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Constipation – and this is how doctors officially call constipation – indicates problems in the gastrointestinal tract. If the process becomes chronic, then this is already a serious cause for concern. Obviously it’s time to see a doctor. Because it turns out that auxiliary drugs alone cannot solve the problem.
“The treatment of chronic constipation should be complex,” says Gastroenterologist Liliya Sagdutdinova. – It is necessary to change the way of life – increase physical activity, reconsider the nature of nutrition, accustom yourself to the optimal water regime, and, of course, choose medications together with the doctor.
But how to deal with the wealth that is full of drugstore windows? According to Dr. Sagdutdinova, as first-line drugs (that is, with which any treatment begins), a number of drugs are prescribed that help soften the intestinal contents and increase its volume. Let’s take a closer look at some of them.
1. Psyllium (Mukofalk, Phytomucil)
Here, the active ingredient is the shell of psyllium seeds. Therefore, the drug is suitable for lovers of everything natural. Depending on the form, packaging, manufacturer, you can choose the same drug for any wallet size.
Indications:
- acute and chronic constipation;
- anal fissures, hemorrhoids;
- postoperative period with interventions in the anorectal region (to get rid of additional torment during the act of defecation).
Seems like a great thing. But, alas, not for everyone. Carefully study the features before using the medicine.
Contraindications:
- organic narrowing of the gastrointestinal tract (stenosis);
- intestinal obstruction;
- abdominal pain of unknown origin (there is a risk not only to be cured, but also to harm);
- children under 18 years of age (this applies to Psyllium, but Mukofalk and Phytomucil can be used by children from 12 years old);
- hypersensitivity to the drug.
Features
“During the treatment period, you should drink at least 1,5 liters of fluid per day,” warns Lilia Sagdutdinova. – The effect of the drug can occur within 24-48 hours, that is, you should not count on an instant effect.
2. Macrogol 4000 (Forlax)
This is already a synthetic drug, the active substance is called macrogol, and the number 4000 does not mean its market price, but only its molecular weight. But these are details.
So, this drug is prescribed for the symptomatic treatment of constipation in adults and children over the age of 8 years. Many doctors are convinced that this substance is practically devoid of side effects, while it can be very useful for solving stool problems. True, there are a number of contraindications. And this should be considered carefully.
Contraindications:
- inflammatory bowel disease (ulcerative colitis, Crohn’s disease);
- toxic megacolon in combination with symptomatic stenosis;
- perforation or threat of perforation of the gastrointestinal tract (perforation is a through defect in the wall of a hollow organ – author’s note);
- intestinal obstruction or suspected intestinal obstruction;
- abdominal pain of unknown etiology;
- children up to 8 years;
- hypersensitivity to macrogol (polyethylene glycol) or other components of the drug.
Features
The laxative effect of Forlax, as in the case of the previous line of drugs, occurs 24-48 hours after administration. Not suitable as an emergency.
3. Lactitol (Exportal)
Lactitol is a hydrocarbon alcohol derived from milk sugar (the well-known lactose). It has a detrimental effect on proteolytic (in other words, putrefactive) bacteria, and promotes the growth of acidophilus bacteria (and these are already very useful microorganisms).
And by the way, the drug helps not only during constipation.
Indications:
- constipation;
- the need to regulate the stool for medical purposes (for example, bowel cleansing in preparation for endoscopic and x-ray studies, surgical interventions on the rectum, anal sphincter and the area adjacent to it);
- intestinal dysbiosis;
- hepatic encephalopathy, hepatic coma and precoma, hyperammonemia (high levels of ammonia in the blood).
Contraindications:
- galactosemia (another metabolic disorder);
- intestinal obstruction;
- suspicion of organic lesions of the gastrointestinal tract;
- abdominal (in the abdomen) pain and rectal bleeding of unknown origin;
- individual intolerance to lactitol.
Reception feature
– The laxative effect usually occurs within 24 hours after the use of the drug, – says Lilia Sagdutdinova. – At the beginning of the course of treatment, a delay in the laxative effect of the drug is possible, the effect may occur on the second or third day of its use. And another important point. At the first dose of the medicine, there may be a feeling of discomfort in the abdomen, flatulence. These phenomena, as a rule, disappear with continued use of the drug, as they adapt to it.
4. Lactulose (Dufalak, Portolak, Normaze)
It acts through a change in the flora of the colon: the number of lactobacilli increases, respectively, acidity increases, and as a result, the process of emptying the intestine from the contents is accelerated.
Indications:
- constipation, incl. chronic, during pregnancy, hemorrhoids;
- after surgery on the colon and / or in the anus, in preparation for surgery on the colon;
- to soften the stool (facilitate defecation) with pain after removal of hemorrhoids;
- hepatic encephalopathy; hepatic precoma and coma.
Contraindications:
- rectal bleeding;
- colo-, ileostomy;
- suspected appendicitis;
- galactosemia; lactose intolerance, lactase deficiency, glucose-galactose malabsorption;
- intestinal obstruction;
- hypersensitivity to lactulose.
Features
As in the previous paragraph: in the first days of admission, flatulence may occur, but usually this effect gradually decreases and disappears.
5. Bisacodyl (Guttalax), sennosides A and B (Senade)
“For patients with constipation, in order to normalize the stool for a short period of time (2 weeks!) It is recommended to prescribe stimulant laxatives,” says Dr. Sagdutdinova. – Such drugs enhance perilstatics by stimulating the nerve endings of the intestinal mucosa.
These include: bisacodyl, sodium picosulfate, anthraquinones, sennosides A and B.
Contraindications:
- intestinal obstruction;
- acute inflammatory diseases of the abdominal organs;
- abdominal pain of unknown origin;
- peritonitis;
- children up to 4 years;
- lactose intolerance, lactase deficiency, glucose-galactose malabsorption.
In addition to contraindications, one must take into account the fact that the use of stimulant laxatives for bowel cleansing often causes side effects. For example, instead of constipation, you can provoke diarrhea, with pain and flatulence in addition. And the frequent use of such drugs leads to a deficiency of potassium in the body and is addictive. Doctors do not recommend using such medicines for more than two weeks!
6. Mikrolax
One of the fastest acting laxatives – Microlax – is a microclyster for rectal administration with sodium citrate, sodium lauryl sulfoacetate and an aqueous solution of sorbitol. Helps with difficult bowel movements, acting directly at the site of constipation.
Approved for use during pregnancy, lactation and newborns. The drug is very easy to use independently at home, each microclyster contains the right dose of the substance. Not recommended for permanent use.
7. Colofort
The drug in the form of lozenges helps to overcome stool disorders, normalizing gastrointestinal motility. Unlike other laxatives, Colofort affects the problem in a complex way and works with irritable bowel syndrome.
It is not recommended to take the drug during pregnancy, during lactation, children under 18 years of age and those who have a lactase deficiency or lactose intolerance. For best results, course treatment is indicated.
8. Fitolax
Senna leaf extract as part of Phytolax triggers intestinal motility, and plantain has an analgesic property.
Among other things, the preparation contains prunes, apricot extract and dill. Due to the natural composition, it has practically no contraindications.
This dietary supplement is presented in pharmacies in several forms of release: tablets, filter bags, bars, marmalade lozenges and sachets. Approved for use by persons over 14 years of age.
9. Glycerin suppositories
Safe to use remedy for constipation are glycerin suppositories. Glycerin in the composition of rectal suppositories helps to soften the stool, acts exclusively locally.
It has no side effects and is often used during pregnancy and lactation. With hemorrhoids and cracks in the anus, it is better not to use the drug.
10. Gas-forming suppositories (Calciolax, Ferrolax)
To activate the natural emptying of the intestines, gas-forming suppositories can be used. The principle of their action is to provoke the urge to defecate, the absence of which provoked constipation.
The manufacturer in the instructions indicates the absence of contraindications. The effect of the drug occurs within half an hour. Do not use the drug for more than five days in a row and if there is inflammation. Children, pregnant and lactating drug is not contraindicated.
How to choose a laxative for colon cleansing
– Of course, anyone can choose a laxative for himself – after all, prescriptions for them are not required. But it is better to entrust this to a specialist, – emphasizes Lilia Sagdutdinova. – Only a doctor, taking into account his education and experience, can choose the most effective medicine for a particular patient from a number of good drugs.
If you dared to solve the problem yourself, it is very important to first study the list of contraindications indicated in the instructions. Ignoring this is fraught with serious consequences.
What if the laxative doesn’t work?
– For patients in whom the use of laxatives is not effective enough, the appointment of prokinetics from the group of 5-HT4 receptor agonists is recommended. The only drug of this class currently available in Russia is Prucalopride (Resolor), the gastroenterologist notes. – In general, to avoid problems with constipation, you need to move more (at least walk – at least 60 minutes a day), drink more water (30 ml per 1 kg of body weight), and add foods consisting of insoluble dietary fiber to the diet such as wheat bran.