Recognizing and responding to the urge to defecate. Attempt defecation first thing in the morn- ing, when the bowel is more active and 30 minutes after meals, to take advantage of the gastrocolic reflex. Eat 20 to 35 g of fiber daily. Fiber-rich foods include bran, fruits, vegetables, nuts, prune juice. Drink plenty of water. Exercise regularly. Bulk laxatives are hydrophilic, absorbing water from the intestinal lumen to increase stool mass and soften the stool. They contain soluble fiber (psyllium, pectin, or guar) or insoluble fiber (cellulose). Emollient laxatives or stool softeners, (e.g., docusates), act by lowering surface tension, allowing water to enter the bowel more readily. Saline or osmotic laxatives cause secretion of water into the intestinal lumen. The most common are oral magnesium hydroxide (Milk of Magnesia), oral magnesium citrate, and sodium biphosphate (Phospho-Soda). Others are are sorbitol, lactulose, and polyethylene glycol (PEG) 3350.
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