Treatment options of constipation

Any underlying cause should be treated. In patients with normal and slow- transit constip ation the main focus should be directed to increasing the fibre content of the diet in conjunction with increasing fluid intake. Fibre intake should be increased by dietary means rather than by prescribing commercially available fibre sources in order to avoid substrate inducibility of colonic bacterial polysaccharidase enzyme systems. These patients should therefore be referred to a dietician.

The use of laxatives should be restricted to severe cases. Osmotic laxatives act by increasing colonic inflow of fluid and electrolytes; this acts not only to soften the stool but to stimulate colonic contractility. Magnesium sulphate 5-10 g dissolved in a glass of hot water should be taken before breakfast; it works in 2-4 hours. The polyethylene glycols (Macrogols) have the advantage over the synthetic disaccharide lactulose in that they are not fermented anaerobically in the colon to gas which can distend the colon to cause pain. The osmotic laxatives are preferred to the stimulatory laxatives, which act by stimulating colonic contractility and by causing intestinal secretion. The use of irritant suppositories can be helpful in some patients with defecatory disorders. The use of enemas should be restricted to the management of elderly, infirm and immobile patients and those with neurological disorders.


What are the available laxatives?

Bulk-forming laxatives

Dietary fibre
Wheat bran
Methylcellulose
Mucilaginous gums - sterculia
Mucilaginous seeds and seed coats, e.g. ispaghula husk

Stimulant laxatives (stimulate motility and intestinal secretion)

Phenolphthalein Bisacodyl
Anthraquinones - senna and dantron (only for the terminally ill)
Docusate sodium

Osmotic laxatives

Magnesium sulphate
Lactulose
Macrogols

Suppositories

Bisacodyl
Glycerol

Enemas

Arachis oil Docusate
Sodium Hypertonic
Phosphate Sodium citrate

Patients with defecatory disorders should be referred to a specialist centre as surgery may be indicated for, for example, anterior rectocele or internal anal mucosal intussusception. Anterior mucosal prolapse can be treated by injection, and those with pelvic floor dyssynergia (anismus) can benefit from biofeedback therapy.

Other Related Articles:

Constipation Causes and Diagnosis
Different Types of Constipation
Treatment Options Of Constipation