Constipation medicines: what should you know about them?

Constipation is an extremely unpleasant and common problem that can significantly affect quality of life. Many people struggle with it, yet few talk about it openly and are often unsure how to manage the symptoms. Difficulty or infrequency of bowel movements, or a feeling of incomplete emptying, may all indicate that help is needed. Fortunately, there are now many effective medicines and preparations available to relieve constipation.

In this article, we describe in detail the medicines used to treat constipation. We look at the different types of laxatives, how they affect the body and when to use them. Our aim is to provide clear and understandable information to help you navigate the options and reduce uncertainty about treatments. Visit Endomedix Gastroenterology Centre experts are committed to ensuring that patients receive the most appropriate care, so we believe it is important to provide credible information.

What exactly is constipation?

Constipation (also known medically as obstipation) is a condition characterised by fewer than three bowel movements per week. However, it is not just the frequency that matters. Doctors also take other symptoms into account when making a diagnosis, such as:

• Hard, berry-like stools: Types 1 and 2 of the Bristol scale are typical.
• Straining during defecation: The patient has to make a considerable effort.
• Not a complete sense of emptiness: The feeling that the intestinal tract has not been completely emptied.
• The need for manual assistance: In severe cases, physical intervention is needed to remove the stool.

Chronic constipation is diagnosed when symptoms have persisted for at least three months.

Possible causes of constipation

Constipation can be caused by a number of factors. It is important to distinguish between primary (functional) and secondary causes.

• Primary constipation: There are no detectable organ changes. These include slow bowel movements (slow transit), rectal emptying disorders (dyssynergic defecation) and irritable bowel syndrome with constipation (IBS-C).
• Secondary constipation: In this case, constipation is the result of another condition or external factor.

- Lifestyle factors: Low fibre and fluid intake, sedentary lifestyle.

- Medicines: It may be a side effect of certain painkillers (e.g. opioids), antidepressants, blood pressure lowering drugs, iron supplements and antacids.

- Diseases: Diabetes mellitus, hypothyroidism, neurological conditions (e.g. Parkinson's disease, multiple sclerosis) and organ lesions affecting the intestinal tract (e.g. cancer).

As persistent constipation can be a sign of a more serious illness, it is essential to make an accurate diagnosis, including Endomedix Gastroenterology Centre specialists are ready to help.

Types of medicines for constipation

Treatment of constipation is usually based on lifestyle changes (higher fibre and fluid intake, regular exercise). However, if these methods do not work, medication may be needed. Laxatives can be divided into several groups according to their mechanism of action.

Laxatives to increase volume

These preparations contain natural or synthetic fibres (e.g. psyllium - Egyptian plantain seed husks, methylcellulose, polycarbophilic). They absorb water in the intestine and swell, thereby increasing the volume of the stool and softening it. The increased intestinal contents stimulate bowel movements (peristalsis), which facilitates defecation.

• Benefits: They are gentle, safe to use over the long term and mimic the effects of natural dietary fibres.
• Important information: Their effects develop slowly, over 1-3 days. It is essential to drink plenty of fluids (at least 2 litres a day), otherwise they can have the opposite effect and aggravate intestinal obstruction. Initially they may cause bloating and gas.

Osmotic laxatives

Osmotic laxatives contain substances that are poorly absorbed or not absorbed at all from the gut. They attract water into the intestinal cavity, diluting and softening the stool, making it easier to pass.

• Sugar alcohols (lactulose, sorbitol): These are broken down by gut bacteria, which can cause gas and abdominal cramps. The effect of lactulose takes 1-2 days to take effect.
• Polyethylene glycol (PEG): This compound does not break down in the gut, so it causes less bloating than sugar alcohols. Very effective and safe, it is often the first choice for chronic constipation.
• Salt laxatives (magnesium sulphate - bitter salt, magnesium citrate): They are fast-acting (usually within a few hours), but long-term use is not recommended because they can upset the body's electrolyte balance. Patients with renal failure should be particularly careful with them.

Stimulant (stimulant) laxatives

These medicines stimulate bowel movements (peristalsis) by acting directly on the nerve endings in the bowel. They include medicines containing senna, bisacodyl and sodium picosulphate.

• Benefits: They have a fast and powerful effect, usually within 6-12 hours.
• Disadvantages: Their long-term, regular use is not recommended. They can cause habituation, which means the bowel becomes „lazy” and normal bowel function can only be maintained with the help of the medicine. They can cause abdominal cramps as a side effect. They are usually only recommended for short-term treatment of occasional constipation or for bowel cleansing before medical procedures.

Stool softeners

Formulations containing docusate salts help water and fats to pass into the stool by reducing surface tension, making it softer and easier to pass.

• Application: Their effects are mild, so they are mainly recommended in cases where exertion should be avoided (e.g. haemorrhoids, ruptured rectum, heart disease, fresh after surgery). They take 1-3 days to take effect.

New generation of prescription medicines

In the case of chronic constipation and irritable bowel syndrome with constipation (IBS-C), if the above-mentioned medicines are not effective, a specialist gastroenterologist may prescribe modern prescription medicines.

• Chloride channel activators (e.g. lubiprostone): They increase intestinal fluid secretion, which softens stools and stimulates bowel movements.
• Guanylate cyclase C agonists (e.g. linaclotide, plecanatide): These medicines also increase fluid secretion in the gut and may also reduce abdominal pain, which is particularly beneficial in IBS-C.
• Serotonin (5-HT4) receptor agonists (e.g. prucalopride): They directly stimulate the movement of the large intestine, thus speeding up transit time. They are mainly effective in chronic constipation with slow transit.

These medicines should only be used on medical advice and under strict supervision.

When should we see a doctor?

Although occasional constipation can usually be treated at home, in some cases it is essential to see a specialist. See a gastroenterologist if you experience any of the following:

• Constipation develops suddenly and your habits change permanently.
• Severe abdominal pain, bloating or nausea may accompany the symptoms.
• Blood appears in the stools (fresh red or digested black).
• You experience unexplained weight loss.
• Constipation and diarrhoea alternate intermittently.
• Over-the-counter laxatives are ineffective, or you can only defecate with continued use.
• The first symptoms occur above the age of 45-50.

From Endomedix Gastroenterology Centre with modern diagnostic techniques (e.g. laboratory tests, colonoscopy) and experienced specialists to identify the underlying causes of constipation and develop a personalised treatment plan.

Safe use of laxatives

Laxatives can be effective, but it is important to use them carefully.

• Always start with a lifestyle change! Try to tackle the problem first with a diet rich in fibre, plenty of fluids and exercise.
• Choose a gentle laxative! As a first step, volume-enhancing (e.g. plantain seed husks) or osmotic (e.g. polyethylene glycol) laxatives are recommended.
• Avoid regular use of stimulant laxatives! Use them only for a short time, occasionally, to avoid getting used to them.
• Read the leaflet! Stick to the recommended dosage and watch out for possible side effects.
• Get professional advice! If you are unsure or if your symptoms persist, consult your doctor or pharmacist.

Summary and next steps

Constipation is a complex problem that requires a personalised approach. A wide range of over-the-counter medicines are available, from gentle bulking agents to fast-acting stimulant laxatives. However, it is important to understand that these medicines are mainly used to relieve symptoms. The key to a long-term solution is to identify the causes and make lifestyle changes.

If constipation persists or is accompanied by alarming symptoms, do not hesitate to seek professional advice. A timely gastroenterological check-up can not only relieve you of unpleasant symptoms, but can also prevent the development of more serious diseases. Visit Endomedix Gastroenterology Centre team is committed to patient health and will help you find the most effective solution to your problem.