Dietary fiber and bulk laxatives with adequate fluid intake are the most physiologic and safest of medical therapies. However, they may be counterproductive in patients with idiopathic slow transit constipation or with constipation associated with irritable bowel syndrome (IBS) because they often worsen bloating and abdominal distension in these populations.
Dietary fiber in cereals contain cell walls that resist digestion and retain water within their cellular structures, whereas those found in citrus fruits and legumes stimulate the growth of colonic flora and increase fecal mass. Wheat bran is the most effective fiber laxative with a clear dose response on fecal output. Patients with poor dietary habits may add 2 to 4 tablespoons of bran to each meal, followed by a glass of water or another beverage. A laxative effect may not be observed for 3 to 5 days. Patients should be cautioned that large amounts of bran can cause abdominal bloating or flatulence; therefore, they should start with small amounts and titrate slowly to the desired effect.
Psyllium (Metamucil), calciumpolycarbophil (Fiber-Con), and methylcellulose (Citrucel) are natural or synthetic poly-saccharides or cellulose derivatives, which primarily exert their effects by water retention and increasing fecal mass, thus decreasing colonic transit time. They should be well diluted to ensure adequate mixing with food and may be consumed before meals or at bedtime. They are more refined and concentrated than bran but are more expensive.
Was this article helpful?
Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.