Constipation Treatment: Types of Laxatives

It is necessary to take into account any individual characteristics. If necessary, drugs that cause constipation should be discarded.

Useful tips for treating constipation

Essential is adequate fluid intake (at least up to 2 liters / day). The diet should contain a sufficient amount of fiber (dietary fiber) (usually 20-30 g / day) to ensure a normal stool. Vegetable fiber, which is largely difficult to digest and not digestible, increases the volume of the stool. Certain fiber components also absorb the liquid, contributing to a softer stool consistency and thereby facilitating its passage. Fruits and vegetables are recommended as sources of fiber, as well as cereals containing bran.

Laxatives should be used cautiously. Some of them (eg, phosphate, bran, cellulose) bind medicines and impair absorption. A rapid passage of intestinal contents can lead to a rapid transit of medicines and nutrients past their optimal absorption zone. Contraindications to the use of laxatives are acute pain in the abdomen of unknown origin, inflammatory bowel disease, intestinal obstruction, gastrointestinal bleeding and calf infringement.

Some exercises can be effective. The patient should try to move the rectum at the same time daily, preferably 15-45 minutes after breakfast, as eating stimulates the motility of the large intestine. Initial curative efforts to achieve regular defecation may include the use of glycerol suppositories.

It is important to explain to the patient what happens to it, although it is sometimes difficult to convince patients with obsessive conditions that they attach too much importance to defecation disorders. The doctor should explain that daily bowel movement is not necessary, that the intestine needs a recovery period for normal functioning and that frequent use of laxatives or enemas (more than once in 3 days) adversely affects this process.

Treatment of coprostasis

Coprostasis is first to be treated with enemas with tap water, you can alternate them with small enemas (100 ml) with ready-made hypertonic solutions (eg Na phosphate). If treatment is ineffective, manual fragmentation and feces removal are necessary. This procedure is painful, therefore peri-rectal and intrarectal applica- tion of local anesthetics is recommended (eg 5% xikain ointment or 1% dibucaine ointment). Some patients need sedation.

Types of laxatives used in the treatment of constipation

Substances that increase the volume of fecal matter (eg, psyllium, polycarbophil Ca, methyl cellulose) are the only laxatives that are acceptable for long-term use. Some patients prefer unrefined shredded bran, 16-20 g (2-3 teaspoons) with fruit or cereals. Substances that increase the volume of feces, act slowly and gently and are the safest substances that can eliminate constipation. Proper use involves a gradual increase in the dose - the most effective application 3-4 times a day with a sufficient amount of fluid (for example, an additional 500 ml / day) to prevent the compaction of stool until a softer and abundant stool is formed. Substances that increase the volume of fecal matter, cause a natural effect and, in contrast to other laxatives, do not lead to atony of the large intestine.

Mitigating agents (eg, docusate, mineral oil, glycerin candles) act slowly, providing a softening of the stool and its easier passage. However, they do not refer to strong stimulants of defecation. Dokuzat is a surfactant that promotes the penetration of water into the stool, providing a softening and increasing volume. The increased mass stimulates peristalsis, which moves the relaxed stool more easily. Mineral oil softens the calories, but reduces the absorption of fat-soluble vitamins. Mitigating agents can be useful after myocardial infarction or proctologic interventions, as well as when bed rest is required.

Osmotic substances are used in the preparation of patients for some diagnostic procedures in the intestines and sometimes in the treatment of parasitic diseases; are also effective for stool retention. They contain difficultly absorbed polyvalent ions (eg, Mg, phosphates, sulfates) or carbohydrates (eg lactulose, sorbitol) that remain in the gut, increasing the osmotic pressure inside the intestine and thereby causing water to diffuse into the intestine. Increasing the amount of intestinal contents stimulates peristalsis. These substances are usually effective for 3 hours.

A rare use of osmotic laxatives is safe. However, Mg and phosphate are partially absorbed and can be unsafe under certain conditions (eg, kidney failure). Na (in some drugs) can enhance cardiac dysfunction. In large doses or with frequent use, these drugs can disrupt the water-electrolyte balance. Whenever intestinal cleansing is required for diagnostic studies or surgical interventions, large volumes of a balanced osmotic substance (eg, polyethylene glycol in electrolyte solution) taken orally or administered via a nasogastric tube are used.

Laxatives, causing secretion or stimulating peristalsis effect (eg, senna and its derivatives, buckthorn, phenolphthalein, bisacodyl, castor oil, anthraquinones), act irritatingly on the intestinal mucosa or directly stimulate the submucosa and the interlacing of the muscle layer. Some substances are absorbed, metabolized by the liver and returned to the intestine in the bile. Strengthening of peristalsis and an increase in the volume of fluid in the lumen of the gut is accompanied by the appearance of spasmodic pains in the abdomen and defecation with a semi-hard chair coming within 6-8 hours. In addition to the foregoing, these substances are often used to prepare the intestine for diagnostic studies. With prolonged use, melanosis of the large intestine, neurogenic degeneration, "lazy gut" syndrome and severe water-electrolyte balance disorders can develop. Phenolphthalein was excluded by the American market because of the identified teratogenicity in animals.

Climes can be used, including tap water and ready-to-use hypertensive solutions.

Drugs used in the treatment of constipation 

Types	Substance	Dosage	Side effects
Fiber	Bran	Up to 1 cup / day	Bloating, flatulence, malabsorption of iron and Ca
	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	Small swelling compared with other substances
	PolycarbophilSa	2-6 tablets / day	Bloating, flatulence
Mitigating agents	Dokuzat Na	100 mg 2-3 times a day	Ineffective in severe constipation
	Glycerol	Suppositories 2-3 g 1 time per	Irritation of the rectum
	Mineral oil	15-45 ml orally 1 time per	Oleopneumonia, malabsorption of fat-soluble vitamins, dehydration, involuntary stool
Osmotic active substances	Sorbitol	15-30 ml orally 70% solution 1 -2 times a day; 120 ml rectally 25-30% solution	Transitory spastic abdominal pain, flatulence
	Lactulose	10-20 g (15-30 ml) 1-2 times a day	Same as for sorbitol
	Polyethylene glycol	Up to 3.8 liters within 4 hours	Involuntary stool (associated with dosage)
Stimulating	Anthraquinones	Depends on the manufacturer	Degeneration of Meissner and Auerbach's plexus, malabsorption, abdominal cramps, dehydration, melanosis of the large intestine
	Bisacodyl	Suppositories 10 mg to 3 times a week; 5-15 mg / day orally	Involuntary defecation, hypokalemia, spastic abdominal pain, burning in the rectum with daily use of candles
Saline laxatives	Mg	Magnesium sulfate 15-30 g 1-2 times per day orally; Milk with magnesium 30-60 ml / day; Magnesium citrate 150-300 ml / day (up to 360 ml)	Mg intoxication, dehydration, spastic abdominal pain, involuntary stool
Enemas	Mineral oil / olive oil	100-250 ml / day rectally	Involuntary stool, mechanical trauma
	Tap water	500 ml rectally	Mechanical Injury
	Phosphate Na	60 ml rectally	Irritation (dose-dependent negative effect) of the rectal mucosa with prolonged use, hyperphosphatemia, mechanical trauma
	Lather	1500 ml rectally	Irritation (dose-dependent negative effect) of the rectal mucosa with prolonged use, hyperphosphatemia, mechanical trauma

[1], [2], [3], [4], [5]