GLP Constipation Guide

Start with Dietary and Lifestyle Modifications

• Increase Fiber Intake:
  1. Aim for 30 grams of fiber per day through diet (fruits, vegetables, whole grains) or fiber supplements such as psyllium (Metamucil), methylcellulose (Citrucel), or polycarbophil (FiberCon).
  2. Mechanism: These work by absorbing water in the intestine to form a soft, bulky stool that is easier to pass.
  3. Dosage: Start with the lowest recommended dose and gradually increase to avoid gas and bloating.
• Hydration: Drink plenty of water, aiming for 60-100 ounces per day. Adequate hydration is crucial when increasing fiber intake.
• Exercise: Regular physical activity can help stimulate bowel movements. Encourage at least 30 minutes of moderate exercise most days of the week.

If Needed, Add Osmotic Laxatives for More Effective Relief

• Options:
  1. Polyethylene Glycol (PEG) 3350 (Miralax): Often preferred due to its gentle action. Start with 17 grams (one capful) dissolved in water or another beverage daily.
  2. Magnesium Hydroxide (Milk of Magnesia): Another option that draws water into the intestines to help soften stool. Start with 15-30 mL at bedtime.
• Mechanism: These laxatives draw water into the bowel, softening stools and making them easier to pass.
• Considerations: PEG is usually well-tolerated, while magnesium hydroxide should be used cautiously in patients with renal insufficiency due to the risk of hypermagnesemia.

Consider Stimulant Laxatives if Constipation Persists

• Options:
  1. Bisacodyl (Dulcolax): Start with 5-10 mg orally at bedtime.
  2. Senna (Senokot): Start with 8.6 mg (1-2 tablets) at bedtime.
• Mechanism: Stimulant laxatives increase intestinal motility and help stimulate bowel movements.
• Use: Use these sparingly and for short periods due to the risk of dependency and potential for cramping or diarrhea.

Use Stool Softeners as Adjunct Therapy

• Options:
  1. Docusate Sodium (Colace): Typically, 100 mg orally once or twice daily.
• Mechanism: Stool softeners help moisten the stool, making it easier to pass, particularly useful if the stool is hard or dry.

For Severe Cases, Rectal Suppositories or Enemas Can Be Considered

• For Severe Constipation: If oral medications are not effective, rectal suppositories or enemas can be considered for immediate relief.
• Options:
  1. Glycerin Suppositories: Provide quick relief by drawing water into the stool and stimulating a bowel movement.
  2. Bisacodyl Suppositories: Provide more potent relief by stimulating the bowel.
  3. Enemas: Saline enemas (e.g., Fleet) can provide immediate relief by stimulating bowel movements and softening stool.
• Use: These are typically used for acute situations and not as a regular treatment.