What should I do if I haven't had a bowel movement in 6 days?

Immediate Management of 6 Days Without a Bowel Movement

You need to start treatment immediately with stimulant laxatives such as bisacodyl 10-15 mg or senna, combined with an osmotic laxative like polyethylene glycol (PEG) 17g in 8 oz water twice daily, while ruling out bowel obstruction or fecal impaction. 1

Critical First Steps: Rule Out Emergencies

Before starting any treatment, you must assess for serious conditions that require immediate medical attention 1:

• Check for bowel obstruction: Assess for severe abdominal pain, distention, vomiting, or inability to pass gas. If present, imaging is needed urgently 1
• Evaluate for fecal impaction: Perform digital rectal examination to check for hard stool in the rectum 1
• Rule out metabolic causes: Consider hypercalcemia, hypokalemia, hypothyroidism, and diabetes mellitus as potential contributors 1

Warning signs requiring immediate medical evaluation include rectal bleeding, severe abdominal pain with tenderness, fever, or complete inability to pass stool or gas 2, 3, 4.

Immediate Treatment Protocol

First-Line Therapy (Start Today)

Stimulant laxatives are your primary intervention 1:

• Bisacodyl 10-15 mg orally, 2-3 times daily 1
• OR Senna (sennosides) as an alternative stimulant 1

Add osmotic laxatives for synergistic effect 1:

• Polyethylene glycol (PEG) 17g (one heaping tablespoon) mixed in 8 oz water, twice daily 1
• OR Magnesium hydroxide, magnesium citrate, lactulose, or sorbitol as alternatives 1

Important caveat: Do NOT use stool softeners like docusate alone—they are ineffective for constipation and provide no benefit 1. If you've been relying on docusate, this explains why it hasn't worked.

Supportive Measures

• Increase fluid intake significantly to help laxatives work effectively 1
• Maintain adequate dietary fiber, but avoid supplemental fiber like psyllium at this stage—it can worsen constipation when you're already severely backed up 1

If No Bowel Movement Within 24-48 Hours

Escalate Treatment

Add rectal interventions 1:

• Bisacodyl suppository (10 mg) rectally 1
• OR Fleet enema, saline enema, or tap water enema to stimulate bowel movement 1
• If impaction is confirmed, glycerin suppositories or manual disimpaction may be necessary 1

Important safety note: Sodium phosphate enemas should be used sparingly and limited to once daily maximum if you have any kidney problems 1.

When to Seek Medical Attention

Stop self-treatment and see a doctor immediately if 2, 3, 4:

• No bowel movement after 7 days of treatment
• Rectal bleeding occurs
• Severe abdominal pain develops
• You develop nausea or vomiting
• You notice abdominal distention or inability to pass gas

Common Pitfalls to Avoid

1. Don't rely on fiber supplements or stool softeners alone—they are ineffective for established constipation and may make things worse 1

2. Don't wait longer to start treatment—6 days is already significant, and the goal is to achieve a bowel movement within 1-2 days 1

3. Don't assume this is "normal for you"—fewer than 3 bowel movements per week occurs in less than 1% of the population and requires evaluation 1

4. Don't ignore medication review—many drugs cause constipation including antacids, anticholinergics (antidepressants, antispasmodics), antiemetics, and especially opioid pain medications 1

If This Becomes a Recurring Problem

If you continue to have constipation despite treatment, you need formal evaluation 1:

• Anorectal manometry to assess for defecatory disorders 1
• Colonic transit studies if simple measures fail 1
• Assessment for underlying conditions like hypothyroidism or diabetes 1

The bottom line: Start aggressive laxative therapy now with both stimulant and osmotic agents, ensure adequate hydration, and seek medical attention if you don't have a bowel movement within 1-2 days or if any warning signs develop.