When patients complain to their health care providers that they are suffering from long-standing constipation, they may get a suggestion to use a stool softener such as docusate (Colace). If that’s not helpful, polyethylene glycol (MiraLAX) may be recommended. But before such solutions are tried, it is crucial to rule out medications as the constipation causes.
Drug-Induced Chronic Constipation:
Q. I have been taking amitriptyline for years to help with sleep problems and depression. The drawback is I am constipated all the time. I hate to rely on laxatives. What else can I do?
A. Let’s start with the cause of your constipation. Amitriptyline is an old-fashioned antidepressant notorious for causing dry mouth and constipation. That’s because this medication has strong anti-cholinergic activity. It slows everything down. Because it interferes with the action of the neurochemical acetylcholine, the muscles of the gut just don’t work normally. Constipation is a common consequence.
Other drugs that have anticholinergic activity and the potential to cause constipation include diphenhydramine (Benadryl). It is found in virtually all of the nighttime pain relievers. If you see “PM” in the name, you can probably assume that the pill contains diphenhydramine.
Medications that are prescribed for incontinence also have anticholinergic activity. That would include oxybutynin (Ditropan) and tolterodine (Detrol). We have compiled a long list of anticholinergic drugs at this link. https://www.peoplespharmacy.com/articles/where-can-i-find-a-list-of-anticholinergic-drugs
Even drugs that that do not have anticholinergic action can be constipation causes. Calcium channel blockers such as amlodipine (Norvasc), diltiazem (Cardizem) or verapamil (Calan, Verelan) can have this effect. And let’s not forget NSAIDs (nonsteroidal anti-inflammatory drugs). Ibuprofen and naproxen can cause constipation too.
When Constipation Causes are Medications:
When you take a drug like Advil PM or Aleve PM on a regular basis, you get a double whammy. The NSAID pain reliever can affect bowel function. So can the diphenhydramine antihistamine that makes people sleepy.
It may not always be possible to change the medication regimen and eliminate a drug that causes constipation. Nevertheless, it is worth asking the prescriber if there is a substitute that doesn’t slow down your digestive tract.
Other Strategies to Overcome Constipation Causes:
The foundation of fighting constipation is fiber and fluid. We include a list of high-fiber foods along with recipes for Pumpkin Bran Muffins, flaxseed solutions and Power Pudding in our newly revised eGuide to Overcoming Digestive Disorders. You will also find a list of some drugs that are among the most common constipation causes.
Many readers sing the praises of coffee (caffeinated or decaf). Others prefer a cup of hot water with a squeeze of lemon juice early in the morning. Additional options include psyllium (a great source of fiber), sugarless gum or ginger.
You might also consider magnesium. This can be found in supplements as well as old-fashioned Milk of Magnesia. Before trying magnesium, however, ask your doctor for a kidney function test. If the kidneys are not working well, they won’t be able to handle additional magnesium.