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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 34294
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I'm suffering with constipation I've used all different

Customer Question

Hi there .... I'm suffering with constipation I've used all different laxitives prescribed by my dr these didn't work so he gave me suppositories again no luck so I've just had an enema again prescribed but nothing how long do enemas take to work and what is the next step .... Lindsay
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.

Hello Lindsay,

I am Dr. Arun and will be helping you today.

Enema usually works in 15-30 minutes. You may repeat enema. /an oil based enema my be better than the water based enema (fleet enema is available without prescription).

Irritable bowel syndrome is considered as one of the prime diagnosis for chronic constipation.

High fiber intake (lot of vegetable and fruits), exercises, walking and plenty of fluids always are part of the management of the chronic constipation. People who do not respond to this and OTC laxative are advised to take the following medications by prescription;

1) Polyethylene glycol 3350 (Miralax)

2) Lactulose

3) Tegaserod (Zelnorm)

These agents are proven for their effectiveness at improving stool frequency and consistency in patients with chronic constipation.

The other helpful agents are;

a) Lubiprostone

b) Linaclotide

Ideally you should consult a gastroenterologist who can perform the following investigations which are the mainstay of the evaluation and which will give true perspective of the cause;

1) Blood investigations do give the clue. A complete blood count, biochemical profile, serum calcium, blood glucose, and thyroid function tests are routinely recommended in the evaluation of patients with constipation.

2) Depending on these blood results further blood work is done; serum protein electrophoresis, urine porphyrins, serum parathyroid hormone, and serum cortisol levels, may be done to identify or rule out myeloma, porphyria, hyperparathyroidism, and Addison's disease. These causes are not common causes so clinical manifestation and physical examination clues are important.

3) Barium enema or barium meal with follow through study

4) Colonic transit time; it can provide a better understanding of the rate of stool movement through the colon.

5) Other investigations like Anorectal manometry, balloon expulsion test, Defecography etc.

6) Colonoscopy / sigmoidoscopy /

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

Expert:  Dr. Arun Phophalia replied 1 year ago.

Following measures can be helpful in long term management of constipation;

1) Increased fluids

2) Prune juice and dried plums

3) Increased fiber; prepration like Benfiber can be tried.

4) An herbal tea, "Smooth Move," have been found to have good result in moving the bowel.

5) Toilet after meals; Toileting 15 to 30 minutes after eating makes use of the gastrocolic reflex. The gastrocolie reflex results in propagating spikes in the colon and rectum within a half an hour after a meal. When we eat, our stomach distends and this sends reflex signals to the large intestines (colon) facilitating for their movements. If one utilizes next half hour of meal, for toilet, the stool elimination time is decreased.

6) Increase in exercise

7) Stimulant laxatives stimulate intestinal motility and increase intestinal secretion. They are anthraquinones (cascara, aloe, and senna) and diphenylmethanes (bisacodyl, sodium picosulfate, phenolphthalein).

8) Avoidance of stress

9) Wheat bran, 20 gms per day can decrease the rectal transit time

10) Vegetables,

11) Fruits (especially dried fruits)

12) Cereals like whole wheat, bran or oatmeal

13) Celery

14) Grainy breads, such as whole wheat, rye or pumpernickel

15) Legumes, such as chickpeas, baked beans and lima beans

16) You can try ground flaxseed sprinkled on salads, cooked vegetables, and cereals.

Food which cause constipation and should be avoided are;

Ice cream


Meat / Red meat

Chips, cookies and pizza


Foods that contain white flour


Junk food or fast food


It is privilege assisting you.
Please let me know if you have further queries or unanswered questions.

Please consider a positive rating if this interaction has been satisfactory, as this is the only way we experts are credited and compensated for the time and work. You are not charged again for giving a rating.

Thank you.

Expert:  Dr. Arun Phophalia replied 1 year ago.

Thank you for the opportunity to answer completely your Question. Please make sure to rate me because that is how I am credited for my work.

Now, I will provide an Additional Service offer so that you have this option available on your question list to get a hold of me directly in the future.

This additional service offer can be used for

- if you would like to schedule a new, private email session or to ask me directly a new question. It's up to you.

Thank you.

Expert:  Dr. Arun Phophalia replied 1 year ago.

Hope you are doing good. Let me know if you have any follow up queries.