Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:.
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional. Call your doctor for medical advice about side effects.
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Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. Mayo Clinic does not endorse any of the third party products and services advertised. A single copy of these materials may be reprinted for noncommercial personal use only. Drugs and Supplements Laxative Rectal Route. Enemas can be used prior to a medical procedure when prescribed by your doctor.
All enemas should be administered rectally, NOT orally. Please refer to each product page for relief times. Enema solution should be held until the urge to evacuate is strong. See drug facts for additional information. Call a doctor promptly after using a saline enema and no liquid comes out of the rectum after 30 minutes, because dehydration could occur.
The best positions are either lying down on your left side, on your back or in a knee to chest position. View Diagram. The enema can be used up to three days in a row before consulting a physician. If you have not received relief after three days of use, please contact your doctor. Using more than one enema within 24 hours can be harmful.
If there is no bowel movement after 5 minutes of using, try to empty bowel. Adult-sized enemas should not be used for children under age NEVER give an enema to children under two years old. Mineral oil helps lubricate and soften the stool.
Bisacodyl is a stimulant laxative that works directly on the intestine to increase the muscle contractions which move stool through the bowel. The suppository draws water into the stool, thus softening the stool and helping to cause a bowel movement. No, the suppository does not need to melt in order to be effective. The suppository is designed to partially dissolve, which may or may not be noticeable.
Using your finger, insert the suppository into the rectum. During the digital examination, external anal tone and voluntary control can be approximated.
Note, however, that unless the rectal vault is clearly patulous, little concordance exists between this estimation and actual anal manometry measurements of rectal tone. The digital examination can also detect a rectocele. Finally, the stool should be screened for occult blood in all patients with constipation.
Flexible sigmoidoscopy should be performed in the patient who has recently become constipated without an obvious cause. Even if a benign distal process is identified, the colon must be examined thoroughly because a change in an elderly patient's stool habits may be caused by an underlying neoplasm.
Flexible sigmoidoscopy with a barium enema is readily available to primary care physicians and is a good first-line evaluation. Colonoscopy is an alternative diagnostic procedure. When colonoscopy is the choice, the patient only undergoes one procedure, and intervention e. All mass lesions should be biopsied because gross appearance may not correlate with pathologic findings.
Inflamed hemorrhoids and fissures found during an examination may explain a patient's constipation. The endoscopic examination may reveal brown to black leopard-like spotting of the colonic mucosa. This condition, known as melanosis coli, is a benign, reversible process resulting from anthraquinone laxative abuse e.
Either viral or syphilitic condyloma is another anorectal condition that can cause constipation. Radiographic studies may be helpful in pinpointing the cause of a patient's constipation. Plain abdominal films can determine the extent of fecal retention and can detect bowel obstructions, megacolon, volvulus and mass lesions. An enema with the contrast agent diatrizoate meglumine Gastrografin is useful in the patient with suspected megarectum. This study may be done without prior bowel preparation because the enema preparation contains a wetting agent that enables it to pass an impaction.
Barium enemas require bowel preparation but may reveal a point of obstruction or narrowed segment. Radiographic transit studies using ingested radiopaque polyvinyl chloride Sitzmark are useful in patients suspected of having a colonic dysmotility syndrome.
Defecography radiographs or videotapes of contrast medium expelled from the rectum can demonstrate rectocele, deangulation of the rectal muscular sling during defecation or paradoxic external anal sphincteric contraction with attempted defecation.
This procedure has the added benefit of not requiring bowel preparation. However, defecography is not routinely performed in all radiology departments. Figure 1 provides an algorithm for the evaluation of constipation in the elderly. A few tertiary medical centers perform complete specialized tests for colonic motility. These tests may be particularly useful when the cause of a patient's constipation is not successfully diagnosed with traditional studies or if the constipation does not respond to empiric treatment.
Motility studies are performed by placing pressure transducers in the rectum and sigmoid colon. Variations in intracolonic pressures and sensitivity thresholds induced by rectal balloon insufflation can identify specific subclasses of constipation.
High-amplitude phasic contractions occur spontaneously as well as in response to stimulation and are sometimes associated with pain. This pain may cause constipation by impeding the distal flow of luminal contents. Alternatively, in a patient with an atonic motility pattern, decreased response to stimulation and loss of resistance to distention can lead to constipation.
The availability of many different pharmacologic agents for constipation makes symptomatic treatment alluring. When possible, however, treatment should be directed at correcting the underlying abnormality. The chronic use of laxatives, especially stimulant laxatives, should be strongly discouraged. Successful therapy must include a discussion of the broad range of normal stooling function and the patient's own concepts of normal stooling.
Often, identifying misconceptions and providing information to patients about normal stooling patterns are therapeutic interventions in themselves. It may be helpful to identify the patient's expectations for treatment. Compared with placebo, laxatives and fiber have been shown to increase stool frequency. Other agents, such as lactulose, improve stool consistency. Bowel retraining is essentially a form of behavior modification and is particularly useful in the patient who does not have a readily identifiable cause of constipation.
The patient should be encouraged to have a regular daily routine, with time set aside for having a bowel movement. Preferably this time should be within five to 10 minutes after a meal, thereby taking advantage of the gastrocolic reflex.
Such a routine encourages the patient to attend to signals and respond to the urge to defecate. In the chronically constipated patient, enemas or suppositories may occasionally be required to aid in the defecatory urge. These interventions generally work by distending the rectal ampulla, which stimulates the defecatory urge and process. Lukewarm tap-water enemas are the ideal because all other solutions irritate the colonic mucosa if used repeatedly.
Carbon dioxide—releasing suppositories sodium bicarbonate—potassium bitartrate; Ceo-two distend the rectal ampulla. Bisacodyl suppositories Dulcolax are generally more effective than glycerin-based suppositories. Unfortunately, chronic use of bisacodyl suppositories eventually irritates colonic tissues.
Diet plays a critical role in bowel function, especially in the elderly. Strong epidemiologic evidence has shown that greater amounts of crude dietary fiber are associated with a lesser prevalence of constipation and other gastrointestinal disorders, including diverticular disease and colorectal cancer.
Fiber is metabolized by colonic bacteria to nonabsorbable, volatile fatty acids, which may act as an osmotic cathartic. The low-fiber diet generally consumed in the United States, along with other variables such as sedentary lifestyle and poor fluid intake in some elderly persons, may account for the large number of older patients who complain of constipation. As an initial step in treatment, the patient should be advised to follow a diet rich in fiber Table 3.
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To ensure that fiber itself does not become constipating, adequate fluid intake is necessary. This is especially true in the patient who is already taking a diuretic. The recommended daily requirement for water or noncaffeinated fluids is eight 8-oz glasses, assuming that the patient has no cardiac or renal problems that prohibit intake of this amount of fluid.
Clearly, many physicians and patients consider laxatives the mainstay of constipation treatment. Pharmaceutical companies have responded to this demand, as evidenced by the more than commercially available products touted to relieve the symptoms of constipation. These formulations are not without side effects, some of them quite significant Table 4. Increased gas; bloating; bowel obstruction if strictures present; choking if powder forms are not taken with enough liquid.
Psyllium seed. Calcium polycarbophil. New discussion Reply. Personally I preferred glycerin. If you are from the UK go to your nearest chemist and ask for Microlax enema or a large fleet enema that really helped me. I was taking roughly 15 laxatives a day as I didn't go for almost a month and I was admitted to hospital. Jimmer amy I found that the dulcolax supposititories bisacodyl irritates me. I went really numb with them and we don't know why I reacted to them but glycerin is like a jelly and is easier to insert too.
The only problem with suppositories is that it will only touch when is there in your rectum. Try taking up to 5 Dulcoease capsules a day which is a stool softener and the enemas but only once a day the enemas can be taken.
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