Ways to get rid of constipation

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

Attention! Do not self-medicate. Contact your doctor to choose treatment tactics.

Useful tips for treating constipation

Adequate fluid intake (at least up to 2 l/day) is essential. The diet should contain sufficient fiber (dietary fiber) (usually 20-30 g/day) to ensure normal bowel movements. Plant fiber, which is largely indigestible and indigestible, increases stool bulk. Certain fiber components also absorb fluid, making stools softer and easier to pass. Fruits and vegetables are recommended as sources of fiber, as well as cereals containing bran.

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

Using some exercises may be effective. The patient should try to perform rectal movements at the same time every day, preferably 15-45 minutes after breakfast, since eating stimulates colonic motility. Initial treatment 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 disorders that they are placing too much emphasis on bowel problems. The doctor should explain that daily bowel movements are not necessary, that the bowel needs a recovery period 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; you can alternate them with small enemas (100 ml) with ready-made hypertonic solutions (for example, Na phosphate). If treatment is ineffective, manual fragmentation and removal of stool is necessary. This procedure is painful, so perirectal and intrarectal application of local anesthetics (eg, 5% xycaine ointment or 1% dibucaine ointment) is recommended. Some patients require sedatives.

Types of laxatives used to treat constipation

Substances that increase the volume of stool (eg, psyllium, polycarbophil Ca, methylcellulose) are the only laxatives acceptable for long-term use. Some patients prefer unrefined ground bran, 16-20 g (2-3 teaspoons) with fruit or cereals. Substances that increase the volume of stool act slowly and gently and are the safest substances to relieve constipation. Proper use involves gradually increasing the dose – most effectively administered 3-4 times daily with sufficient fluids (eg, an additional 500 ml/day) to prevent stool hardening until softer, larger stools are formed. Substances that help increase the volume of feces cause a natural effect and, unlike other laxatives, do not lead to atony of the large intestine.

Emollients (eg, docusate, mineral oil, glycerin suppositories) act slowly to make stools softer and easier to pass. However, they are not strong stimulants of bowel movements. Docusate is a surfactant that promotes the penetration of water into the stool, providing softening and increasing volume. The increased mass stimulates peristalsis, which moves softened stool more easily. Mineral oil softens stool but reduces the absorption of fat-soluble vitamins. Emollients may be useful after myocardial infarction or proctological surgery, as well as when bed rest is necessary.

Osmotic agents are used in preparing patients for certain diagnostic bowel procedures and sometimes in the treatment of parasitic diseases; also effective in stool retention. They contain poorly absorbed polyvalent ions (eg Mg, phosphates, sulfates) or carbohydrates (eg lactulose, sorbitol) that remain in the intestine, increasing the osmotic pressure within the intestine and thereby causing the diffusion of water into the intestine. Increasing the volume of intestinal contents stimulates peristalsis. These substances are usually effective within 3 hours.

Rare use of osmotic laxatives is safe. However, Mg and phosphate are partially absorbed and may be unsafe under some conditions (eg, renal failure). Na (in some drugs) may increase cardiac dysfunction. In large doses or with frequent use, these drugs can disrupt the water and electrolyte balance. When bowel cleansing is necessary for diagnostic testing or surgery, large volumes of a balanced osmotic agent (eg, polyethylene glycol in electrolyte solution) taken orally or administered through a nasogastric tube are used.

Laxatives that cause secretion or stimulate peristalsis (eg, senna and its derivatives, buckthorn, phenolphthalein, bisacodyl, castor oil, anthraquinones) act as an irritant to the intestinal mucosa or directly stimulate the submucosa and plexuses of the muscular layer. Some substances are absorbed, metabolized by the liver and returned to the intestines as part of bile. Increased peristalsis and an increase in the volume of fluid in the intestinal lumen are accompanied by the appearance of cramping pain in the abdomen and defecation with semi-solid stool, which occurs within 6-8 hours. In addition to the above, these substances are often used to prepare the bowel for diagnostic tests. With long-term use, melanosis of the large intestine, neurogenic degeneration, lazy bowel syndrome and severe disturbances in water and electrolyte balance may develop. Phenolphthalein was withdrawn from the American market due to demonstrated teratogenicity in animals.

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

Drugs used in the treatment of constipation