DIGESTIVE SYSTEM-PART-1-CONSTIPATION

CONSTIPATION-TREATMENTS

Because of our modern lifestyle, our eating styles and the method of cooking are all changed. Even the natural edibles such as fruits, grains, nuts, and herbs are all grown in chemically fertilized fields. The days are modernized in such a way that everybody whether they are poor or rich has to rely on foods with slow poisonings to satisfy their hunger.

Because of this everybody becomes sick and somehow relies on medicines which are also chemicals as an added tragedy of self-poisoning. Even animals, birds are not escaped from this moral tragedy.

Simply we are self-poisoning in the name of food drinks and medicines with a moral just.No another way to escape.

Stomach distress is a common discomfort with many people in this modern world because our eatings are first dumped into this part only. Some people because of their careless eating behavior do not give respect to their stomach instead they use it as a dustbin by dumping into it mercilessly with whatever they saw and whenever they feel to munch something as fast foods. The result is stomach distress like upset, constipation, or diarrhea.

Constipation is defined as the difficult or infrequent passage of stool. Normal passage of stool must range in frequencies from 1 or 2 times daily or 2 to 3 times weekly.

Constipation may generally give a discomfort of headache, stomach bloating, or an abnormal rectal fullness.

Causes

1.Insufficient dietary fibers

2.Lack of movements

3.Poor bowel habits such as not responding to the defecatory urge, or hurried and incomplete evacuation.

4.Stress

5.Fever

6.Medicines such as opium, marijuana, nicotine, anticholinergics like antidepressants, antihistamines, phenothiazines antispasmodics, and calcium-containing antacids.

7.Pathological conditions like intestinal obstructive tumors, diabetes, and hypothyroidism.

 Diverticulitis a condition in which small pouches are formed at the bowel wall.

Counsellings

1.Normal stool frequencies

2.Duration of the constipation

3. Amount of dietary fibers taken

5.Medicines in use

6.Presence of other symptoms.

7.Chronic medical history. 

Treatments

A.Non-Medical 1.Advice to increase intake of fluids and fibers such as cereals, fruits, green vegs, potatoes

2.Increase exercise to increase bowel movements

3. Bowel training to increase regularity

B.Medical

1.Laxatives: Laxatives generally should not be taken if nausea, vomiting, or stomach pain is present.

a)Bulk Laxatives  

Bulk laxatives are natural or synthetic polysaccharides that work in both small and large intestines.

Because their onset of action is slow(24 to 72 hrs) they are better to be used as a preventive rather than as a curative.

Bulk laxatives should be taken at least with a minimum of 5 ounces of water otherwise they may cause constipation. Some bulk forms may contain sugar hence care must be taken by diabetics.

Bulk laxatives are contraindicated in obstructive bowel syndrome, intestinal tumors or Crohn's disease(a type of inflammatory disease that affects any part of the digestive system)

Examples of Bulk Laxatives 

1.Natural

a)Psyllium (The adult dose is 3.7 to 7 gms/day, child dose is 1/2 of the adult dose)

b)Malt extract (Adult 16 gms 4 times/day;child dose 16 gms 2 times/day)

2.Synthetic

a)Methylcellulose (Adult dose 1to 2 gms 1to 2 times/day; child dose 05 gms 1 to 3 times/day)

b) Polycarbophil (Adult dose 1 gm 1 to 4 times/day;child .05 gm 1 to 3 times/day)

Tetracyclines should not be taken with any calcium compounds like calcium polycarbophil.

b)Saline and Osmotic Laxatives

These laxatives work by forming an osmotic gradient to pull water into the lumen of the intestine and thereby form a bulky feeling to promote the peristalsis and motility.

These laxatives also the activity of an enzyme known as cholecystokinin a pancreatic enzyme that increases the fluid secretion of the GI tract.

Available as rectal enemas and suppositories work within 5 to 30 minutes and the oral preparations work within 4 days. 

A.Saline Laxatives

1.Magnesium citrate

2.Magnesium hydroxide

3.Magnesium sulfate

4.Sodium phosphate.

B.Osmotic Laxatives

1. Glycerin is available in suppositories or enema liquid.

An adult dose is 3 gm as suppository or 5 to 15 ml as an enema

A child dose is 15 gm as suppository or 2 to 5 ml as an enema

2. Lactulose is available as prescription medicine.

This may cause flatulence or cramping and must be taken with fruit juice, water, or milk.

The adult dose is 15 to 30 ml 2 to 3 times daily;

A child dose is 2.5 to 5 ml 2 to 3 times daily.

3. Sorbitol is a nonabsorbable sugar similar in efficacy and action with lactulose. It can be given orally as a 70% solution or rectally as a 25% solution. At the beginning of the first few days, sorbitol will give stomach flatulence, cramps, and pains similar lactulose but these will disappear on continued use.

An adult dose is 15ml orally (70% solution) or 120ml rectally (25% solution)

A child dose is 15 ml orally (70% solution) or 30 to 60 ml rectally (25% solution)

C.Stimulant Laxatives

These drugs work both in the small and large intestines by stimulating their motility. Their major drawback is abdominal cramping. Continuous use may produce numbness and reduced sensitivity of the bowel.

Oral preparations have the onset of action in 6 to 10 hours while the rectal preparations have the onset within 30 to 60 minutes.

1. Anthraquinone Laxatives include senna, cascara sagrada, and Castrol.

Long time use may cause melanosis coli a condition in which a dark pigmentation of the colonic mucosa occurs which disappears in 12 months after discontinuation of the drug. There are no other serious side effects.

Urine becomes colored as pink/red, brown, or yellow.

Cascara sagrada may be excreted in the milk.

a)Senna an adult dose is 300 to 1200mgs/day and for children 100 to 600mgs/day.

b)Cascara sagrada adult dose is 300 to 1000mgs/day.

2.Diphenhydramine derivatives
a)Phenolphthalin
These preparations may cause allergies in some people.
The adult dose is 60 to 200 mg/day.
alkaline urine
discoloration of the urine to pink/red, yellow or brown.
b)Bisacodyl (Dulcolax)
The tablets are enteric-coated and they should not be crushed or chewed. 
Bisacodyl should not be taken within 1 hour of ingesting antacid or milk.
3.Castor Oil
It has an onset of action within 2 to 6 hours. It works mainly at the small intestine. Hence it produces strong cathartic effects such as excess fluid and electrolyte loss. Cause dehydration. Contraindicated in pregnancy.
Adult dose 15 to 60ml
The child's dose is 5 to 15ml.
4.Emollient Laxatives
They cause surfactant effects and allow absorption of water by the stool to soften. They are very useful to heart patients to avoid them in straining to pass the hard stool.
The onset of action is very slow. (24 to 72 hours)
a)Docusate sodium
b)Docusate calcium
c)Docusate potassium
The adult dose is 100 to 300 mg/day
Child dose is 50 to 150 mg/day
Large quantity of water (8oz) water should be consumed after each dosage
This product should not be given with mineral oils as they may cause systemic absorption of mineral oils
5.Lubricant Laxatives 
Mineral oil-like liquid paraffin can be included in this category. They form fine lubrication of the bowel wall and thereby produce laxative effects.
The onset of action is 6 o 8 hours.
The adult dose is 15 to 45 ml/day
Child dose is 10 to 15 ml/day
Cautions 
1. Mineral oil may interfere with the absorption of fat-soluble vitamins like vitamin-A, D, E, and K.
2. Debilitated and dysphagia patients are at the risk of lipid pneumonitis from mineral oil aspirations.
3. Emollients like docusate should not be used concurrently as it may cause the absorption of mineral oil into the system.
4.May cause seepage
5.Should be taken in an empty stomach.