Medicines to Treat Constipation
It is rather curious, but the precise definition of constipation does not exist, given that the "frequency of bowel movements" and "bowel regularity" are very subjective parameters. In any case, in general, constipation refers to a non-pathological condition in which the emission of feces is scarce and / or infrequent. In the medical field, we speak of constipation when the delay in evacuation is greater than 60 hours, and the stools are clearly dehydrated.
The causes involved in constipation are numerous and heterogeneous: the etiological elements can have a physical-mechanical, functional, nutritional or psychological origin. The most common causes are: hormonal alterations, anorexia, anxiety / stress, celiac disease, colitis, diabetes, weight loss or low fiber diet, diverticulitis, hemorrhoids, drugs, pregnancy, hypothyroidism, irritability, fissures, sedentary lifestyle, irritable bowel syndrome.
In the context of constipation, even the symptoms, just like the causative factors, are multiple and subjective: difficulty in "evacuation, hard / ribbon-like / dark stools, abdominal swelling, perception of intestinal obstruction (pathology), number of weekly bowel movements less than 2 .
Diet and Nutrition
The information on Constipation - Drugs for the Treatment of Constipation is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Constipation - Drugs to Treat Constipation.
Before taking drugs for the treatment of constipation, a diagnosis is a must: in fact, many patients require laxatives against constipation, when, in reality, they are not necessary.
Although it is established that constipation is a highly subjective condition, laxatives are certainly not indicated when, simply, you do not have regular bowel movements every day: following an excessive, excessive and unregulated intake of these drugs, the intestine tends to adapt and continually need to administer them. Furthermore, the abuse of these active ingredients can generate hypocalcemia.
Constipation drugs are useful for treating the disorder itself, not the underlying cause, so much so that often constipation only expresses a symptom that conceals some primary pathologies or disorders.
The diet, moreover, represents another substantial element, which heavily affects constipation: a diet low in fiber (or one that is excessively rich) can increase the difficulty of evacuation, dragging all the symptoms that accompany the disorder.
Laxative drugs are particularly useful on several occasions:
- The evacuation effort is such as to exacerbate a pathology (eg angina)
- Difficulty in evacuation increases the chances of rectal bleeding (haemorrhoidal syndrome)
- Before surgery or diagnostic tests (e.g. colonoscopy)
- Constipation associated with bacterial infections: drugs are a valuable aid to eliminate pathogens faster
- Drug-induced constipation
The following are the classes of drugs most used in the treatment of constipation, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment:
Anthraquinones (or contact laxatives): they act by increasing intestinal motility, but their side effects (abdominal cramps) hinder their use. They are not recommended for the treatment of intestinal obstruction.
- Bisacodyl (eg Dulcolax, Stixenil, Alaxa): take orally 5-10 mg of the drug in the evening (effect in 10-12 hours); alternatively, take 5 mg of the drug rectally in the morning, in the form of suppositories (effect in 20-60 minutes)
- Senna (eg. Xprep, Agiolax, Pursennid, Falquilax): the drug exerts its therapeutic activity in 8-12 hours. Available in powder and solvent for oral solution, take one or two teaspoons of product in the evening. Do not exceed the recommended dose.
- Sodium docusate (eg Macrolax, Sorbiclis): take orally max. 500 mg of drug per day, preferably in divided doses.
Other drugs belonging to this category may consist of: castor oil, cascara, frangula, rhubarb, aloe.
Volume laxatives: By increasing fecal mass, volume laxatives promote peristalsis. It is important to know that these drugs carry out their therapeutic activity after a few days of treatment: the effect, therefore, is not immediate. They are generally indicated for patients who do not take enough fiber with their diet. Volume laxatives must always be associated with an abundant intake of liquids, to avoid intestinal obstruction.
- Methylcellulose: also exerts its function as an emollient. Take the drug for the treatment of constipation at the dosage of 2 tablets of 1 gram, with plenty of water, 6 times a day. Consult your doctor.
- Sterculia gum (eg Normacol): take 2-4 sachets per day, each containing 6.1 grams of sterculia gum. It is recommended to take the product with plenty of water for the treatment of occasional episodes of constipation.
- Psyllium seeds (eg Fibrolax): it is recommended to take the drug orally, at a dosage of 3.5 grams after meals, 2-3 times a day, for 2-3 days. Take the constipation treatment product with plenty of water in order to increase the fecal content.
Emollients / lubricants: the progenitor of this class of drugs is liquid paraffin: the active ingredients are indicated in the case of hemorrhoids and fissures in the context of constipation.
- Liquid paraffin (eg Lacrilube, Paraf L BIN): the indicative dosage is 10-30 ml, when necessary.
- Peanut oil: formulated in the form of enemas, it lubricates and softens the intestinal contents (compact), promoting intestinal motility.
- Glycerin (eg San Pellegrino Glycerin Suppositories): in the form of enemas, take 5.6 grams of the drug rectally; alternatively, insert a 2-3 gram suppository, as needed.
Osmotic laxatives: through an osmotic mechanism, these drugs are able to retain fluids in the intestine, or they act by modifying the distribution of fluids in the fecal mass:
- Lactulose (eg Duphalac, Epalfen, Normase): it is recommended to start the treatment for constipation with a low dosage (15 ml of 62-74% solution), twice a day. The dose should be adjusted according to the severity of the condition.
- Macrogol (eg Movicol, Isocolan, Selg Esse, Moviprep, Paxabel): the dose should be established according to the subject.
Anticholinesterases (or para-sympathomimetics): these drugs against constipation are so called because they increase the activity of the parasympathetic system in the digestive system, thus favoring peristalsis. They are not the first-line drugs to treat constipation, as they have numerous gastrointestinal side effects.
- Bethanechol (eg Myocholine): is a cholinergic agonist drug used - albeit rarely - to empty the bladder, and to exert a mild prokinetic effect. Generally, it is taken orally at a dosage of 10-50 mg three times a day: the method of administration must be respected according to the doctor's instructions.
- Neostigmine (eg. Prostigmine): available in ampoules (1ml) for slow intramuscular / intravenous injection or in tablets to be taken by mouth. Intestinal peristalsis can be observed after 20-30 minutes from the injection. Eventually, to facilitate the transit, it is possible to apply an enema (150-200 ml with 15-20% of glycerin), after 30 minutes from the injection.
Saline laxatives: indicated for occasional use in the treatment of constipation or before surgery on the colon (the "intestine must" be completely clean).
- Phosphates (eg Sod Fos Sof Enema, Sod Fos Zet Enema): used mostly before radiological examinations of the intestine or surgery.The dosage should be established by the doctor.
- Magnesium hydroxide (eg. Magnesia, Maalox): they are used when a rapid bowel emptying is required. Take the drug preferably in the morning: usually a teaspoon of product with plenty of water is needed (the drug is available as a powder for suspension 90 grams of active ingredient per 100 grams of product). Excessive use can cause colic.
- Sodium Citrate (eg Biochetasi, Novilax): to rebalance intestinal motility in the context of constipation, take two effervescent tablets (425 mg of sodium citrate) three times a day, with water.
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