Five practical approaches to relieve constipation - what works and when to see a doctor

Modern constipation care starts with diet and lifestyle: increase fiber (about 25 g/day for adult women, 38 g/day for adult men), hydrate, and stay active. If needed, use bulk-forming fibers or osmotic laxatives (PEG) first. Stimulant laxatives and enemas work quickly but should be used short-term. Colonics are not routinely recommended. See a clinician for prolonged, severe, or complicated cases; prescription drugs and evaluation for underlying causes are available.

Constipation means infrequent or difficult bowel movements. It usually responds to simple changes: more fiber, more fluids, regular activity, and attention to bathroom timing. When those measures fail, several medical options exist - each with benefits and trade-offs.

Start with diet and lifestyle

Increase dietary fiber gradually. Aim for about 25 grams per day for adult women and about 38 grams per day for adult men (adjust downward slightly after age 50). Good sources: vegetables, fruits, whole grains and bran. Fiber softens stool and increases stool bulk, which helps passage.

Drink enough fluids. Fiber works best with adequate water intake. Also prioritize regular physical activity and establish a consistent bathroom routine after meals to take advantage of the gastrocolic reflex.

Over-the-counter options: bulk-forming and osmotic agents

Bulk-forming fiber supplements (psyllium, methylcellulose) mimic dietary fiber and are safe for long-term use when taken with water.

Osmotic laxatives such as polyethylene glycol (PEG 3350) draw water into the bowel and are effective for short- to medium-term relief. They are commonly used when increased fiber and fluids are not enough.

Stimulants and stool softeners - use appropriately

Stimulant laxatives (bisacodyl, senna) increase intestinal contractions. They work quickly but are generally recommended for short-term use or when faster relief is needed.

Stool softeners (docusate) may help when stool is hard and dry, though evidence for their effectiveness is mixed. Avoid long-term overuse of stimulants without medical supervision.

Enemas and colon hydrotherapy

Enemas can provide rapid relief for acute constipation or fecal impaction when used as directed. Colon hydrotherapy (colonics) involves flushing the colon and is offered commercially, but major medical groups do not recommend routine use because benefits are limited and rare complications (electrolyte imbalance, bowel injury) can occur.

When to seek medical care and prescription options

See a clinician if constipation is severe, lasts more than a few weeks despite OTC measures, or comes with "red flags" such as unexplained weight loss, blood in the stool, persistent abdominal pain, or changes in bowel habits in older adults.

For chronic or refractory constipation, prescription medications (for example, guanylate cyclase-C agonists and chloride channel activators) and specialized treatments may be appropriate. A clinician can evaluate underlying causes (medication side effects, metabolic issues, pelvic floor dysfunction) and recommend targeted therapy.

Safety points

Avoid laxative abuse. Overuse or incorrect use can cause dehydration, electrolyte disturbances, or worsening bowel function. Use enemas and stimulant laxatives sparingly and under guidance for chronic problems.

In most cases, a plan that combines more fiber, fluids, exercise, and sensible use of OTC options resolves constipation. If it does not, get medical evaluation to rule out treatable causes and to discuss prescription therapies.