How to get motion without strong laxative. . - #9563

**Patient Name**: Piyaly Dutta **Age**: 55 years **Date**: 12-04-2025 **Presenting Complaint**: Piyaly presents with a **chronic history of constipation** and reports an inability to pass stool without the use of **strong laxatives**. She also experiences **bloating** and general discomfort related to irregular bowel habits. She is a known hypertensive and hypothyroid patient, both under control with regular medications. Her blood pressure currently remains stable around **130/90 mmHg**, and thyroid levels are reportedly normal with treatment. --- **Clinical Impression**: Chronic constipation in this case is likely functional, possibly compounded by long-term dependence on stimulant laxatives, sluggish colonic transit, and potential dietary or lifestyle factors. Over time, the colon can become less responsive to natural signals due to excessive stimulant use, leading to what is known as “lazy bowel.” In such cases, a stepwise approach to retrain the bowel, optimize diet, and restore gut health is recommended **Management Plan**: 1. **Dietary & Lifestyle Modifications**: Piyaly is advised to slowly increase her **dietary fiber intake to 25–30 grams/day**, which can be achieved through oats, wheat bran, flaxseeds, vegetables (like spinach, beans, carrots), and fruits (papaya, prunes, pear). **Hydration is crucial**, and she should aim for 2.5 to 3 liters of water per day unless medically restricted. Begin each day with **1–2 glasses of warm water** on an empty stomach. Incorporate **light walking, yoga, or stretching exercises**, especially in the morning, to stimulate bowel movement naturally. 2. **Stool Regulation Without Harsh Laxatives**: - Start **Isabgol (psyllium husk)** 1–2 teaspoons in warm water at bedtime. - Add **Lactulose syrup (15 ml at bedtime)** to help soften stools—this is gentle and non-habit forming. - Introduce a **probiotic supplement** like *Sporlac DS* or *Vibact DS*, once daily after lunch, for 3–4 weeks to reduce bloating and promote gut flora balance. - Soaked raisins or figs overnight can be taken in the morning for natural bowel stimulation. 3. **Habits & Bowel Training**: A fixed daily routine is vital. Even without the urge, Piyaly should sit on the toilet at the **same time every morning**, ideally after warm water intake and light physical movement. This helps retrain the bowel to resume natural peristalsis. 4. **Avoid**: - Prolonged use of stimulant laxatives like bisacodyl or senna (unless absolutely necessary and prescribed) - Highly processed food, refined flour (maida), and fried or spicy meals - Irregular meal timings or skipping meals, especially breakfast **Follow-Up Advice**: - Monitor for gradual improvement over 2–4 weeks. - If no improvement is seen, consider further evaluation: **Colonoscopy**, **thyroid profile**, **electrolyte levels**, and **abdominal imaging**. - Maintain regular BP and thyroid medication adherence. With consistent dietary and lifestyle efforts, along with supportive non-habit-forming agents, the bowel can be retrained and dependency on strong laxatives reduced over time. Regular follow-up is important to ensure sustainable improvement and overall well-being. Dr Shayeque Reza MD 9800280276