Several types of medications and supplements are readily available and help provide effective relief from constipation.
Depending on the type and mode of delivery, medications for constipation are available in the form of tablets, powders, wafers, liquids, and solid preparations for insertion into the rectum (suppository).
In This Article:
- Preventing Constipation After Back Surgery
- Medications for Constipation Relief
Over-the-Counter Constipation Medications
Non-prescription constipation medications, called laxatives, help prevent or manage constipation after spine surgery. Laxatives are available at most grocery stores, convenience stores, and pharmacies.
Effective OTC options are described below.
Osmotic laxatives
These drugs enable the retention of water inside the cavity of the intestine, adding bulk to the stool and helping to soften it.
Polyethylene glycol or PEG (Miralax), magnesium-based laxatives, such as Milk of Magnesia or magnesium citrate, and lactulose are examples of osmotic laxatives.
Magnesium-based compounds, such as magnesium citrate, are further classified as saline laxatives and act quickly, producing a bowel movement in 30 minutes to 3 hours.
Osmotic laxatives, such as PEG, are poorly absorbed into the body and almost 100% of the drug is excreted, making them well tolerated with a lower risk of adverse effects.
Stool softeners
Emollient laxatives help fluids mix with stool to make it soft and aid with a bowel movement. Stool softeners include docusate (Colace, Dialose, Surfak) and iron with docusate (Ferro-DSS).
Stool softeners usually take 1-3 days to take effect.
Stool softeners are best used as medications to prevent constipation and may not be effective if constipation has already occurred.
Stimulant laxatives
These medicines act on the nerves that power the muscles of the intestine to stimulate bowel contractions and move stool out of the rectum.
Stimulant laxatives take 6-12 hours to work and are categorized as follows:
- Diphenylmethane derivatives (eg, bisacodyl [Dulcolax] and sodium picosulfate)
- Plant-based anthraquinones (eg, senna [Senokot], aloe, and cascara)
These drugs may possess irritant properties that cause diarrhea and abdominal pain in some individuals.
Bulk-forming laxatives
These drugs help increase the bulk or weight of the stool and also help soften it, stimulating a bowel movement. Examples include psyllium (Metamucil), calcium polycarbophil (FiberCon), and methylcellulose fiber (Citrucel).
This type of laxative usually takes 2-3 days to be effective.
Bulk-forming laxatives must be avoided in patients taking opioid medications after surgery. The action of opioid medications prevents the intestinal movements induced by this specific laxative, potentially worsening abdominal pain and contributing to bowel obstruction.
Suppositories
A suppository is a small round, conical, or cylindrical-shaped structure that contains a medical preparation. Suppositories are inserted into the rectum and dissolve quickly to release the medication. These drugs act fast and stimulate the colon to contract and push the stool out.
Examples of suppositories include bisacodyl (Dulcolax) and glycerin (Fleet).
Enemas
Enemas are injectable liquids that are administered in the rectum and upward into the colon. They help stimulate the colon to pass stools.
Examples of liquids used in an enema include water, saline, or mineral oil (Fleet).
For all medications, including over-the-counter versions, it is important to read the directions carefully and/or consult a pharmacist or primary care provider if there are any questions.
Prescription Medications for Constipation
Prescription medications are recommended when OTC options are ineffective in easing the symptoms of constipation.
Patients recovering from surgery, and especially those with opioid-induced constipation (when constipation occurs as a side effect of taking opioid pain medications), may need prescription-grade medications to aid in a bowel movement.
Prescription medications for constipation include:
Opiate agonists and antagonists
These drugs block the effects of opioid medications in the intestine that lead to constipation, while still allowing the pain-relieving effects of the drug to work on the body. Opiate agonists are not used in patients with peptic ulcer, colon cancer, or intestinal obstruction.
See Opioid Medication Potential Risks and Complications
Methylnaltrexone (Relistor) is an example of this drug and may be taken as a tablet or an injection.
Additionally, naloxegol (Movantik) blocks mu-opioid receptors in the bowel and can be used to treat opioid-related constipation.
Type-2 chloride channel activators
These drugs increase the secretion of fluids in the intestine and increase the tone, motility, and speed of muscle activity in the intestine – aiding in a bowel movement. They also help increase the overall frequency of bowel movements each week.
Lubiprostone (Amitiza) is an example of a type-2 chloride channel activator. This drug may be used in patients with or without cancer.
Other prescription medications include naloxegol (Movantik) and naldemedine (Symproic).
Vitamins and Supplements to Ease Constipation
It is surprising how effective many supplements are in stimulating regular bowel movements. The supplements tend to have the added benefit of providing the body with essential vitamins and minerals that are healthy and necessary.
For example, magnesium fosters regular bowel movements and has also been found to be deficient in 45% of adults in the US.,
Important vitamins and dietary supplements that help relieve constipation are:
Magnesium
Adding more magnesium to the diet enhances the absorption of water into the intestines, causing dilation of blood vessels and stimulation of the muscles, improving bowel movement.
- Magnesium supplements are available in the form of tablets containing magnesium oxide as the active ingredient.
- The exact dosage of magnesium varies for each individual and depends on the patient’s age and other medical conditions.
In rare cases, prolonged or excessive intake of magnesium supplements or drugs containing magnesium (eg, laxatives and antacids) may cause hypermagnesemia.
Common symptoms of hypermagnesemia include weakness, fatigue, nausea, vomiting, and headache. This risk is typically higher in patients with impaired kidney function.
Kiwifruit extracts
Kiwifruits are rich in fiber, vitamins, and specific nutrients that help in:
- Improving intestinal movements
- Digesting protein and emptying the stomach through the action of a special enzyme, actinidin
- Improving the gut’s microflora (bacteria)
A combination of the above processes helps in the propulsion of stool out of the intestines, preventing build-up and constipation.
Kiwifruit extracts are available as chewable capsules from freeze-dried kiwifruit.
Flaxseed oil
The oil, mucilage, soluble fiber, and insoluble fiber contained in flaxseeds may help ease constipation by lubricating the intestines and softening the stool.,
Flaxseeds can be added to cereals, baked goods, or smoothies. Flaxseed oil may also be taken as a dietary supplement, available in the form of capsules.
Probiotics
Probiotics contain strains of live bacteria and yeast that are part of a healthy gastrointestinal system. They help improve gastrointestinal health and relieve constipation by:
- Modifying intestinal bacteria to foster a more natural and balanced environment
- Altering intestinal function to improve bowel movement and shorten the time taken to propel stool
Probiotics are available in the form of chewable gummies, tablets, sachets, and fortified foods such as yogurt, milk, and beverages.
The above suggestions include a variety of ways patients can prevent or manage constipation following back surgery. However, if these actions do not produce results, or if discomfort or prolonged constipation is experienced, it is advisable to seek medical care. Usually, a primary care physician is best suited to treat constipation.
