Obstipation (constipation) is a very common health problem that manifests itself as irregular and difficult bowel movements, with scarce and hard stool. Usually constipation involves less than 3 stools per week, but the range of normal bowel movements is from 2-3 stools a day to 1 stool in 3 days.
Problem that affects a large number of people
According to world statistics, almost every third person is suffering from constipation. The incidence increases with age, and women are more affected by this problem. This is a major medical problem confirmed by a large number of visits to the doctor, which only in the US is around 2.5 million annually.
There is hardly a person who did not, at least once in the life, have had a problem with constipation. In most cases, this condition does not last very long and does not require special analysis and treatment. It is important to recognize the causes that lead to constipation because then we can easily help ourselves.
The most common causes
The most common causes of constipation are:
- irregular and inadequate nutrition,
- insufficient physical activity,
- knowingly suppressing the reflex to defecate,
- use of certain drugs,
- diseases of the digestive tract.
It is most common during pregnancy and after childbirth, after surgery, in the elderly and bedridden people, during travel, and in cases of stress.
In case of long-term constipation, undigested food residues are retained in the intestines. It comes to the accumulation of toxic products of metabolism in the body and to the manifestation of their adverse effects. Uncomfortable and painful bloating and heaviness occur in lower abdomen.
If behavioral changes and increasing fiber intake does not help, you may try taking laxatives. For treating constipation there is variety of laxatives. Selection is based upon their action, safety of the treatment and doctor`s recommendations.
The osmotic laxatives are substances that are poorly absorbed - laxative salts and lactulose, sodium sulfate, polyalcohols (glycerol, mannitol, sorbitol), an organic acid which is poorly absorbed (citric, tartaric and malic acid). Through osmosis they provide an increase in volume of intestinal juice, which leads to the accelerated passage through the small intestine and release into colon in voluminous amount. Due to the expansion of the wall of the colon, defecation occurs an hour after taking laxatives. Abdominal cramps may also occur.
When it comes to the salts, magnesium - sulfate and magnesium hydroxide are generally used. These salts are insoluble, while maintaining water they increase the volume of stool. Magnesium from these compounds is absorbed in small amounts that do not provide systemic side effects, but it still should be avoided in young children and patients with impaired renal function, since they can cause heart block, neuromuscular blockade or depression of CNS.
Lactulose is a semi-synthetic compound, a disaccharide composed of galactose and fructose. In the column, under the influence of bacteria, it breaks down to these two sugars, which are poorly absorbed. Their fermentation results in lactic and acetic acid, which acts as an osmotic laxative. Lactulose needs 2-3 days to start having the effect.
Side effects occurring in taking high doses: bloating, cramps, diarrhea and electrolyte disturbance. One can also develop tolerance.
Glycerol is used as a laxative, and it has osmotic effect and operates so that it gathers water to the intestinal lumen from the surrounding tissue. Content of the intestines becomes softer and intestinal function becomes easier. It is available in the form of liquids or suppositories. Such laxative can help in many situations: when it is necessary to develop normal intestinal function after a period of poor nutrition and lack of physical activity, in preparation for examination or surgery, before birth, during a period of a few days after birth and it can help with constipation often caused by other drugs.
Some side effects connected with its use may be discomfort in the abdomen, cramps, gas. Possibility of allergic reactions should be taken into account.
Laxatives that increase the volume of intestines
These laxatives increase volume of stool. While retaining water in the intestinal lumen, they increase the volume of intestinal content and thus accelerate peristalsis. It takes a few days for them to start working, but the positive side is that they have no side effects that leave unwanted consequences. These are, for example, pectins from fruits (figs, plums), bran, flakes seeds methylcellulose, sterculia, agar and ispagula shell.
These laxatives facilitate defecation by diluting and softening the feces. These are liquid paraffin (which is not used on suspicion of carcinogenicity) and olive oil. Also, they include sodium docusate which is nothing but a special type of a detergent. Today they are not used so often.
These are extremely strong laxatives. They act in a way that causes water entry or blocking of the absorption of water, and stool becomes soft. In fact, these agents cause diarrhea condition. These are for example, castor oil, croton oil, etc.
They very strongly, effectively and directly stimulate the wall of the colon, causing tightening and movement of stool. These are bisacodyl, sennosides A and B from the plant Senna (Cassia angustifolia), rhamnoside from the bark of buckthorn (Rhamnus frangula), phenolphthalein, glycosides from rhubarb (Rhea rhizomae). It should be noted that their use is very limited because they cause cramps, and can also cause dependency, because if taken too often they cause lazy bowel syndrome. Also, frequent and prolonged intake of such laxatives will cause damage to the colon.
Senna owes laxative effect to derivatives of anthracene, which create glycosides. The drug reaches the colon unchanged, and under the influence of bacteria it causes termination of the glycosidic bond and releases anthracene derivatives. It is absorbed and acts directly on the myenteric plexus, thus it causes smooth muscle contraction and the defecation.
Bisacodyl is chemically and pharmacologically related phenolphthalein, but its action is 10 to 20 times more potent. It is absorbed in the small intestine and after biotransformation it is excreted into the small intestine through the bile. It has effect on the lining by stimulating peristalsis. The effect starts after 6 to 12 hours, but if applied in the form of suppositories it starts much sooner - after half an hour to an hour.