Q: I am a 57 year-old woman that has tried to quit smoking with the patch. My side effect is constipation. The meds I take are Welchol, Axid and Metoclopram. While I am not smoking, I can’t have a normal movement. My doctor prescribed stool softeners and has sent me for a colonoscopy. No problems there. The last time I tried to stop smoking I thought I would wean myself from the nicotine by reducing the amount of cigarettes to about 13 a day. I became totally constipated again.
My doctor believes the cigarettes are my stimulant. I am taking stool softeners and drinking a lot of fluids, along with fruit and Citracal every night. Ducolax is the only thing that works and I can not keep using it. I do not like prune juice so I have not tried that. When I eat something that normally moves a person, I become bloated and have a lot of burping. The last time I quit smoking I went like this for a month and I couldn’t take it any longer so I started smoking again. Within two weeks I was fine with regular movements every day.
I have not met anyone with this problem and am wondering if you have any knowledge of this.
A: Constipation is described as bowel movements that are infrequent or hard to pass. Severe cases include fecal impaction that can progress to a bowel obstruction and obstipation which is a failure to pass stools or gas. Several common causes of constipation are the result of hormonal disorders, diet, hypothyroidism, specific medications and in rare instances, heavy metal toxicity.
Constipation is a symptom, not a disease or disorder, which indicates that the underlying cause can hopefully be determined so steps can be taken to get things back on track. The condition is common and affects up to 20% of our country’s population at one time or another. Guidelines for diagnosis include having to strain during more than 25% of movements, having a sensation of an incomplete movement, and having three or fewer movements per week.
It is well-known that discontinuing smoking can, for some individuals, cause major constipation. Those health care professionals that treat smokers have found a dramatic rise in cases of constipation in people who attempt to kick the habit.
Anti-depressants, antihistamines, opioids, diuretics, antacids that contain aluminum, anti-convulsants, or anti-spasmodics can contribute to or cause constipation. Another consideration is the consumption of a low-fiber diet or failure to drink sufficient amounts of liquids. Specific diseases including hypothyroidism, diabetes, celiac disease and cystic fibrosis must also be considered. Of the medications you are on, Welchol may cause mild constipation. To a lesser degree, Axid may also cause constipation. Citracal is a calcium supplement. It lists constipation as a potential side effect and on the flip side, Metoclopramide may cause diarrhea. It is recommended people not take it for more than 12 weeks. Were I you and with your doctor’s permission, I would temporarily discontinue the Citracal to determine if that over-the-counter alone may be what is causing such chaos in your life. I believe you require lab work because you may have a low magnesium count which could be contributory, as well as a complete examination.
It goes without saying that constipation is much easier to prevent than it is to treat. Exercise, continue the increased fluid intake, add fiber to your daily diet, consider milk of magnesia, and make an appointment with a health care professional such as a gastroenterologist. There may be substitute meds for two of the three prescription drugs you are on that don’t have constipation as a possible side effect. You should discontinue or replace only one medication at a time if you are going to determine the culprit. Good luck.
