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Best bet for long-term constipation is an over-the-counter drug

Consumer Reports News: December 18, 2008 06:15 PM

Nearly everybody will experience constipation at some point in their lives. On any given day, an estimated 35 to 45 million people in the U.S. are afflicted with this condition. And the holiday season can play havoc with your bowels. Traveling and the disruption in your usual diet and routine that goes hand in hand with the holidays can trigger constipation. Both prescription and nonprescription drugs can provide relief, but how do you choose among the wide selection of treatments.

Our Consumer Reports Best Buy Drugs project took a close look at which drugs work best, whether you have constipation on its own or as part of a condition called irritable bowel syndrome (IBS).

Most episodes of constipation are temporary and don't require a doctor's visit. Including more fiber-rich foods, such as fruits, vegetables, and whole grains in your diet is often all that's needed to get things moving again. If you need a fiber supplement, we recommend those that contain psyllium because it's the active ingredient that's been studied the most in treating chronic constipation. Metamucil is the best known brand containing psyllium but you can also find it in generic versions, which are often less expensive.

If diet changes and/or fiber supplements don't help, our Best Buy Drug report found that the over-the-counter drug polyethylene glycol (MiraLax) is your best bet. This drug offers greater improvements for constipation symptoms than the prescription drug lactulose, according to studies that have compared the two remedies head-to-head in adults. It also has a track record of being safe and well tolerated. In addition, since it is available without a prescription, it's a less expensive option. Note that MiraLax is also available as a more costly prescription drug. If your doctor prescribes it, you should ask him or her why since you’ll generally save money by buying the non-prescription version.

Our report cautions against the long-term use (beyond a few days) of the laxatives senna (Ex-Lax, Senokot) and bisacodyl (Correctol, Dulcolax). They generally don't help improve chronic constipation.

If you have IBS with constipation as the main symptom, there's a newer prescription drug called lubiprostone (Amitiza) that's approved to treat women with this condition. However, it may not be any better or safer than other constipation medicines. It's also a very expensive treatment option. So try other medicines first, in addition to lifestyle changes, and only turn to Amitiza—with your doctor's guidance—if those strategies fail to bring you relief.

Steve Mitchell, associate editor, Best Buy Drugs

Download the free Best Buy Drug report in PDF form. You also may want to read an article on constipation from our chief medical adviser, Marvin Lipman.

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