LAXATIVES 101: Your guide to pooping when you're not

So you’ve mastered your pooping ritual and are going like a boss every morning after breakfast. THEN IT HAPPENS. Maybe you had to travel and switch time zones, maybe you had to take an exam and have been stressed out, maybe you changed your diet, maybe you just forgot to drink water all day. Suddenly, you’re bloated, gassy, your head hurts. Yup, you’re constipated. I’m going to help get you through it. Here is absolutely everything you need to know to get back in the poop groove.

1st cover your bases

  • Make sure you’re following the pooping ritual described on the “poop” section of this website and make time to poop in the AM after meals when colonic motor activity is highest.
  • Optimize your water & fiber intake (wheat bran, beans/hummus, citrus, apples, broccoli)! And don’t forget about prunes!
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Next, add a Bulk-forming fiber supplement

  • Ex. Benefiber (wheat dextrin) 1 tbsp 1-2x/day with a huge glass of water. Or Metamucil
  • How does it work? The fiber absorbs water to form a liquid that promotes peristalsis and reduces transit time in colon
  • How fast does it work? 12-72hrs
  • Side effects are mild but worse if you don’t drink enough water. Some bloating and gas, especially in the beginning. Go slow.
  • This is your rock. Consider taking this regularly to ensure perfect poops.

Need backup… for your backup? Next try Miralax (Polyethylene Glycol 3350).

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  • Start with 17 g powder dissolved in big glass of water once a day and increase up to a maximum of 34 g daily or decrease as necessary
  • How does it work? It’s an osmotic agent that absorbs water to increase colon distension and stimulate peristalsis. Also increases poop mass.
  • How fast does it work? 24-96hrs
  • Side effects are mild but can include bloating and gas.
  • You can take this on a regular basis and know it’s safe. I mean, we use it in mega doses for colon prep before colonoscopy.

 

OK, it’s been 1-2 days & that didn’t work. I need to go NOW.

If you need to go NOW like TODAY, then try one of these:

1. Stimulant laxatives: Bisacodyl (dulcolax), Senna (Senokot)

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  • How does it work? Alters water and electrolyte transport in the colon wall and directly increase intestinal motor activity and peristalsis by irritating the smooth muscle and nerves of the intestine
  • How fast does it work? 6-12hours
  • Side effects: Diarrhea and abdominal pain even with a couple doses.
  • Do NOT take these long term—they lead to dangerous electrolyte abnormalities, salt overload, and even colonic INERTIA—a scary term that means your colon motility slows down to the point that it STOPS. Its surgical management at that point.
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2. Milk of magnesia or Magnesium citrate

  • How does it work? It’s an osmotic agent that absorbs water to increase colon distension and stimulate peristalsis. Also increases poop mass.
  • How fast does it work? 30minutes – 6hrs
  • Do NOT take if you have kidney problems!
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If you need to go NOW like this MINUTE, then try a Suppository

  • Glycerin or bisacodyl, either one works. Keep it in your rectum for a good 15 minutes if you can.
  • How does it work? Glycerin an osmotic agent that absorbs water to increase colon distension and stimulate peristalsis. Also increases poop mass.
  • How fast does it work? 15-60min
  • Side effects minimal if used infrequently. Abdominal cramps, rectal irritation, feeling of incomplete evacuation

 

If it’s been DAYS & you may just die of constipation then an enema is just the thing you need.

  • Enemas should only be used to prevent fecal impaction if you have several days of constipation and are miserable.
  • If that’s the case buy a mineral oil enema or use tap water
  • How fast does it work? 2-15 minutes
  • Side effects: abdominal cramps, diarrhea, rectal leakage

 

Don’t waste your time:

  • Colace (docusate sodium): this is a STOOL SOFTENER. It’s not for constipation per se, but to prevent straining while pooping and help with hard, dry stools in a very weak way. This is for HEMORRHOIDS.
    • How does it work? Lowers surface tension of stool, allowing water to enter more easily
    • How fast does it work? 12-72hrs
  • Lactulose (synthetic sugar): Although effective, this med just comes with tons of side effects, tons of  bloating and gas
    • How does it work? Its an undigested sugar that keeps water and electrolytes in the gut lumen
    • How fast does it work? 24-48hrs

 

Last, but not least at all. Actually super important:

If your constipation becomes more frequent or severe, see you doctor! There are plenty of diseases that cause constipation. There are also more powerful drugs your doctor can give you once you make sure nothing else is going on.