Self-Care Measures for the Prevention and Management of Constipation

Constipation is one of the most commonly reported gastrointestinal complaints for which individuals elect to use nonprescription laxatives, fiber supplements, or lifestyle measures such as increasing fiber intake. Constipation also accounts for an estimated 2.5 million health care visits annually.¹

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According to a publication in The American Journal of Gastroenterology, constipation affects an estimated 15% of the population but possibly affects more and is often self-diagnosed and self managed.² The most recent statistics from the American Society for Nutrition indicate that only 5% of men and 9% of women obtain the recommended daily amount of dietary fiber, which ranges from 21 g to 38 g, depending upon age.³

Findings from a survey conducted in 2023 reveal that an estimated 6% of adults (representing more than 18 million individuals) met the diagnostic criteria for chronic constipation.⁴ Additionally, the survey findings revealed that although some participants exhibited symptoms that met the diagnostic criteria, an estimated 50% did not report taking any constipation medications, whether prescription or OTC.⁴

The causes of constipation are multifaceted, including diets low in carbohydrates, calories, and fiber; inadequate water intake; a sedentary lifestyle; genetic predisposition; colonic motility issues; certain medical conditions; and specific medications.^5,6 Left untreated, constipation, especially chronic episodes, can adversely affect quality of life (QOL), resulting in psychological and physical discomfort and diminishing productivity.⁵ The effect of constipation on a patient’s QOL is contingent on the severity of constipation and the underlying diagnosis.^5,6 When no contraindications are present, occasional bouts of constipation can be typically self-managed with proper treatment, including lifestyle measures and the use of available nonprescription laxatives and fiber supplements. However, chronic constipation should be evaluated by a health care provider because it can contribute to complications such as hemorrhoids, anal fissures, and fecal impaction.^5,6

Before recommending any nonprescription products for treating and preventing constipation, pharmacists should ascertain whether self-treatment is appropriate and encourage patients with chronic or repeated episodes of constipation to seek further medical evaluation from a health care provider to identify potential causes.

Due to their drug expertise, pharmacists can be instrumental in identifying medications and medical conditions that may augment the risk of and/or exacerbate constipation. Examples include anticholinergics, narcotics, antidepressants, iron, bismuth, calcium channel blockers, nonsteroidal anti-inflammatory drugs, and psychotropic drugs.^5,6 Examples of medical conditions associated with constipation include hypothyroidism, diabetes, multiple sclerosis, colorectal cancer, Parkinson disease, and eating disorders.^5,6

Prevention and Treatment

The treatment approach for constipation should consider the underlying cause, the patient’s medical and medication history, allergies, and the severity and duration of constipation. After consideration of patient-specific factors, initial management often involves nonpharmacological measures such as increased fluid and fiber intake (whole grains, bran, fruits, and vegetables) and behavioral changes such as exercise when suitable.⁶

Nonprescription options include hyperosmotic agents (polyethylene glycol 3350 and glycerin), saline laxatives (magnesium citrate and magnesium hydroxide), emollients (docusate sodium or docusate calcium), lubricant agents (mineral oil), and stimulant laxatives (bisacodyl, senna, and castor oil) or combination laxatives.6 To increase fiber intake or when dietary fiber intake is insufficient, many consumers use fiber supplements as a preventive measure. Fiber supplements may contain bulk-forming agents such as methylcellulose, calcium polycarbophil, psyllium, inulin, powdered cellulose, or wheat dextrin.⁶

Recent News and Clinical Data

Study data published in Clinical Gastroenterology and Hepatology revealed that a disruption in a patient’s gut flora, specifically the overgrowth of Archaea—unique microorganisms in the gut microbiome—could cause constipation in some individuals. Results revealed that patients with intestinal methanogen overgrowth experience more frequent and severe constipation and less frequent and severe diarrhea, necessitating the inclusion of their distinct phenotype in patient-reported outcome measures and its correlation with mechanistic microbiome studies for further understanding.⁷

Other study results published in BMC Gastroenterology explored the correlation between daily sodium intake and constipation in men and discovered that increased daily sodium intake is associated with reducing the prevalence of constipation in men. The authors wrote, “While this association was consistent across different models and subgroups, it does not imply that high sodium intake is universally beneficial. Sodium intake may affect intestinal health in various ways, including potential adverse effects.”⁸ The authors also noted that more studies are warranted to confirm sodium intake’s role in intestinal health, explore its link to constipation, and evaluate its overall health impact.⁸

Additionally, study results published in Therapeutic Advances in Neurological Disorders revealed that constipation in patients with amyotrophic lateral sclerosis (ALS) is associated with swifter progression of ALS and poorer clinical outcomes.

This association could potentially be through the peroxisome proliferator-activated receptor pathway.⁹

Conclusion

When counseling patients about constipation, pharmacists should ensure that self-treatment is appropriate and screen for potential drug-drug interactions and contraindications. Moreover, to prevent interactions, patients should be advised to avoid taking most laxatives within 2 hours of other medications.^5,6 Patients should be advised to adhere to the manufacturer’s recommendations, including dosage; administration; duration; potential adverse drug reactions such as cramping, bloating, flatulence, or diarrhea; and treatment expectations.^5,6

For those using fiber supplements, gradually increasing them over 1 to 2 weeks is advised to improve tolerance and reduce adverse drug reactions.

Pharmacists can also recommend nonpharmacological measures to prevent or decrease constipation, such as consuming more fruits, vegetables, and whole grains high in fiber; drinking plenty of water (if appropriate); exercising when suitable; and not postponing bathroom trips.^5,6 Patients should seek medical care if they experience abdominal distention or pain, fever, unexplained changes in bowel habits, blood in stool, or if symptoms do not improve or worsen after self-management.^5,6

REFERENCES

1. Constipation and defecation problems. American College of Gastroenterology. Accessed January 23, 2025. https://gi.org/topics/constipation-anddefection-problems

2. Rao SSC, Lacy BE, Emmanuel A, et al. Recognizing and defining occasional constipation: expert consensus recommendations. Am J Gastroenterol.2022;117(11):1753-1758. doi:10.14309/ajg.0000000000001945

3. Most Americans are not getting enough fiber in our diets. American Society for Nutrition. June 9, 2021. Accessed January 23, 2025. https://nutrition.org/most-americans-are-not-getting-enough-fiber-in-our-diets/

4. Liang J, Almario CV, Chey WD, Higgins CS, Spiegel BMR. Prevalence and burden of illness of Rome IV chronic idiopathic constipation, opioid-induced constipation, and opioid-exacerbated constipation in the United States. Am J Gastroenterol. 2023;118(11):2033-2040. doi:10.14309/ajg.0000000000002376

5. Diaz S, Bittar K, Hashmi MF, Mendez MD. Constipation. In: StatPearls.StatPearls Publishing; 2023. Accessed January 23, 2025. https://www.ncbi.nlm.nih.gov/books/NBK513291/

6. Weitzel K, Gatewood S. Chapter 15: constipation. In: Krinsky DL, Ferreri SP,Hemstreet BA, Hume AL, Rollins CJ, Tietze KJ, eds. Handbook of Nonprescription Drugs. 20th ed. American Pharmacists Association; 2020.

7. Mehravar S, Takakura W, Wang J, Pimentel M, Nasser J, Rezaie A. Symptom profile of patients with intestinal methanogen overgrowth: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2024:S1542-3565(24)00716-X.doi:10.1016/j.cgh.2024.07.020

8. Peng XF, Yang H, Chen WX, Yu M, Wang DC. Daily sodium intake and constipation in US adult males: an uncommon negative association revealed by national health and nutrition examination survey data from the United States (2005-2010). BMC Gastroenterol. 2025;25(1). doi:10.1186/s12876-024-03543-x

9. Niu T, Wang P, Zhou X, et al. An overlap-weighted analysis on the association of constipation symptoms with disease progression and survival in amyotrophic lateral sclerosis: a nested case-control study. Ther Adv Neurol Disord. 2025;18:17562864241309811. doi:10.1177/17562864241309811