When should you use a laxative to treat your constipation? In this excerpt from our Health After 50 newsletter, Dr. H. Franklin Herlong, Associate Professor of Medicine at Johns Hopkins, offers advice.

The National Institutes of Health defines constipation as having bowel movements less than three times a week; however, frequency isn’t as important as whether you experience constipation symptoms, such as painful stools, bloating, or cramping.

Drinking more water, eating foods rich in fiber, and exercising more can usually help alleviate chronic constipation. If not, you can try laxatives for constipation. There are four different types of laxatives, some available over the counter, others only by prescription. Bulk, lubricant, and hyperosmotic laxatives make stools easier to pass by absorbing water into the stool. Over-the-counter types of bulk, lubricant, and hyperosmotic laxatives include Metamucil, Epsom salts, and Miralax (previously a prescription product and now available over the counter). Stimulant laxatives prompt intestinal contractions -- Ex-Lax is an over-the-counter type of this laxative. While bulk laxatives are safe for long-term use without significant side effects, lubricant, hyperosmotic, and stimulant laxatives should be used under a physician’s supervision.

Recently, the medication Amitiza (lubiprostone) was approved to treat chronic constipation. But H. Franklin Herlong, M.D., Associate Professor of Medicine at Johns Hopkins, says, "Since the long-term safety of this drug isn’t established, it should be considered only after other therapies have failed."

Some people worry that laxatives are addictive, but that’s not exactly the case. Dr. Herlong states, "Many individuals believe that a daily bowel movement is necessary for ‘good health’ and may use laxatives to maintain a regular schedule even if they're not constipated. As a result, the natural urge for defecation may wane, and these people end up taking laxatives most of the time.”