Constipation Treatments and Medications

Constipation refers to having difficulty passing stool, including straining to go or passing hard, dry stools. It’s typically measured as fewer than three bowel movements per week. As many people experience it at some point, it’s more bothersome than it is a medical emergency. However, some people have chronic constipation with symptoms that last for longer than three months. In most cases, constipation improves with a fiber-rich diet, increased fluid intake, and over-the-counter laxatives taken as directed. It’s important to see a healthcare provider if constipation lasts more than a few weeks or happens with symptoms like severe pain, abnormal weight loss, or blood in the stool.

RELATED: What you need to know about constipation after surgery

How is constipation diagnosed?

Constipation is often seen as a sign or symptom rather than a disease itself. A healthcare provider will generally want to look deeper into what may be causing it. For example, they might ask about symptoms, how long they’ve lasted, current dietary habits, and overall lifestyle. If symptoms persist or worsen, the following may be recommended:

• A sigmoidoscopy or colonoscopy to check for an obstruction or other potential problems in the colon or rectum

• An anorectal manometry or a balloon expulsion test to see how well the muscles around the anus and pelvic floor are working

• A colonic transit study to look at whether the stool moves too slowly through the colon

• Blood tests to check for any problems with the thyroid, hormones, or overall metabolism

In any case, a healthcare provider may ask about serious problems that may require further care, such as blood in the stool, anemia, or a family history of colon cancer. A gastroenterologist is a healthcare provider who specializes in conditions involving the gut and can help treat more serious cases of constipation. 

RELATED: What you need to know about constipation after surgery

Constipation treatment options

Constipation treatment options usually start with managing the underlying cause. For many people, that means lifestyle and dietary changes, including eating more fiber, drinking more fluids, and staying active. If these changes don’t improve constipation, an over-the-counter laxative or prescription medication may be recommended. For more serious cases, biofeedback or surgery can be helpful, especially if there are any structural problems in the colon. A healthcare provider will review a person’s complete medical history and the medications they’re currently taking before recommending the best treatment option. 

Types of constipation medication

Laxatives are the most common type of medication used for constipation. They work in different ways, such as adding bulk or water to the stools or directly stimulating bowel movements. Over-the-counter options are usually recommended before moving on to a prescription drug. 

Bulk-forming laxatives

For most people with constipation, bulk-forming laxatives are a first-line treatment. These can help pull water into the stool, increasing its size and causing a bowel movement within a few days. Examples include Metamucil (psyllium), Citrucel (methylcellulose), and FiberCon (polycarbophil), which should be taken with plenty of water. 

Stool softeners

Stool softeners, also known as emollient laxatives, help the stool absorb more water, making it softer and easier to pass. Colace (docusate) is the most commonly used one. However, they’re mainly recommended for people who need to avoid straining, including those with hemorrhoids or pain in the anal area. Otherwise, they are not routinely recommended for cases other than mild, temporary forms of constipation.

Osmotic laxatives

Osmotic laxatives are a common option if bulk-forming laxatives don’t work well enough. MiraLax (polyethylene glycol 3350) is an over-the-counter option that works within 1 to 3 days and is recommended in treatment guidelines for chronic constipation. Magnesium hydroxide, magnesium citrate, and sugar-based laxatives, such as lactulose and glycerin suppositories, are other examples. 

Stimulant laxatives

Stimulant laxatives can directly stimulate the colon's muscles to contract, which can lead to a bowel movement within several hours. They’re typically recommended as a short-term or as-needed medication rather than a daily treatment. Common options include Dulcolax (bisacodyl) and Senokot (sennosides). 

Prokinetic agents

Prokinetic agents are prescription drugs that work on serotonin receptors in the gut to stimulate colon contractions. Motegrity (prucalopride) is a prescription option approved in the U.S. for chronic idiopathic constipation, usually after over-the-counter laxatives have been tried.

Prosecretory agents

Also known as secretagogues, these prescription drugs help the intestines secrete fluid into the colon. They are approved for chronic idiopathic constipation or irritable bowel syndrome (IBS) with constipation. Three approved options include Amitiza (lubiprostone), Linzess (linaclotide), and Trulance (plecanatide). RELATED: Linzess alternatives | Dulcolax vs. Miralax

Other medications

Relistor (methylnaltrexone) is a medication option for constipation caused by opioid pain relievers. Medications like misoprostol and colchicine may be reserved for more severe cases of constipation. Over-the-counter enemas can be used to rapidly cleanse the bowels. In addition, probiotic supplements are accessible options that may help improve stool consistency. 

Over-the-counter constipation medicine

Most first-line options for constipation are found over the counter, including bulk-forming laxatives, stool softeners, osmotic laxatives, and stimulant laxatives. Some over-the-counter drugs may need to be avoided since they could potentially cause constipation as a side effect. These include NSAID pain relievers, first-generation antihistamines, and calcium or aluminum antacids.

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