If you have uncomfortable symptoms of constipation, the first step is ensure you are drinking enough fluids, and to increase your fiber intake. The fiber content of your diet by adding cereal grains, fruits and vegetables, or daily doses of a fiber supplement (for example, Metamucil or Citrucel). If constipation persists, it is reasonable to use a laxative treatment to help your bowel expel the stool. There are many laxatives available without a prescription, and they are safe for occasional use.
Salt-based or carbohydrate-based ("osmotic") laxatives use natural salts, magnesium salts or undigested sugars to help loosen stool by drawing water through the bowel wall into the bowel. Examples are milk of magnesia, lactulose, and polyethylene glycol (Miralax)
Stimulant laxatives, such as laxatives that contain senna, cascara or bisacodyl, are less gentle. Stimulant laxatives cause the colon muscles to contract more frequently or more aggressively.
Laxatives are available in forms that can be swallowed or inserted into the rectum as a suppository.
Enemas also can relieve constipation and are available at pharmacies without a prescription. A traditional enema is done with a bag of liquid (usually a mixture of salt and water) attached to a plastic tube with a tapered tip. The enema fluid can be emptied into the rectum after the tip is inserted into the anus. The fluid is emptied when you lift the bag several inches and allow the fluid to move with gravity. An enema loosens stool in the rectum and triggers the rectal muscles to squeeze as a reaction to their being stretched.
If you have fecal impaction, your doctor may remove part of the fecal mass by hand, by using a lubricated, gloved finger inserted in the rectum. The rest of the mass usually can be removed with an enema. Rarely water irrigation through a sigmoidoscope is needed to clear a fecal impaction. Once the impacted stool is removed, your doctor will have you follow a high-fiber diet and may recommend a stool-softening medication or laxative to promote regular bowel movements.
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