Treatment of constipation

Constipation:-

      Change in the pattern from the normal defecation such as reduction in the frequency, hardening the stool, reduction in volume or feeling incomplete evacuation.

     This may be due to Lifestyle change, change in Diet, drug toxicity or other underlying disorders..

Causes

Dehydration

When you’re dehydrated, water is absorbed from your intestines, making your stools harder. To keep stools soft and mobile, drink more water, juices or herbal beverages..

Tea and coffee

Caffeine can stimulate muscle contractions in the bowel to make stools easier to pass. But it also has a diuretic effect, making you urinate more often than usual. When that happens, your colon may not absorb enough fluids, making you dehydrated, which can cause constipation or make it worse. The solution? If you consume coffee and black tea, also try to drink plenty of non-caffeinated liquids (preferably water) to compensate for their diuretic effects. That way, you can keep your stools moist and moving.

Eat regularly

Your body has its own internal clock and likes to keep to a regular schedule. So try to eat at regular times, because skipping meals can slow down the time that food and waste takes to pass through your system. If you know you’ll be busy, snacking on an apple or fibre-rich granola bar can help.

Drug effect

Constipation is a side effect of many medications, from over-the-counter antacids to prescription painkillers. If you think the drug(s) you’re taking are causing your problem, speak to your pharmacist or doctor.

Jogging

Getting moving gets your bowel muscles moving as well. You don't have to join a gym. Simply walking for half an hour three times a week is enough for most people.

🔔🔕🕕 Time

There’s a reason they call it getting regular your body has an internal clock that is easily disrupted by changes. So try to get into a routine, setting up regular times for a bowel movement. Keep in mind that travel or starting a new job can affect your bowel movements, so don’t stress too much if they’re off for a while. Just try to get back into your regular routine as soon as possible.

Hormones

The hormonal disruptions of pregnancy can all affect a woman’s bowel function. Being prepared with proven constipation relief strategies such as upping your fluid intake or getting more exercise can help when you’re feeling hormonal.

Treatments

1. Normally a high fibre diet will help to relieve the symptoms of constipation in majority of patients.

There is No precious definition for dietry fiber...

Plant polysaccharides and lignin resist to hydrolyse by digestive enzymes in human is basically knows as fiber..

Soluble fibre attracts water to your stools, making them softer, larger and easier to pass. You can get this type of fibre from oats, barley, psyllium, oranges, dried beans and lentils.

Insoluble fibre adds bulk to your stools, helping them pass more quickly through the intestines. Good sources include wheat bran, vegetables and whole grains.

Also keep in mind that fibre absorbs more water in your gut. So if you’re adding more fibre to your diet, be sure to increase your fluid intake as well.

10 - 30 gm daily intake of dietary fiber are recommended.

2.bulk laxatives.

bulk laxatives are the first choice of drug in the treatment of constipation in cas hie of dietary fibre unacceptable. (☝😇)

bran

methylcellulose

ispaghula

psyllin.

Bran is the fibrous outer layer of cereal grains.

(pieces of grain husk separated from flour after milling. -- തവിട്- in local language malayalam)

Ispaghulahusk & Psyllium

Dose - 3.5gm twice / day.

It should be taken immediately after dispersed in water/juice.

Or swallow with water.

Bulk laxatives generally have an effect after 1-3 days, so a gradual increase in dose is advisable. which also help to avoid flatulence and distension.

3.Stimulant laxative

stimulant laxative may be given in case of failure in dietary fibre and bulk laxatives.

many of them fall due to adverse effect, abuse &  causing damage in colonic nerves and muscles..

Anthraquinone derivative Such as senna, diphenylMethane such as sodium picosulfate, bisacodyl , castor oil

- Affective with in 6-12 hr.

 Senna

Dose - 15- 50 mg.

Available as tablet/granules/syrup form..

(Eg:A-lax tab)

Senna and fibre diet combination are most useful in elderly patients.

Bisacodyle available as enteric coated tablet to avoid gastric irritations.

🎯 Milk or antacids are avoided with/ just within 2hour. (eg - Dulcolax tab)

5mg/tab available.

5-15mg/day tab at night

10mg suppository at morning time 

Senna + bisacodyle combination also available ( bekunis)

Sodium picosulphatde.

Dose.

2-5 yr. - 2.5mg

5-10yr - 2.5 - 5 mg

10 < yr - 5 - 15 mg

Castor oil available as capsule form / syrup.

4. Osmotic laxatives

MgCo3

MgOH

MgSo4 

Very rapid action. ( Alternative to stimulant laxative) 

Rarely used because may cause urgency, occasional incontinence, watery stool.

MgOH

Orally upto 5gm.

Lactulose and sorbitol ( slow action)

Lactulose (synthetic disaccharide)

Dose. 15-30 ml/ as single dose or 2 dose.

1> yr .  2.5ml od/bd

1-5yr - 5ml bd

5-10yr - 10ml bd (3.33gm/5ml)

Sorbitol dose 20-50gm.

5. Surfactant laxative

docusate  rarely used by combined with stimullent laxative.

6. Enema / suppositories

Its for rapid relief.

Combination of osmotic and stimulant laxative enemas used.

Glycerol suppo. May act with in 15 - 30 minutes.

Topics to be continued...!.

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