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If these initial measures fail, the health care professional may try a number of laxatives on a short-term basis. The patient must consult with his or her doctor before using any of these agents, particularly on long-term basis.

• Mineral oils can be very helpful in the short-term, but are associated with health risks with long-term use. They also can cause substantial diarrhea if too much is taken.
• Sodium docusate or calcium docusate may be useful when the patient must avoid straining for a short period of time, such as after a heart attack, during pregnancy, or after gastrointestinal surgery. They often will lose their effectiveness after several days.
• Fiber supplements as mentioned previously.
• Polyethylene glycol 3350 (Miralax) is an osmotic laxative that is not absorbed by the intestines. It holds water in the bowel, resulting in looser stools. It may be taken occasionally for constipation (up to 2 weeks). Miralax is a drink prepared by mixing a powder with 240 mL (8 oz) of water. Some physicians may prescribe it on a long term basis.
• Lubiprostone (Amitiza) stimulates the bowel to secrete more fluid into the stool and therefore makes it softer. It is typically taken twice daily and should be taken on a regular basis whether or not constipation is present.
• Nonabsorbable sugars such as lactulose and sorbitol may be useful. Furthermore, they are may acceptable for long-term use. However, they usually produce crampy abdominal pain, diarrhea, and electrolyte imbalance.
• Saline laxatives such as magnesium hydroxide (Phillips Milk of Magnesia) or sodium phosphate (Phospho-Soda, Fleet enema) are not recommended if the affected individual has renal insufficiency (an inability or reduced capacity of the kidney to remove waste). These laxatives may produce severe side effects if used on long-term basis. A doctor may prescribe them on an occasional basis if the patient has normal kidney function.
• Cisapride (Propulsid) may work if the patient has constipation caused by slow fecal movement. However, the srug has been withdrawn from US market because it can cause lethal irregular heartbeats.

A doctor will treat any underlying diseases (intestinal obstruction, anal fissure, hemorrhoids, and bowel cancer).

• If the patient has irritable bowel syndrome (IBS), he or she should stop smoking and avoid coffee and milk-containing foods. A food diary may help to identify foods that seem to worsen the symptoms.
• Thyroxin will be prescribed if the doctor determines through clinical and laboratory tests that the patient has an underactive thyroid gland (hypothyroidism).

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