What can I do to have regular bowel movements?

A fellow caregiver asked...

I'm not having regular bowel movements. I've taken laxatives and tried Miralax. The laxitives work but I know they aren't good for me. The Miralax barely works. What in the world should I do. It really scares me. I just want to be regular

Expert Answer

Jennifer Serafin, N.P. is a registered nurse and geriatric nurse practitioner at the Jewish Homes for the Aged in San Francisco.

Constipation is a common problem, as everyone gets constipated at one time or another during their life. Constipation is defined as bowel movements (BMs) that are difficult to pass or come less frequent than you would normally have them. The normal frequency of BMs really depends on the person. Some people have bowel movements a couple of times a day, while others go only a couple of times a week. So, you have to think about your regular pattern and why it has changed.

Things that can increase constipation: 1) Dietary: Poor fluid or fiber intake 2) Lack of physical exercise/ immobility 3) Medications: calcium supplements, antacids, iron pills, pain pills, diuretics, blood pressure pills (just to name a few) 4) Stress or a change in routine (like travel) 5) Delaying BMs ("I will go when I get home") 6) Medical conditions: like hypothyroidism, depression, neurological conditions (Parkinson's disease), pregnancy, irritable bowel syndrome

So, think about this list in regards to yourself. Has something changed? Are you eating a new diet? Did you start a new medication? Did you recently have surgery? This may help you figure out how to help yourself with this problem.

To improve/prevent constipation: 1) Eat more fiber: increase the amounts of fruits, vegetables, beans, and high fiber breads (think brown, not white). Try eating some bran cereal in the morning. Also, prunes are especially helpful. 2) Increase your fluid intake: drink 2 extra glasses of water a day. Try to cut down on coffee and sodas, as they can actually be dehydrating. Try a warm glass of prune juice in the morning (warm it for a few seconds in the microwave- its magical!). 3) If you do not exercise, try to start walking regularly for at least 15 minutes a day, increasing your time as you tolerate it. 4) When you feel the urge to go, then go! Don't delay moving your bowels, as this will dry out the stool and make it more difficult to pass.

If you have tried all of the above and get no constipation relief, then you can try the following: 1) Colace: remember this is a softener, not a laxative. If it doesn't work for you, then stop it. 2) Senekot: great laxative that works overnight. Can cause some mild stomach cramps. Really good for people whose constipation is due to medications. 3) Miralax: This really allows the stool to be softer, as it makes the bowel not absorb as much water from your stool.

I would not recommend Milk of Magnesia (MOM), Fleets phosphate soda, or magnesium citrate for more than sporadic use, as it can cause some electrolyte imbalances if used in excess. Glycerin suppositories and Fleets enemas can be helpful if the stool is dry and hard to pass, but these can be difficult to use if you have mobility issues.

If your constipation continues to be a problem for you, you should really let your health care provider know, so that they can help you deal with this problem. You should also call them immediately if you notice blood in your stools, if you have lost weight, if your abdomen is painful/ bloated, or if you have nausea or vomiting as well. Good luck!