Treatment > Medications

Overview of medication for constipation

Dr. med. Andre Sommer

Dr. med. Andre Sommer

Many people are affected by constipation. The causes are varied. For example, certain medications, bowel movement disorders, or poor nutrition may be responsible. Various diseases such as Parkinson's or multiple sclerosis can also cause constipation. There are medicines available for annoying constipation: so-called laxatives. Some of these remedies are also available without a prescription. The following is an overview of these drugs. Other methods of treating constipation are also presented.

What is the therapy for constipation in general?

The first step is to treat constipation naturally. A high-fiber diet plays an important role here. Under certain circumstances, additional fiber such as Indian psyllium husks can be added to the food. These are available in the health food store or in the drugstore and must be combined with a sufficient amount of drinking. These remedies are often enough to make bowel movements easier.

If the symptoms persist, drug therapy is used. Medicines for constipation are called laxatives. Laxatives can work in different ways: Some draw water into the intestine, others cause the intestine to actively release water into the intestine, making the stool softer. Still other drugs stimulate bowel movements.

First choice drugs include macrogol, bisacodyl and sodium picosulfate. If these are not effective or if they are not well tolerated, second-choice products such as lactulose or antrachinones can be used.

If the constipation is due to an emptying disorder of the rectum, enemas or suppositories can help. These help on-site (locally) to clear the constipation and to restart the bowel movement. However, enemas should only be used for a short time, because side effects can result from prolonged use.

If none of these measures work, newer drugs such as prucalopride or linaclotide are available.

What over-the-counter constipation medicines are there?

There are many over-the-counter medications that can successfully treat constipation. Macrogol, sodium picosulfate and bisacodyl are the first choice. With these drugs, there is no habituation or addiction.

Degree of recommendation Medications
Especially recommended Macrogol

Natriumpicosulfat

Bisacodyl

Recommended Lactulose

Antrachinones (especially for chronic constipation)

Not recommended <agnesium salts

Epsom salt

Glauber's salt

Enemas (only in acute situations)

Tab. 1. Anti-constipation drugs with degree of recommendation


Important

Before using laxatives, you should try to stimulate digestion naturally. Nutrition also plays an important role here, as explained in more detail at the end of the article.


1. Macrogols

Macrogols (for example Dulcolax M Balance, Movicol, Movicol Junior, Isomol) are osmotically active laxatives. This means that they bind water in the intestine and thus make the stool more supple. In rare cases, side effects such as abdominal pain or bloating occur. As a rule, there are no changes in the body's salt balance, so that you can take them without any time limit. These agents are often used before a colonoscopy. It is important when using macrogols that they are taken with a lot of liquid.

2. Sodium picosulfate

Sodium picosulfate occurs as an active ingredient in Laxoberal and Agiolax Pico, among others. Sodium picosulfate is a derivative of bisacodyl, which is found in Dulcolax and Bekunis, for example. Both sodium picosulfate and bisacodyl are stimulant laxatives. They increase the fluid excretion in the intestine, inhibit the absorption of fluid from the intestine and stimulate the intestinal movement.

Abdominal pain may occur as a side effect. The effect starts after six to eight hours. Accordingly, it is best to take it before going to bed. Adequate hydration should also be ensured when using bisacodyl and sodium picosulfate. Changes in the salt balance are not to be feared when taken alone. This effect can be increased if other medications that promote the excretion of potassium are used at the same time. A habituation effect is extremely rare.

3. Anthraquinones

Anthraquinones are mainly used for permanent (chronic) constipation. The substances can be found, for example, in senna leaves or fruits (for example Alasenn, Midro laxative tablets). Anthraquinones can also be taken in the form of laxative tea, for example as Bekunis or Midro tea. Furthermore, they are contained in aloe or rhubarb root. Anthraquinones are a second choice for constipation. Abdominal pain may occur as a side effect. They stimulate bowel movement and make the stool more supple. The effect occurs after eight to ten hours. Habituation rarely occurs.

4. Lactulose

Lactulose (for example contained in bifiteral or lactulose hexal) is also used for chronic constipation. Lactulose cannot be absorbed in the intestine, where it is broken down into lactic acid by bacteria. This in turn binds water and makes the stool softer. When lactulose is converted to lactic acid and acetate, however, gases are produced which can lead to bloating.

5. Saline laxatives

Saline laxatives such as magnesium salt, epsom salt (for example FX Passage SL) or Glauber's salt or sodium sulfate were used quite frequently in the past. But they are not recommended according to current knowledge. These laxatives have an osmotic effect, draw water into the intestine and thus prevent the stool from thickening. Overdose can lead to problems such as poisoning, an intestinal obstruction or kidney failure. Therefore, they are rarely used today.

6. Suppository

Bisacodyl suppository or carbon dioxide (CO2) -releasing suppositories can be used rectally to promote bowel evacuation. Suppositories are particularly helpful if the constipation is due to an emptying disorder of the rectum. This can be the case, for example, due to pain during bowel movements caused by hemorrhoids.

7. Enemas

Enemas include lactulose or sodium phosphate. Enemas should not be used permanently because regular use can lead to an imbalance in the blood salts (electrolyte imbalance). In the case of acute constipation, enemas are a useful therapy. For example, sodium hydrogen phosphate as an enema can quickly remedy the situation.

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What medication can I take for constipation during pregnancy?

The first choice in pregnancy is lactulose. In addition, pregnant women can also use macrogol. If neither of the two agents works sufficiently, the substances bisacodyl or sodium picosulfate are further options.

Anthraquinone compounds such as those contained in senna, rhubarb root or aloe should not be used during pregnancy. Epsom salts are also unsuitable. Laxatives should not be used without advice from a doctor or pharmacist.

How can you prevent constipation?

Before using medication, you should try to fight constipation naturally. Consult a doctor or pharmacist before using medication. This is especially true if there are other illnesses or other medications are already being taken.

General points to follow

It is important to drink enough: A lack of fluids can make the stool hard and reduce the amount of stool. One and a half to two liters of water a day are recommended. Certain foods and luxury foods, such as dark chocolate or red wine, may make the stool firmer and can thus lead to constipation.

If you suppress the urge to defecate due to lack of time, stress or disgust, constipation is additionally promoted. A lack of exercise also has a negative effect on bowel movements: Elderly, bedridden people in particular suffer from constipation. A stomach massage can be helpful to stimulate bowel activity.

Avoid medication that can cause constipation

Another cause of constipation is various medications. Certain pain relievers (opiates), diuretics and antidepressants can cause constipation. If you suffer from constipation and are taking such medication, you should speak to the doctor treating you so that alternative medication may be used or the constipation treated.

Dietary fiber

A low-fiber diet is often the reason for constipation. To prevent this, you should take over 30 grams of fiber per day. High-fiber foods include whole grains, fruits and vegetables. The diet should also contain low-fiber foods such as white bread, meat or fish. Drug therapy is usually not suitable for treating constipation permanently. A change in diet, on the other hand, can permanently and naturally prevent constipation.

There are various natural fibers that can be added to the diet. Wheat bran, Indian psyllium husk or linseed can be mixed into the cereal, for example. They work by swelling in the intestine, stretching the intestinal wall and stimulating the intestinal movements. Therefore, it is particularly important to make sure that you drink enough with these. However, supplementary fiber intake can also lead to complaints such as abdominal pain and bloating.

Herold, Gerd: Innere Medizin, 2018

Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. AWMF – Leitlinien. Langfassung der Leitlinie. Chronische Obstipation bei Erwachsenen. Register number 021/019. Downloaded on 18.3.2018 from http://www.awmf.org/uploads/txszleitlinien/021-019lS2kChronischeObstipation_2013-06-abgelaufen.pdf

Karow, Thomas / Lang-Roth, Ruth: Pharmakologie und Toxikologie 2018, 26. Auflage.

Dr. med. Andre Sommer

Dr. med. Andre Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara Care.

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