It is often difficult to clearly identify the cause of constipation because there is a limit to the kind of tests that are covered by insurance or that can be performed only at specialized facilities. However, drugs for constipation can be prescribed at most clinical departments if patients consult about their symptoms of constipation. Therefore, it is recommended to consult your family physician and to receive follow-up examinations. It is recommended that patients with functional constipation first consult their family physicians and then consult or be referred to a specialist if the constipation is not cured. This does not apply to patients with organic constipation in whom bowel diseases are suspected. Constipation may occur due to side effects of drugs being taken at that time, such as cold or cough medications, and antihistamines used for pollinosis. It should also be noted that elderly people may suffer from constipation due to side effects of drugs because persons of more advanced age are often taking more medications.
For constipation, drug therapy is the main conservative therapy, in which non-irritant drugs, such as stool softeners, are used. Since irritant laxatives are used in cases urgently requiring bowel evacuation, long-term use of such laxatives is not recommended. Although the use of Kampo laxatives is increasing, caution must be exercised because such laxatives contain irritating ingredients. It is also recommended to use bifidobacteria to regulate the intestinal environment. Drugs to be used for constipation vary depending on symptoms. If stools reach the anal canal but do not pass through the anus, a suppository or enema is used because taking oral medications is less effective in such cases. If it is difficult for you to select an appropriate drug, consult an internist, gastroenterologist, or proctologist for treatment with prescription drugs.
Constipation can be classified into rectal or atonic constipation, but in communication with my patients, I avoid using medical terminology. I try to give patients advice based on symptoms such as "at what intervals they have bowel movements," "whether stools reach the anal canal but are not evacuated" and "whether they have hard or soft stools." I give patients an explanation using expressions that are easy to understand, such as "they should drink adequate fluid" for patients with hard stools and "they should do exercise" for patients with intestinal hypomotility.
Improvement of lifestyle is important in the treatment of constipation. I recommend to form the habit of not going to bed late and arising at a sensible time. In humans, a happiness hormone called “serotonin” is secreted from the small intestine; the secretion of this hormone is facilitated by exposure to the morning sunlight. Taking the morning sunshine and telling yourself "you will have a good day!” will help in making the bowels function well.
There are more than a few patients who constantly use laxatives despite not having constipation, mistakenly assuming that “they are constipated.” Even if there are days without a bowel movement, it is not considered constipation. Although it is ideal to have a bowel movement at the same time every day, there is no problem with a bowel movement every 2 or 3 days if the patient passes stools smoothly without feeling a sensation of inadequate defecation. There are patients who visit our hospital, saying "they want to stop using OTC drugs for constipation." Some patients suffer from diarrhea due to excessive use of laxatives. Such patients have a sensation of inadequate defecation and rough skin around the anal region. We advise such patients to improve their lifestyle, to stop using OTC drugs, and to use only oral prescription drugs, which can be well tolerated if continuously taken. However, when constipation does not subside soon after discontinuation of OTC drug use and there is no response after taking an oral prescription drug for 3 days, we recommend taking one dose of the previously used OTC drug and encouraging the patient, saying "you will have more frequent bowel movements or more stools evacuated compared with previously." It is important for patients to have confidence that “they can achieve regular bowel movements.”
Question to a doctor “Proper knowledge and use of OTC drugs for constipation”
Question to a doctor “Measures against constipation. When should you go to a hospital?”
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