digestive function. Implement stress-reduction techniques such as:

• Meditation
• Deep breathing exercises
• Yoga
• Regular relaxation time

Bathroom Habits

Developing good bathroom habits can help prevent constipation:

• Don’t ignore the urge to have a bowel movement
• Try to establish a regular bathroom routine
• Allow sufficient time for bowel movements without rushing
• Use proper posture on the toilet to facilitate easier passage of stool

The Role of Probiotics in Digestive Health

Probiotics have gained attention for their potential benefits in maintaining digestive health. How can these beneficial bacteria help prevent or alleviate constipation?

Understanding Probiotics

Probiotics are live microorganisms that, when consumed in adequate amounts, can provide health benefits. They help maintain a healthy balance of gut bacteria, which is crucial for proper digestion and regular bowel movements.

Probiotic Sources

Probiotics can be obtained from various sources:

• Fermented foods like yogurt, kefir, and sauerkraut
• Probiotic supplements
• Certain fortified foods

While research on the effectiveness of probiotics for constipation is ongoing, many individuals find that incorporating probiotic-rich foods or supplements into their diet helps maintain regular bowel function.

Special Considerations for Different Age Groups

Constipation can affect individuals of all ages, but certain life stages may require special attention. How does constipation management differ across age groups?

Constipation in Children

Childhood constipation is common and can often be addressed through dietary changes and proper toilet training. However, persistent issues may require medical evaluation to rule out underlying conditions.

Managing Constipation in Older Adults

Older adults are more prone to constipation due to factors such as:

• Decreased mobility
• Medications
• Chronic health conditions
• Changes in diet and fluid intake

Management strategies for this age group often involve a combination of lifestyle modifications, careful medication management, and sometimes the use of gentle laxatives under medical supervision.

The Psychological Impact of Chronic Constipation

While constipation is primarily a physical issue, its effects can extend beyond physical discomfort. How does chronic constipation impact mental health and quality of life?

Emotional and Social Effects

Chronic constipation can lead to:

• Anxiety and depression
• Social isolation due to discomfort or embarrassment
• Reduced quality of life
• Decreased work productivity

Addressing the Psychological Aspects

Managing the psychological impact of chronic constipation may involve:

• Open communication with healthcare providers about symptoms and concerns
• Seeking support from mental health professionals if needed
• Joining support groups or online communities for individuals with similar experiences
• Practicing stress-reduction techniques to manage anxiety related to bowel issues

Recognizing and addressing both the physical and psychological aspects of chronic constipation is crucial for comprehensive care and improved overall well-being.

13 Surprising Causes of Constipation

Everyone is affected by constipation now and then — your diet, travel, and a lack of activity can all trigger a brief bout.

But you might be surprised by the conditions and other factors that can be responsible for longer term or chronic constipation. The list is wide-ranging, from pregnancy constipation to a side effect of antidepressants.

Some of these causes of constipation can be handled at home with an over-the-counter product or changes in your medicine cabinet, but serious constipation warrants a prompt doctor’s visit.

“Constipation that’s new, different, associated with bleeding or weight loss, and lasts a couple of days may be a sign of colon cancer,” says gastroenterologist Benjamin Krevsky, MD, associate chief of the section of gastroenterology at Temple University in Philadelphia, Pa.

But since there are several more common causes of constipation that aren’t as serious, don’t worry too much. Your doctor can help you determine what’s really behind your constipation.

Sneaky Causes of Constipation

Here’s an overview of some of the conditions that may be to blame for your discomfort:

• Hypothyroidism. “The thyroid is a general regulator and affects organs all over the body,” explains Dr. Krevsky. This includes the bowel. Your family doctor might miss this, but a gastroenterologist who sees this effect several times a year will probably test you for hyperthyroidism and can treat it to relieve your chronic constipation.
• Hyperparathyroidism. Less common than hypothyroidism, an overactive parathyroid — a gland close to the thyroid — can also be a cause of constipation. Simple testing and treatment will also bring relief.
• Prescription painkillers. Opioids — not over-the-counter pain relievers — can cause constipation. For people recovering from surgery or managing chronic pain, this side effect can be an obstacle to quality of life (or possibly, hospital discharge). Solutions include taking different pain medications or adding a laxative. Krevsky explains that research in this area is progressing and within the next several years doctors might have new medications to treat pain without causing constipation.
• Laxatives. Ironically, the laxative you are taking could ultimately lead to chronic constipation. Your body builds up a tolerance to medications that act as stimulant laxatives, such as castor oil. Technically, says Krevsky, they aren’t causing constipation so much as failing to ease it. A better bet for laxatives that won’t lead to tolerance is milk of magnesia or polyethylene glycol (Miralax).
• Antidepressants. Constipation was one of the unpleasant side effects of an older class of antidepressants called tricyclics. “That’s because they interfere with the transmission of nerves that stimulate the bowel to move,” says Krevsky. Constipation is a much less common but still possible side effect of the more modern SSRI antidepressants. Talk to your doctor about whether you should take a different antidepressant or add a laxative.
• Antacids. So you have heartburn and now, to add to your misery, constipation sets in. Antacids that contain aluminum are the likely culprit, says Krevsky. Read the ingredient list and make a switch if necessary. Try an over-the-counter acid controller medication, or better yet, talk to your doctor. If you take antacids often enough to get chronic constipation, you should probably be tested for gastroesophageal reflux disease (GERD).
• High blood pressure medications. Chronic constipation is a side effect of an older class of high blood pressure medications called diuretics, which act on the salt in your body to control fluid levels. “You get dehydrated and your body steals moisture from the stool,” says Krevsky. You cannot compensate by drinking more water than you need — you’ll just lose it through urination. The solution is to talk to your doctor about a switch in blood pressure medication or adding a laxative.
• Irritable bowel disease (IBD). Though diarrhea is more associated with IBD, some people with Crohn’s disease that affects the small bowel will get chronic constipation. In this case, you need more aggressive therapy for the IBD or surgery, says Krevsky.
• Pregnancy. Pregnancy constipation is a common problem. Early in pregnancy, constipation may be caused by changing hormones or your diet; in later months, the pressure that the baby is putting on your organs becomes the culprit. Don’t strain, warns Krevsky, because this can cause hemorrhoids, which will just make you more uncomfortable. And don’t take a laxative without talking to your ob-gyn first.
• Diabetes. People who have diabetes face a number of potential health problems, including chronic constipation. “This is in large part due to the nerve inflammation that goes along with being a diabetic,” Krevsky says. Solutions include getting better control of diabetes to prevent more damage and talking to your doctor about medication to fight constipation.
• Heavy metal poisoning. Many family doctors don’t think about lead poisoning as a cause of constipation, but a work-up occasionally reveals significant exposure to lead, which can come from chipping old paint and other sources of exposure at home. Nerve damage is one of the outcomes of heavy metal poisoning, and this can affect the normal function of the bowels.
• Supplements. Calcium supplements and iron supplements both can cause constipation. If you suspect either one, get a recommendation from your doctor for a better way to supplement if you are truly deficient.
• Diseases of the colon. Any painful colon problem, such as an anal fissure or hemorrhoids, can cause chronic constipation because people avoid bowel movements and “detrain their bowel to work properly,” Krevsky explains. Treating the underlying cause can end this type of constipation.

Finally, Krevsky suggests, it’s possible that you don’t actually have constipation at all. He explains that while many people have a bowel movement regularly, such as once or twice a day, there are others who only do so two or three times a week — and they are just fine. Call this a hazard of pharmaceutical and food product advertising, but Krevsky says he occasionally has patients who are convinced they are constipated because they have seen ads promoting daily regularity. But as long as you’re being regular, you’re probably fine, as long as this doesn’t change and you don’t feel any discomfort.

If you are constipated and worried about the cause, check in with your doctor. Ending your chronic constipation could be as simple as choosing a better over-the-counter laxative or getting better control over a chronic health problem.

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How to Treat Constipation Caused by Your Medications

 You can treat this type of constipation with laxatives that you can buy at a drug store or supermarket. You do not need a prescription for these laxatives.

Laxatives work in two ways:

• Stimulant laxatives help stool move along your bowel or
• Osmotic laxatives help liquid stay in your bowel so stool does not become dry and hard.

Just as you need to eat every day, you must take laxatives every day for them to work.  

Sennosides

The first laxative you should try is the stimulant type called
sennosides. It is mild and works for most people. You can buy sennosides in pills or in liquid. 

PEG

If you have a history of frequent bowel cramps (also known as “Irritable Bowel Syndrome”), you may want to try an osmotic laxative first, such as
PEG. 

Steps to treat constipation that is caused by your medication:

Each person has a different bowel pattern. What is “normal” for you will be different than what is “normal” for another person. However, having a bowel movement should not be uncomfortable. You should not have to push too hard and your stool should be soft, but formed.

It is important to tailor your laxative doses based on your bowel pattern and goal. A treatment that is tailored for you is called a protocol. 

Look at the diagram below. 

Click
here to enlarge diagram. 

Each step up the protocol has a higher dose so you can work up to the level you need to maintain a comfortable bowel pattern. If you move up the protocol as shown, you will not risk over-treatment, which could cause diarrhea.

You should start EITHER the sennosides protocol OR the PEG protocol. Do not start both at the same time

Most people find the sennosides protocol to be the easiest to take. Sennosides cost less than PEG but PEG works just as well. 

Whichever protocol you choose, start at step 1. Wait 24 hours. If you have a bowel movement within 24 hours that is soft and comfortable to pass, stay at step 1.

If you do not have a comfortable bowel movement within 24 hours, go to the next step in the protocol.

Only go to the next step if you are still feeling constipated after 24hrs. 

Keep moving up a step every 24 hours until you feel your bowel pattern is good for you.

If you have diarrhea, stop taking laxatives until you have a normal bowel movement. Restart the protocol at a lower step than you were on when the diarrhea happened.
Do not take pills for diarrhea.

If you have very bad stomach cramps, stop taking sennosides and call your health care team.

Call your health care team if you:

• Feel the protocol is not working for you. You may need an osmotic laxative call lactulose syrup. This is sometimes necessary when you have reached the highest step on your protocol and you are still constipated.

• Are not sure how much laxative to take or when you should move to the next step of the protocol.
• Are still constipated after getting to the top step of the protocol. You may need a combination of laxatives or a change in medication or pain management. 
• Start having watery stools after a period of being constipated. There may be hard stool stuck in your rectum. If this happens, do not take pills for diarrhea.

Medicines can cause constipation

Constipation is a bowel disorder. Its characteristic features are a reduction in the number of bowel movements (2 times a week), increased hardness of feces, a feeling of incomplete emptying of the intestine after a bowel movement.

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There are two types of constipation: sluggish bowel and defecation disorder. While sluggish bowel is characterized by slow intestinal transit of stool, when bowel movements are impaired, incomplete bowel emptying occurs.

Constipation usually has many causes. Often these are the features of human nutrition, and sometimes we will take medications. Many medications directly affect bowel function and can interfere with digestion.

Cardiovascular drugs

The active substances of various drugs can affect bowel function. So, many patients who regularly take cardiovascular drugs suffer from constipation. These drugs include beta-blockers and ACE inhibitors, which lower blood pressure.

Diuretics cause sluggish bowel movements

People with heart failure and high blood pressure are often prescribed diuretics (diuretics). These drugs remove excess fluid from the body, thereby reducing the load on the heart. However, along with the liquid, minerals, such as potassium, are also excreted from the body. This can cause the stool to become harder and difficult to pass.

Painkillers can cause constipation

Pain therapy often consists of opioid analgesics such as morphine and codeine. One of the most common side effects of opioids is constipation. Opioids suppress the activity of nerve cells in the gastrointestinal tract and slow down intestinal motility. In this case, constipation can be avoided by adjusting the dose of drugs or by parallel administration of drugs that improve digestion.

Antidepressants reduce intestinal activity

Many antidepressants have a calming and relaxing effect. As a result, the intestines often become sluggish and digestion slows down. There is constipation.

Iron supplements interfere with bowel function

Iron supplements have to be taken because of low hemoglobin. These medications often cause digestive problems. Stomach pain, diarrhea, and constipation are possible side effects because iron can irritate the lining of the stomach and intestines.

Massage can stimulate the intestines

For constipation, a light abdominal massage is often recommended. Experts say that it helps to improve peristalsis by stimulating nerve connections in the intestines. Massage should be done for 10-15 minutes before going to the toilet, making circular and stroking movements. Abdominal breathing will be equally effective: deep breaths increase pressure on the intestines, making bowel movements easier.

You may also be interested in:

• Why constipation occurs and how to deal with it?
• 9 easy ways to improve digestion
• The 13 Most Common Bowel Diseases: Symptoms and Treatments

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Treating constipation in adults and children

For most people, the normal frequency of bowel movements is between three times a day and three times a week. Some people may not have a bowel movement for a week or more and experience no discomfort. The frequency of bowel movements directly depends on the diet. The daily diet of the average person contains 12-15 g of fiber. And for the normal functioning of the intestines, you should consume at least 25-30 g of fiber and 1. 5-2 liters of fluid per day. Sufficient physical activity is also necessary to maintain normal bowel function.

To ensure you get enough fiber in your diet, include fiber-rich foods such as bran, whole grains, whole grain breads, and certain fruits and vegetables in your daily diet.

About 80% of people suffer from constipation at some point in their lives, and such short periods of constipation are quite normal. The diagnosis of “constipation” is made with a frequency of bowel movements less than three per week. The common belief that everyone should have a bowel movement every day has led to the overuse and dependence of many people on laxatives.

What causes constipation?

There are several reasons for the development of constipation, including insufficient intake of fiber and fluids, a sedentary lifestyle and a change in the usual environment. Travel, pregnancy, or dietary changes can lead to constipation. In some people, constipation may occur following repeated volitional refusal to defecate when the urge to defecate appears.

More serious causes of constipation may be neoplasms or areas of narrowing of the intestinal lumen. Therefore, with persistent, not amenable to self-correction, constipation, you should consult a coloproctologist. In rare cases, such serious diseases as scleroderma, lupus, disorders of the nervous and endocrine systems: thyroid disease, multiple sclerosis, Parkinson’s disease, stroke, spinal cord injury can lead to the development of constipation.

Can medications cause constipation?

Yes, many medications, including pain relievers, antidepressants, tranquilizers and other psychiatric medications, blood pressure medications, diuretics, iron supplements, calcium supplements, and aluminum-containing antacids, can cause or worsen constipation.

Moreover, some people who do not experience constipation in normal life may become dependent on the laxatives they take to achieve daily bowel movements. For many of them, the constant use of laxatives brings significant harm.

When should I see a doctor about constipation?

Any long-term bowel dysfunction, such as increased or decreased frequency or volume of stools, or difficulty passing stools, should be treated by a specialist. If symptoms of constipation persist for more than three weeks, see a physician. If traces of blood appear in the stool, you should immediately contact a coloproctologist.

How can I determine the cause of constipation?

Constipation can be caused by a variety of causes and it is important to identify them in order to prescribe the correct and most effective treatment. The attending physician will definitely prescribe special studies to exclude the anatomical causes of constipation, such as tumors and areas of narrowing of the intestinal lumen.

A digital examination of the rectum is often used as the first examination method. This method is simple and can answer many questions about the causes of constipation. Examining the bowel with a flexible illuminated instrument or using a barium x-ray can help pinpoint the cause of constipation and rule out serious conditions such as polyps, tumors, or diverticular disease.

Other research methods help to determine the functional state of the intestine. For example, to conduct a marker study, the patient swallows capsules containing certain biological markers that are visible on x-ray examination performed a few days later. The results of the study show the presence or absence of violations of the muscular apparatus of the intestine. Other studies are aimed at assessing the condition of the anal canal and rectum. These include examining the reflexes of the anal sphincter muscles, which controls the defecation process, using a small plastic canister, as well as x-rays during defecation.

In most cases, neither anatomical nor functional disorders of the bowel can be detected and the causes of constipation are considered non-specific. Conducting an adequate study is a very important point, especially when the cause of constipation is: a decrease in the speed of food moving through the intestine, difficulty in evacuating feces, or other conditions.

Treatment of constipation

Most patients with constipation can be successfully treated by adding fiber-rich foods such as bran, whole grains, whole grain bread, vegetables and fruits, and sufficient fluids to the daily diet. Your doctor may also recommend lifestyle changes. The use of foods containing non-digestible dietary fiber in the intestine, such as bran, has a positive effect not only on constipation, but also on digestion in general. With their regular use, the level of cholesterol in the blood decreases, the risk of developing polyps and colon cancer decreases, and the development of hemorrhoids is prevented.

Adequate fiber should be consumed for several weeks, possibly months, to achieve the full effect. However, its constant use does not form dependence, unlike stimulant laxatives. Other types of laxatives, enemas, and suppositories should only be used as directed by a physician and under the supervision of a coloproctologist.

For some patients, it may be helpful to set a daily time of day for bowel movements.