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ConstipationInitial treatment of constipation must be dictated by the underlying pathophysiology. Mild constipation may improve with increasing dietary fiber and oral liquid intake. Docusate salts (docusate sodium,Colace,Perdue Pharma,Stamford,CT) are surfactants that soften the stool by facilitating the combining of aqueous and fatty substances. These agents stimulate intestinal fluid and electrolyte secretion. Mineral oil acts to soften the stool. The use of mineral oil should be limited because it interferes with absorption of fat-soluble vitamins. Chronic constipation that fails diet management is best treated with osmotically active products such as saline laxatives (magnesium citrate,sodium phosphate),nonabsorbable sugars (lactulose),or polyethylene glycol (Miralax,Braintree Laboratories,Braintree,MA). Stimulant laxatives act to increase colonic motility and induce water and electrolyte secretion. There is concern that long-term use of these agents can cause a progressive loss of colonic; however,a causative relationship between stimulant laxative use and colon dysfunction has not been well demonstrated.","department":"