Publication:

Management of constipation in women: the role of milk of magnesia and liquid paraffin combination from a gynecologist's perspective

Constipation is highly prevalent, affecting approximately 15-20% of the general population, with women impacted nearly twice as often as men. It significantly impairs quality of life, psychological well-being, clinical outcomes, and healthcare utilization. From a gynecological perspective, constipation extends far beyond pregnancy-related concerns and remains an under-recognized clinical burden in routine practice. While pregnancy-associated constipation is well acknowledged, non-pregnancy etiologies-including anorectal disorders, PCOS or related hormonal fluctuations and menopause, gynecological postoperative states, endocrine dysfunction, and drug-induced causes (notably opioids and iron therapy)-are frequently overlooked. Milk of magnesia (MoM), particularly in combination with liquid paraffin, offers a distinct dual-action advantage in the management of constipation-combining osmotic stool softening with surface lubrication. Its non-fermentative osmotic mechanism promotes water retention within the intestinal lumen, effectively softening stools without causing gas or bloating, while liquid paraffin enhances ease of passage through lubrication. In women, constipation frequently manifests as hard stools, delayed transit, and painful defecation, especially in scenarios such as menopause, hormonal imbalances, anorectal disorders, and postoperative recovery. In these contexts, therapy must deliver relief that is both effective and gentle. MoM’s predictable onset of action, coupled with its favorable tolerability profile, makes it an ideal choice where rapid yet non-irritating relief is required. By addressing both stool consistency and transit comfort, this dual-action approach ensures a more comprehensive and patient-friendly solution to constipation management. Its non-habit-forming profile and low incidence of bloating are advantageous in constipation patients with anorectal disorder, iron-induced gastrointestinal effects, and menopausal symptoms. In postoperative gynecologic patients, MoM supports early bowel recovery without inducing spasmodic activity, thereby minimizing strain on surgical repairs and mitigating opioid-related constipation. Overall, MoM, alone or in combination with liquid paraffin, remains a clinically relevant and practical therapeutic option for managing diverse non-pregnancy-related causes of constipation in women, particularly when rapid symptom relief, tolerability, and adherence are prioritized. This manuscript reviews the role of MoM (magnesium hydroxide), particularly in combination with liquid paraffin, in managing constipation associated with these non-pregnancy-related conditions in women. Clinical evidence and guidelines support the use of magnesium-based osmotic laxatives in chronic constipation, while evidence for MoM-based combinations in specific non pregnant etiologies remains limited and largely extrapolated from pharmacology, clinical experience, and selected studies.