Non-Pharmacological treatment: For mild to moderate condition, some non-pharmacological treatment options can be recommended such as:
- Bowel training: Leave time for morning call of nature
- Increase fluid intake: 1500 to 2000 ml per day
- Increase fiber intake such as vegetables, whole grains, fruits etc. Goal is 25 to 35 gm of fiber per day.
- Exercise: Walking after meals
Pharmacological Treatment: The following options are available:
- Oral bulk formers: such as generic forms of Benefiber, Metamucil, Fibercon etc. absorb water to form soft, bulky stool and promote contraction of intestinal muscles. Onset of action 12 to 72 hours.
- Oral stool softners: Such as docusate. Mainly effective for mild condition. It works better for prevention not good for treatment. Onset 24 to 72 hours.
- Oral Stimulants: Bisacodyl tablets, Senna etc. Bisacodyl enteric coated tablets must be separated from antacids and milk products by 1 - 2 hours. Taking with antacids may make the stomach environment basic which makes the drug release in the stomach instead of the colon. Onset of action 6 to 12 hours.
- Rectal stimulants: Bisacodyl suppositories. Onset of action 15 to 60 minutes. For acute constipation only
- Osmotic laxatives: Miralax, Glycerin, sorbitol etc. Onset is 24 to 48 hours. Good for mild to moderate condition and safe in kids.
Hematochezia, anemia, melena, Family history of IBD and colon cancer, unresponsive to OTC treatment are some of the red flags and requires physician visit.
Posted by: Kamaldeep Kainth, PharmD 2015