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Questions in the Gastroenterology and Liver Diseases Forum have been answered by Dr. Kevin Pho who is board certified in Internal Medicine and by doctors from Henry Ford Health System.
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Subject: Re: constipation For years, I had to use an enema in order to defecate. Since my mom had colon cancer, I went for a colonoscopy; I was okay. The doctor told me to stop using enemas. She recommended Citrucel. I did what she said; it didn't help at all. I eat a lot of fruits (including prunes) and vegetables. I drink water. I eat high fiber soups, cereals and breads. Nothing works. I now take two laxatives a day in order to have a bowel movement. I am scared of future problems from prolonged reliance on laxatives. I've been doing the laxatives for about a year now. However, I've tried everything else, and nothing works. I do not take any medications other than the laxatives which I only take in order to have bowel movements. 1) Is there anything else that I can do to have my bowels work naturally? I would appreciate any advice or suggestions you cold give.
I am 48 years old. Dear Maureen, Thank you for your e-mail, Constipation is a common problem for many Americans. Physicians have two responsibilities when seeing patients with this problem. First they must look for a treatable cause. If no cause is identified, they must then provide symptomatic treatment. In searching for causes it is necessary to exclude mechanical obstruction and you have done that with the colonoscopy. Some concurrent medical illnesses can cause constipation as well as abnormalities of the nerves innervating the colon. In most cases, however, a specific treatable etiology is not found and the constipation represents a learned pattern of behavior. How does the physician treat the patient with refractory constipation who does not have a specific cause identified? Patients are instructed to set aside time to have a bowel movement. They are encouraged to relax. Eating fruits and fiber is definitely encouraged. Many times I will see patients referred by other physicians who are taking fiber (including Citrucel) and are still constipated. My first therapeutic intervention is to increase the dose and frequency of the Citrucil. I may also add a second osmotic agent to encourage defecation. I prefer to use Lactulose, a nonabsorbable sugar. I will prescribe several tablespoons of Citrucel twice daily and several tablespoons of Lactulose. In some people with neurologic disease I will have them take 500 cc of Golytely every two to three days. In all cases, the dose of laxatives is titrated to obtain an acceptable bowel pattern and to minimize discomforting effects e.g. nausea, cramps. With regard to the risk of long term laxative use, we know that some laxatives have more side effects than others. The bowel can become dependent on these agents and defecation takes place only if these laxatives are used. In general terms, you are best using natural compounds e.g. Metamucil, Citrucil, lactulose and to avoid the other laxcatives. This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician. If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital and perform the appropriate investigations after we have had the chance to meet you and to review your history in greater detail. You can arrange an appointment with Dr. Fogel, one of our experts in the diagnosis and treatment of constipation, by calling the Henry Ford Physician Referral Line at (800)653-6568. HFHSM.D.-rf
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