Constipation: 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! And don’t forget about prunes!

    • SOLUBLE FIBER: oats, barley, legumes (peas & beans ex. Lentils, chickpeas), nuts, fruits (apples, blueberries), psyllium, wheat dextrin. Fiber in citrus fruits and legumes stimulates growth of colonic flora, thereby increasing fecal mass!

    • INSOLUBLE FIBER:Grains! Wheat/whole wheat/wheat bran, rye products like bread, brown rice, carrots, cucumbers and tomatoes.

Next, add a Bulk-forming fiber supplement

·       Ex. Benefiber (wheat dextrin) Or Metamucil. Start with 1 teaspoon a day with a huge glass of water or black coffee and increase to 1 tablespoon a day with a huge glass of water or black coffee after 2 weeks

·       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).

·       Start with 17 g powder dissolved in big glass of water once a day and increase up to a maximum of 34 g twice a day 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)

·       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.

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!

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

Other options:

·       Acupuncture— Data from at least one randomized trial support the use of acupuncture