Constipation is not a glamorous topic, but it’s certainly important, especially in older adults.
As anyone who has experienced occasional — or even chronic — constipation can tell you, it can really put a damper on quality of life and well-being.
Constipation can also cause more substantial problems, such as:
- Severe abdominal pain, which can lead to emergency room visits
- Hemorrhoids, which can bleed or be painful
- Increased irritability, agitation, or even aggression, in people with Alzheimer’s disease or other forms of dementia
- Stress and/or pain that can contribute to delirium (a state of new or worse confusion that often happens when older adults are hospitalized)
- Fecal incontinence, which can be caused or worsened by having a hard lump of stool lodged in the lower bowel
- Avoidance of needed pain medication, due to fear of constipation
Fortunately, it’s usually possible to help older adults effectively manage and prevent constipation. This helps maintain well-being and quality of life, and can also improve difficult behaviors related to dementia.
The trouble is that constipation is often either overlooked or sub-optimally managed by busy healthcare providers who aren’t trained in geriatrics. They are often focused on more “serious” health issues. Also, since many laxatives are available over-the-counter, some providers may assume that people will treat themselves if necessary.
Personally, I don’t like this hands-off approach to constipation. Although several useful laxatives are indeed available over-the-counter (OTC), I’ve found that the average person doesn’t know enough to correctly choose among them.
Also, although in geriatrics we often do end up recommending or prescribing laxatives, it’s vital to start by figuring out what is likely to be causing — or worsening — an older person’s constipation.
For instance, many medications can make constipation worse, so we usually make an attempt to identify and perhaps deprescribe those.
In short, if you’re an older adult, or if you’re helping an older loved one with health issues, it’s worthwhile to learn the basics of how constipation should be evaluated and managed. This way, you’ll be better equipped to get help from your health providers, and if it seems advisable, choose among OTC laxative options.
Here’s what I’ll cover in this article:
- Common signs and symptoms of constipation
- Common causes of constipation in older adults
- Medications that can cause or worsen constipation
- How constipation should be evaluated, and treated
- The laxative myth you shouldn’t believe
- 3 types of over-the-counter laxative that work (and one type that doesn’t)
- My approach to constipation in my older patients
I’ll end with a summary of key take-home points, to summarize what you should know if you’re concerned about constipation for yourself or another older person.
Common signs and symptoms
Constipation can generally be diagnosed when people experience two or more of the following signs, related to at least 25% of their bowel movements:
- hard or lumpy stools
- a sense of incomplete evacuation
- the need for “manual maneuvers” (some people find they need to help their stools come out)
- fewer than 3 bowel movements per week
People often want to know what is considered “normal” or “ideal,” when it comes to bowel movements. Although it’s probably ideal to have a bowel movement every day, it’s generally considered acceptable to have them every 2-3 days, provided they aren’t hard, painful, or difficult to pass.
The handy Bristol Stool Scale can be used to describe the consistency of a bowel movement, with Type 4 stool often being considered the “ideal” (formed but soft).
Constipation is pretty common in the general population and becomes even more so as people get older. Experts estimate that over 65% of people over age 65 experience constipation, with straining being an especially common symptom.
Other symptoms that may be caused by constipation in older adults
Constipation may be associated with a feeling of fullness, bloating, or even pain in the belly. In some people, this may interfere with appetite.
Although most older adults will admit to symptoms of constipation when asked, a person with Alzheimer’s or a related dementia may be unable to remember or relay these symptoms. Instead, they might just act out or become more irritable when they are constipated.
Prolonged constipation can also lead to a more urgent problem called “fecal impaction.” This means having a hard mass of stool stuck in the rectum or colon. It happens because the longer stool remains in the colon, the dryer it tends to get (which makes it harder to pass).
Impaction tends to be very uncomfortable, and can even provoke a full-on crisis of belly pain. It can also be associated with diarrhea and fecal incontinence.
Clearing out impacted stool can be hard to do with oral laxatives; these can even make things worse by creating more pressure and movement upstream from the blockage.
Fecal impactions are usually dislodged using treatments “from below” to soften and break up the lump, such as suppositories and/or enemas. (I address what type of enema is safest below.) They sometimes require help from clinicians in urgent care or even the emergency room.
Common causes of constipation in older adults
Like many problems that affect older adults, constipation is often “multifactorial,” or due to multiple causes and risk factors.
To have a normal bowel movement, the body needs to do the following:
- Move fecal material through the colon without excess delay (stool gets dryer and harder, the longer it stays in the colon).
- Coordinate a defecation response when stool moves down to the rectum, which requires properly working nerves and pelvic muscles.
As people get older, it becomes increasingly common to develop difficulties with one or both of these physical processes. Such problems can be caused or worsened by:
- Medication side-effects (more on those below)
- Insufficient dietary fiber
- Insufficient water intake
- Electrolyte imbalances, including abnormal levels of blood calcium, potassium, or magnesium
- Endocrine disorders, including hypothyroidism
- Slow transit due to chronic nerve dysfunction, which can be due to neurological conditions (including Parkinson’s disease) or can be caused by long-standing conditions that eventually damage nerves, such as diabetes
- Irritable bowel syndrome
- Pelvic floor dysfunction
- Psychological factors, such as anxiety, depression, or even fear of pain during the bowel movement
- Very low levels of physical activity
- “Mechanical obstruction,” which means that the colon or rectum — or their proper function — is impaired by some kind of mass, lump, narrowing, or another physical factor
- A tumor can cause this problem, but there are also non-cancerous reasons that a person can develop a mechanical obstruction affecting the bowels.
Medications associated with constipation
Several commonly used medications can cause or worsen constipation in older adults. They include:
- Anticholinergics, a broad class which includes sedating antihistamines, medications for overactive bladder, muscle relaxants, anti-nausea medications, and more. (This group of medications is also associated with worse brain function; they block acetylcholine, which is used by brain cells and by the nerves in the gut.)
- Opiate painkillers, such as codeine, morphine, oxycodone
- Some forms of calcium supplementation
- Some forms of iron supplementation (often prescribed for anemia)
It’s not always possible or desirable to stop every medication associated with constipation. If a medication is otherwise providing an important health benefit and there’s no less constipating alternative, we can continue the medication and look for other ways to improve bowel function.
Still, it’s important to consider whether any current medications can be deprescribed, before deciding to use laxatives and other management approaches.
If opioids are absolutely necessary to manage pain (such as in someone with cancer, for instance), a special type of medication can be used, to counter the constipating effect of opioids in the bowel. This is generally better than depriving a person of much-needed pain medication.
How to evaluate constipation
How to treat constipation basically depends on what appears to be the main causes and contributors to a person’s symptoms.
An evaluation should start with the health provider asking for more information regarding the symptoms, including how long they’ve been going on, as well as the frequency and consistency of stools.
It’s also important for the clinician to ask about “red flags” that might indicate something more serious, such as colon cancer. These include:
- Blood in the stool (which can be red, or black and “tarry” in appearance)
- Weight loss
- New or rapidly worsening symptoms
The next steps of the evaluation will depend on a person’s medical history and symptoms. It’s generally reasonable for a healthcare provider to check for these common causes of constipation:
- Medication side-effects
- Low intake of dietary fiber
- Low fluid intake
- Common causes of painful defecation, such as hemorrhoids or anal fissures
Evaluation for possible mechanical obstruction will depend on what the clinician sees on physical examination, the presence of potential red flags, and other factors. Generally, a rectal exam is a good idea.
In a 2013 review, the American Society for Gastroenterology recommends that clinicians evaluate for possible pelvic floor dysfunction mainly in those people whose constipation doesn’t improve with lifestyle changes and over-the-counter (OTC) laxatives.
They also recommend diagnostic colonoscopy only for people with alarm symptoms, or who are overdue for colorectal cancer screening.
How to treat constipation
In most older adults with constipation, there are no red flags or signs of mechanical obstruction.
To treat these cases of “garden-variety” constipation, geriatricians usually use a step-wise approach:
- Identify and reduce constipating medications if possible.
- This might mean checking to see if iron is really indicated for anemia treatment (it might no longer be needed)
- Increase dietary fiber intake and fluid intake, if indicated.
- Prunes are often effective because they contain fiber and also sorbitol, a non-absorbable type of sugar that draws water into the bowel. A randomized study published in 2011 found that prunes were more effective than psyllium (brand name Metamucil), for the treatment of constipation.
- Other forms of fiber should be slowly increased, to avoid bloating or discomfort. Adequate hydration is essential, because otherwise, fiber can become a hard mass in the colon that is difficult to move out.
- For a detailed technical take on the effect of fiber in the bowel, see Understanding the Physics of Functional Fibers in the Gastrointestinal Tract: An Evidence-Based Approach to Resolving Enduring Misconceptions about Insoluble and Soluble Fiber.
- Encourage a regular toilet routine, with time on the toilet after meals and/or physical activity.
- If necessary — which it often is — use over-the-counter laxatives to establish and maintain regular bowel movements.
The American Society of Gastroenterology recommends more in-depth constipation evaluation for older adults who fail to improve from this type of first-round treatment. Some older adults do have pelvic floor disorders, which can be effectively treated through biofeedback.
The laxative myth you shouldn’t believe
People often have concerns about using laxatives more than occasionally, because they’ve heard this can be dangerous, or risky.
This is a myth that really should be dispelled. Although medical experts used to worry that chronic use of laxatives would result in a “lazy” bowel, there is no scientific evidence to support this concern.
In fact, in their technical review covering constipation, the American Society of Gastroenterology notes that “Contrary to earlier studies, stimulant laxatives (senna, bisacodyl) do not appear to damage the enteric nervous system.”
(FYI: the “enteric nervous system” means the system of nerves controlling the digestive tract.)
Lifestyle changes and over-the-counter oral laxatives are the approaches endorsed as the first-line of constipation therapy, by the American Gastroenterology Society and others. There are no evidence-based guidelines that caution clinicians to only use laxatives for a limited time period.
The four types of OTC laxatives that I’ll cover in the next section have been used by clinicians and older adults for decades, and when used correctly, are considered safe and do not seem to cause any long-term problems.
That’s not to say that they should be used willy-nilly, or in any which way. You absolutely should understand the basics of how each type works, so let’s cover that now.
Three types of laxative that work (and one that doesn’t)
There are basically four categories of oral over-the-counter (OTC) laxative available. Three of them are proven to work. A fourth type is commonly used but actually does not appear to be very effective. Each has a different main mechanism of action.
The three types of OTC laxative that work are:
- Osmotic agents: These include polyethylene glycol (brand name Miralax), sorbitol, and lactulose. Magnesium-based laxatives also mostly work through this mechanism.
- These work by drawing extra water into the stool, which keeps it softer and easier to move through the bowel.
- Studies have shown osmotic agents to be effective, even for 6-24 months. Research suggests that polyethylene glycol tends to be better tolerated than the other agents.
- Magnesium-based agents should be used with caution in older adults, mainly because it’s possible to build up risky levels of magnesium if one has decreased kidney function, and mild-to-moderately decreased kidney function is quite common in older adults.
- Stimulant agents: These include senna (brand name Senakot) and bisacodyl (brand name Dulcolax).
- These work by stimulating the colon to squeeze and move things along more quickly.
- Studies have shown stimulant laxatives to be effective. They can be used as “rescue agents” (e.g. to prompt a bowel movement if there has been none for two days) or daily, if needed.
- Bisacodyl is also available in suppository form, and can be used this way as a “rescue agent.”
- Bulking agents: These include soluble fiber supplements such as psyllium (brand name Metamucil) and methylcellulose (brand name Citrucel).
- These work by making the stool bigger. Provided the stool doesn’t get too dried out and stiff, a bulkier stool is easier for the colon to move along.
- Bulking agents have been shown to improve constipation symptoms, but they must be taken with lots of water. Older adults who take bulking agents without enough hydration — or who otherwise have very slow bowels — can become impacted by the extra fiber.
- People with drug-induced constipation or slow transit are not likely to benefit from bulking agents.
(For more details regarding the scientific evidence on these laxatives, see this 2013 technical review.)
And now, let’s address the type of OTC laxative that is least likely to work.
The type of OTC laxative that isn’t really effective is a “stool softener”, such as docusate sodium (brand name Colace).
These create some extra lubrication and slipperiness around the stool. They actually have often been prescribed by doctors; when I was a medical student, almost all of our hospitalized patients were put on some Colace.
But, the scientific evidence just isn’t there! Because this type of laxative is so commonly prescribed, despite a weak evidence base, the Canadian Agency for Drugs and Technologies in Health completed a comprehensive review in 2014. Their conclusion was:
“Docusate appears to be no more effective than placebo for increasing stool frequency or softening stool consistency.”
So, save your money and your time. Don’t bother buying docusate or taking it. And if a clinician suggests it or prescribes it, politely speak up and say you’ve heard that the scientific evidence indicates this type of laxative is less effective than other types.
Laxatives do work and are often appropriate to use, but you need to use one of the ones that has been shown to work.
About prescription laxatives
Newer prescription laxatives are also available, and may be an option for those who remain constipated despite implementing lifestyle changes and correctly used over-the-counter laxatives. These include lubiprostone (brand name Amitiza) and linaclotide (brand name Linzess).
But, it’s not clear, from the scientific research, that they are more effective than older over-the-counter laxatives. In its technical review, the American Society of Gastroenterology noted that “meta-analyses, systematic reviews, and the only head-to-head comparative study suggested that some traditional approaches are as effective as newer agents for treating patients with chronic constipation.”
Since these newer medications have a more limited safety record and are also expensive, they probably should only be used after an older person has undergone careful evaluation, including evaluation for possible pelvic floor disorders.
Enemas are another form of “constipation treatment” available over-the-counter in the U.S.
The main thing to know is that the most commonly available form, saline enemas (Fleet is a common brand name), have been associated with serious electrolyte disturbances and even kidney damage. Because of this, the FDA issued a warning in 2014, urging caution when saline enemas are used in older adults.
Enemas certainly can be helpful as “rescue therapy,” to prevent a painful fecal impaction if an older person hasn’t had a bowel movement for a few days. But they should not be used every day.
Frequent use of enemas is really a sign that a person needs a better bowel maintenance regimen. This often means some form of regular laxative use, plus a plan to use a little extra oral laxative as needed, before things reach the point of requiring an enema.
If an enema appears necessary, experts recommend that older adults avoid saline enemas, and instead use a warm tap water enema, or a mineral oil enema.
My approach to constipation in my older patients
Generally, to help my older patients with garden-variety constipation, I start by checking for medications that are constipating, and then recommending prunes and encouraging more fiber-rich foods. As noted above, a randomized trial found that 50 grams of prunes twice daily (about 12 prunes) was more effective in treating constipation than psyllium (brand name Metamucil).
Then we usually add a daily osmotic laxative, such as polyethylene glycol (Miralax). If needed, we might then add a stimulant agent, such as senna.
We do sometimes try a bulking agent, but I find that many frailer older adults tend to get stoppered up by the extra bulk. Again, if you use a supplement (such as Metamucil) to put extra fiber in the colon but can’t keep things moving along fast enough, that extra fiber might dry out and become very difficult to pass as a bowel movement.
It usually takes a little trial and error to figure out the right approach for each person, so it’s essential for an older person — or their family — to keep a log of the bowel movements and the laxatives that are taken. If a person has loose stools or too many bowel movements, in response to a given laxative regimen, we dial back the laxatives a bit.
It’s also important to have a plan for “rescue,” which means adding some extra “as-needed” laxative (usually either senna or a suppository), if a person hasn’t had a bowel movement for 2-3 days. The goal of rescue is to avoid the beginnings of fecal impaction.
Last but not least, we also try to make sure an older person is getting enough physical activity, and to establish a routine of having the person sit on the toilet after meals.
With a little time and effort, we usually find a way to help an older person have a comfortable bowel movement every 1-2 days. This does often require taking a daily oral laxative indefinitely, but this is quite common in geriatrics. And as best we can tell, daily laxatives are unlikely to cause harm, provided one doesn’t use a magnesium laxative daily.
The most important take-home points on constipation in older adults
Here’s what I hope you’ll take away from this article:
1.Know that constipation is common but shouldn’t be considered a “normal” part of aging. It deserves to be evaluated and managed by your healthcare providers.
- Be sure to ask for help, if you’ve noticed any difficulties having a comfortable bowel movement every 1-2 days.
- A log of bowel movements and related symptoms will be very helpful to your health providers.
2. If an older person with Alzheimer’s or another dementia is acting out, consider the possibility of constipation.
3. Be sure to speak up if you’ve noticed any “alarm symptoms.”
- The main ones to look for are red blood in the stool, black or tarry stools, unintended weight loss, and new or worsening symptoms.
4. An initial evaluation of constipation should include the following:
- A review of concerning symptoms
- A review of diet, fiber, and fluid intake
- Checking for medications that cause or aggravate constipation (especially anticholinergics) and making sure that any prescribed iron is really necessary
- A rectal exam
5. Most garden-variety constipation can be effectively managed through a combination of lifestyle changes, deprescribing constipating medications, and using over-the-counter (OTC) laxatives.
- Lifestyle changes to consider include avoiding mild dehydration, eating fiber-rich foods, getting enough physical activity, and encouraging a regular toilet routine (e.g. sitting on the toilet after meals).
- Anticholinergics and other constipating medications should be deprescribed whenever possible.
- Daily prunes are especially effective as a “natural” laxative, since they contain soluble fiber and exert an “osmotic laxative” effect.
6. It is often ok to use OTC oral laxatives daily or regularly.
- Many older adults will need to use OTC laxatives to maintain regular bowel movements.
- There is no credible evidence that it’s harmful to use OTC oral laxatives long-term.
7. Three types of OTC laxative have proven efficacy: bulk-forming fiber supplements, osmotic laxatives, and stimulant laxatives. It often takes some trial and error to find the right regimen for a person.
- Osmotic laxatives such as polyethylene glycol (brand name Miralax) are well-tolerated by most older adults, and can be used daily.
- Fiber supplements such as psyllium (brand name Metamucil) are usually effective, provided an older adult drinks enough fluid and doesn’t suffer from a condition causing slow colonic transit. Fiber supplements that get dried out in a slow colon can worsen blockage.
- Stimulant laxatives such as senna are often helpful, and can be used in combination with an osmotic laxative. They can be used daily or as needed, for “rescue therapy.”
8. “Stool softeners” such as docusate sodium (brand name Colace) do not appear to be effective. Don’t bother taking them.
9. It’s best to have a bowel maintenance plan and also a “rescue plan.”
- Your health providers can help you determine which additional laxatives to use “as-needed,” if a person hasn’t had a bowel movement for a few days.
- Frequent use of “rescue” laxatives usually means the regular regimen should be adjusted.
10. Be prepared to do some trial and error, to figure out the best way to manage chronic constipation in any particular person.
- Be sure to keep track of bowel movements and what laxatives you — or your older relative — are taking.
- Your clinicians will need this information in order to advise you on how to further adjust your laxative use.
I hope you now feel better equipped to address this important issue for yourself, or on behalf of an older loved one. Please post any questions or comments below!
This article was first written in 2018. Minor updates were made in November 2022 (the basics of constipation management don’t change quickly!).
Tom Bowman says
Thanks Dr. Didyk for taking the time to offer support,
I am 64 man that does everything from drinking lots of water, exercise and fiber diet but still struggle daily with constipation. I have used Restoralax everyday for the past 6 months. My GI doctor and family doctor said that was okay and I don’t have any kidney issues but is that safe?
I use teaspoon of baking soda once a week and it works fast but is that safe? Also I use Gadorade twice a week and it seems to work but have you heard that it is effective for constipation? I use a number of other strategies and try not to overuse any one method other than the Restoralax. So I use Gadorate one day, Senokot another day, extra dose of Restoralax the next and so on.
My GI doctor said Senokot once is week is fine but not to overuse while my family doctor stated it is okay to use on a regular basis so I am confused as the label also states not to use for more that 7 days. So is it really true to use simulants long term? I want to believe it but makes me nervous. Is Bisacodyl the same as Senokot and can I use it weekly? I been told that senior residents in care homes are often given Senokot on a daily basis as well.
The worst part of all of this is how constipation occupies my mind on a daily basis. I hate that and wish I could instead focus on life activities rather than worrying daily whether I will have a bowel movement or not.
My GI doctor stated that once bowels slow down with age than it is likely permanent. He prescribed a new drug called Trulance but it costs $185 for 30 tablets so just not an option as I can’t afford it.
Thanks for taking the time to consider my questions and sorry for the long message,
Nicole Didyk, MD says
It sounds like you have a lot of healthy habits, which I would advise continuing!
Trulance, or plecanatide, acts on the small bowel to add fluid to the stool and promote movement. It appears to be safe and effective, but does sound costly.
Baking soda is OK at the level you mention: 1 tsp is about the same as a couple of glasses of soda pop. The only thing to watch with Gatorade is the sodium content (about 320 mg in a 20 oz bottle), keeping in mind that for older adults, about 1500 mg a day of sodium is enough.
Senna and bisacodyl are both stimulant laxatives. There are some patients who need to use senna daily (it’s milder than bisacodyl) and for most, it’s safe. An example would be someone who is on an opioid (like morphine) or other medication that slows the bowel. Restoralax, or PEG 3350, can be used daily, but you’re correct that it can disrupt electrolytes in some conditions.
In terms of your struggle to get your mind off your bowels, you’re not alone. I have many patients who are very distracted by their bowel habits, sometimes to the point that it gets in the way of quality of life. One thing that might help is CBT, or Cognitive Behavioural Therapy. Here’s a paper about it: https://bpsmedicine.biomedcentral.com/articles/10.1186/s13030-021-00226-x. This is a type of psychological therapy that often includes mindfulness, and can relieve anxiety and depression symptoms.
Good luck on your bowel journey.
Very informative article and comments, I’m glad I came across it. I’m a 66 male and I’ve had major issues with IBS and severe constipation for over 10 years. Been to 2 different GI docs and neither one has really helped. I’ve tried EVERYTHING mentioned here and elsewhere, all the different meds and supplements, but nothing really helps much.
After a daily ritual of taking various things, at best I can have an incomplete bowel movement, which leads me to do a daily warm water enema using an enema bulb. I know this isn’t a long-term solution and I’ve read that it isn’t good to do it this often, some say it’s even dangerous, but I don’t know what else to do. Doing this gives me some relief. I did tell my GI doc and surprisingly he didn’t seem to have a problem with it. My primary doc was another story, he didn’t like it.
I just had my 4th colonoscopy and they found 3 polyps which were removed, but other than the diagnosis of diverticulosis, which has also showed up on my other colonoscopies, it appears they didn’t find much to explain my issues.
Sometimes I feel my doctors think I’m making up or exaggerating my symptoms, esp my primary doc. I’ve literally gotten into arguments with him, which obviously isn’t helpful. It’s not a good feeling when you feel that your own doctor doesn’t believe you.
I often take Senna along with dried prunes, PEG 3350, extra fiber, and a few other daily supplements. My GI doctor doesn’t seem to like me taking Senna every day. He wants me to start taking Linzess again, but it doesn’t work very well for me, and I don’t like the side effects when it does work, i.e., diarrhea for 3-4 hours.
Dr. Kernisan and Dr. Didyk, I really appreciate your knowledge, understanding, and kindness. I wish all doctors were as compassionate as both of you are about this subject.
Do you have any thoughts or advice? Also, I live in the SF Bay Area, do you know of any doctors or clinics in my area which specialize in these issues?
Sorry to be so long-winded. Thanks very much for your help.
Nicole Didyk, MD says
Hello Kevin and thank you for your kind feedback.
Unfortunately, many of us in the medical field forget about nutrition and diet as a way to help GI issues. Many of my patients have had good results with a diet low in FODMAPs, which you can read about here:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019579/. FODMAPs stands for Fermentable Oligo-, Di-, Mono-saccharides, And Polyols, which are found in foods like garlic, onions, most dairy products, some fruits and many others.
Key dietary changes might be the key to fewer symptoms, along with following the advice of your medical team. Good luck!
So glad to find this site
Thank you so much doctor for a beautiful ,informative ,clear artical .. i have a chronic constipation since childhood i go every 5 days in average and was afraid to take a daily dose of laxative least becoming dependant and my bowels wouldnt move without it ..am 60 and lately its been affecting my bladder and was thinking to try osmotic agents, couldnt find polyethylene glycol products in egypt but there is lactulose product , ( LACTULOSE 67 GM / 100 ML ) can you plz advice is it a good replacement ?
greetings from Egypt 🙂
Nicole Didyk, MD says
I’m so glad you found our site too and that you enjoyed the article, Mona!
Lactulose is different to PEG3350 but is also used for constipation. Lactulose is a non-absorbable sugar that interacts with colon bacteria to speed up bowel activity and draw water into the colon, which promotes bowel movements.
PEG 3350 works by drawing water into the colon too, but doesn’t have the same effect on bacteria as lactulose.
Lactulose can have side effects such as diarrhea, bloating and gas. Sorbitol can also be used for constipation (it’s a sugar alcohol, or polyol) and is found in many foods like peaches, plums, berries and some dried fruits.
Remember to work on those lifestyle changes too: dietary fiber, exercise and consuming enough water. Thanks for taking the time to comment and good luck!
Tom Wright says
My dad hates prunes but he loves eating dates. Do dates have similar beneficial results as prunes and if so would you still recommend the 50 g of dates per day? Thank you for a great article.
Nicole Didyk, MD says
Dates are similar to prunes in fiber content, with 100 grams having 6.7 grams of dietary fiber, versus about 7.1 in 100 g of prunes. However, dates are lower in sorbitol, a type of sugar that pulls water into the colon and also helps with constipation.
So dates are a good source of fiber but not likely to be as effective for constipation as prunes.
Shmuel Shimshoni says
For yyears I;ve been eating two or three cooked prunes every day, but but, I gues, with aging (91) my mevements have been reduced to once every two or thre days, often with two orthree time that day, to complete evacuation.
After reading this study, i probably have to increase the number of “cooked”to correct my growing problem. I’ll try it starting today, but won’t jump from two to 12 right away.
Nicole Didyk, MD says
Always a good idea to proceed slowly, even when it comes to an increase in dietary fiber. Going too quickly could have untoward side effects like flatulence, cramps, or diarrhea.
Remember that frequency of bowel movements can be very different between individuals, but still normal, so it may be that once every 2-3 days is normal for you.
Is Miralax safe forever? What is a noninvasive way to be evaluated, diagnosed and treated?
Nicole Didyk, MD says
As I’ve replied before: “Miralax is also known as PEG 3350, or polyethylene glycol 3350. As Dr. K mentions, it’s an osmotic agent that draws water into the bowel and promotes more freqent bowel movements.
Occasional use is no problem for the kidneys, but using PEG3350 every day for more than a few weeks, or more than once a day, could upset the balance of fluid and electrolyes (sodium and potassium levels in the blood) in people with kidney problems. I have patients with kidney impairment who use PEG 3350 occasionally, but if the kidney failure is severe (e.g. on dialysis or pre-dialysis), I would talk to their nephrologist first.
It’s ideal if people can use laxatives once in a while and work on lifestyle changes to bring about sustainable and natural regulation of bowel movements, but of course that’s not always possible.”
I hope that’s helpful!
Mingchun Chien says
The article and site is filled with useful information. Thank you Dr. Kernisan and Dr. Didyk! I understand each of the three categories of OCT constipation meds work differently, what about the time they start working after taking them? What’s the best time of the day to take them?
Thank you again!
Leslie Kernisan, MD MPH says
Thank you, glad you found it helpful! Osmotic agents and bulking laxatives are often given in the morning. An oral stimulant laxative such senna is traditionally given at bedtime, the idea being that it works overnight.
I would recommend trial and error to see what works best for you (or your older relative). Good luck!