Treatment of constipation: types of laxatives

Any individual characteristics must be taken into account. If necessary, medications causing constipation should be discontinued.

Helpful Tips for Treating Constipation

Adequate fluid intake (at least 2 L/day) is essential. The diet should contain sufficient fiber (usually 20-30 g/day) to ensure normal stool. Plant fiber, which is largely indigestible and indigestible, increases stool bulk. Certain fiber components also absorb fluid, contributing to a softer stool consistency and thus facilitating its passage. Fruits and vegetables are recommended as sources of fiber, as are cereals containing bran.

Laxatives should be used with caution. Some laxatives (e.g., phosphate, bran, cellulose) bind medications and interfere with absorption. Rapid passage of intestinal contents may result in rapid transit of medications and nutrients past their optimal absorption zone. Contraindications to the use of laxatives include acute abdominal pain of unknown origin, inflammatory bowel disease, intestinal obstruction, gastrointestinal bleeding, and fecal impaction.

Some exercises may be effective. The patient should try to move the rectum at the same time each day, preferably 15 to 45 minutes after breakfast, since eating stimulates colonic motility. Initial therapeutic efforts to achieve regular bowel movements may include the use of glycerin suppositories.

It is important to explain to the patient what is happening to him, although it is sometimes difficult to convince patients with obsessive-compulsive disorder that they attach too much importance to bowel movements. The doctor should explain that daily bowel movements are not necessary, that the intestines need a period of recovery to function normally, and that frequent use of laxatives or enemas (more than once every 3 days) negatively affects this process.

Treatment of coprostasis

Coprostasis is initially treated with enemas with tap water, alternating with small enemas (100 ml) with ready-made hypertonic solutions (e.g., sodium phosphate). If the treatment is ineffective, manual fragmentation and removal of the feces is necessary. This procedure is painful, so perirectal and intrarectal application of local anesthetics (e.g., 5% xycaine ointment or 1% dibucaine ointment) is recommended. Some patients require sedatives.

Types of laxatives used to treat constipation

Bulking agents (eg, psyllium, polycarbophil Ca, methylcellulose) are the only laxatives acceptable for long-term use. Some patients prefer unhulled ground bran, 16-20 g (2-3 teaspoons) with fruit or cereal. Bulking agents act slowly and gently and are the safest agents for relieving constipation. Proper use involves gradual increases in dosage - most effectively 3-4 times daily with sufficient fluid (eg, an additional 500 ml/day) to prevent stool hardening until softer, larger stools are formed. Bulking agents produce a natural effect and, unlike other laxatives, do not cause atony of the colon.

Emollients (e.g., docusate, mineral oil, glycerin suppositories) act slowly to soften stool and make it easier to pass. However, they are not strong stool softeners. Docusate is a surfactant that helps draw water into the stool, providing softening and bulk. The increased bulk stimulates peristalsis, which moves the softened stool more easily. Mineral oil softens stool but reduces the absorption of fat-soluble vitamins. Emollients may be useful after myocardial infarction or proctologic procedures, or when bed rest is necessary.

Osmotic agents are used in the preparation of patients for some diagnostic procedures on the intestine and sometimes in the treatment of parasitic diseases; they are also effective in stool retention. They contain poorly absorbed polyvalent ions (e.g. Mg, phosphates, sulfates) or carbohydrates (e.g. lactulose, sorbitol), which remain in the intestine, increasing the osmotic pressure inside the intestine and thereby causing diffusion of water into the intestine. The increase in the volume of intestinal contents stimulates peristalsis. These agents are usually effective for 3 hours.

Osmotic laxatives are safe to use occasionally. However, Mg and phosphate are partially absorbed and may be unsafe under certain conditions (eg, renal failure). Na (in some preparations) may increase cardiac dysfunction. In high doses or with frequent use, these preparations may disrupt the water-electrolyte balance. When bowel cleansing is necessary for diagnostic tests or surgical interventions, large volumes of a balanced osmotic substance (eg, polyethylene glycol in an electrolyte solution) are used, taken orally or through a nasogastric tube.

Laxatives that cause secretion or stimulate peristalsis (e.g. senna and its derivatives, buckthorn, phenolphthalein, bisacodyl, castor oil, anthraquinones) act irritatingly on the intestinal mucosa or directly stimulate the submucosa and muscular plexuses. Some substances are absorbed, metabolized by the liver and returned to the intestine in bile. Increased peristalsis and increased fluid volume in the intestinal lumen are accompanied by the appearance of spastic abdominal pain and defecation of semi-solid stools occurring within 6-8 hours. In addition to the above, these substances are often used to prepare the intestine for diagnostic examinations. With prolonged use, melanosis coli, neurogenic degeneration, lazy bowel syndrome and severe disturbances of water-electrolyte balance may develop. Phenolphthalein was removed from the American market due to its teratogenicity in animals.

Enemas may be used, including tap water and ready-to-use hypertonic solutions.

Drugs used in the treatment of constipation

Types	Substance	Dosage	Side effects
Fiber	Bran	Up to 1 cup/day	Bloating, flatulence, iron and calcium malabsorption
	Psyllium	Up to 30 g/day in divided doses of 2.5-7.5 g	Bloating, flatulence
	Methylcellulose	Up to 9 g/day in divided doses of 0.45-3 g	Little bloating compared to other substances
	PolycarbophilSa	2-6 tablets/day	Bloating, flatulence
Emollients	Dokuzat Na	100 mg 2-3 times a day	Ineffective for severe constipation
	Glycerol	Suppositories 2-3 g 1 time per	Rectal irritation
	Mineral oil	15-45 ml orally 1 time per	Olepneumonia, malabsorption of fat-soluble vitamins, dehydration, involuntary stool
Osmotically active substances	Sorbitol	15-30 ml orally 70% solution 1-2 times a day; 120 ml rectally 25-30% solution	Transient spasmodic abdominal pain, flatulence
	Lactulose	10-20 g (15-30 ml) 1-2 times a day	The same as for sorbitol
	Polyethylene glycol	Up to 3.8 l in 4 hours	Involuntary stool (dosage related)
Stimulating	Anthraquinones	Depends on the manufacturer	Degeneration of Meissner's and Auerbach's plexuses, malabsorption, abdominal cramps, dehydration, melanosis coli
	Bisacodyl	Suppositories 10 mg once a week; 5-15 mg/day orally	Involuntary defecation, hypokalemia, abdominal cramping, burning in the rectum with daily use of suppositories
Saline laxatives	Mg	Magnesium sulfate 15-30 g 1-2 times a day orally; milk with magnesium 30-60 ml / day; magnesium citrate 150-300 ml / day (up to 360 ml)	Mg intoxication, dehydration, abdominal cramps, involuntary stool
Enemas	Mineral oil/olive oil	100-250 ml/day rectally	Involuntary stool, mechanical injury
	Tap water	500 ml rectally	Mechanical trauma
	Na phosphate	60 ml rectally	Irritation (dose-dependent adverse effects) of the rectal mucosa with prolonged use, hyperphosphatemia, mechanical trauma
	Lather	1500 ml rectally	Irritation (dose-dependent adverse effects) of the rectal mucosa with prolonged use, hyperphosphatemia, mechanical trauma

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