Constipation (OTC Treatment)

CONSTIPATION

  • Constipation is not a disease & most of the time it is temporary & not serious
  • Constipation is a reduction in the frequency of bowel movements that is less than normal for a particular person
  • Constipation symptoms:  strain during bowel movements, infrequent evacuation, hard/lumpy/difficult stools, incomplete evacuation, sense of blockage, bloating, abdominal pain, distention
    • Constipation may be a symptom of IBS, hypothyroidism, depression, colon cancer, stroke, neurological diseases
    • Ppl likely to become constipated: elderly, sedentary, bed-bound, chemo, prego, women (more than men), children (more than adults)
    • See a doctor when:  blood in stool, losing weight & not sure why, pain in lower abdomen, if constipation is severe or persistent, bowel movements are painful
  • Causes of constipation:  not enough fiber, not enough physical exercise, meds, large amounts of dairy, dehydration
  • Factors that affect the choosing of a laxative: safety & speed (inverse relationship)
    • Safety: (safest)  bulk forming > stool softener > (hyper)osmotic > stimulants > salines > lubricants > suppositories > enemas
    • Speed: (fastest)  enemas > suppositories > lubricants > salines > stimulants > (hyper)osmotic > stool softeners > bulk forming
  • Bulk forming laxatives
    • Safest and slowest
    • Fiber absorbs water forming a gel-like mass and helps make the stool soft and easier to pass
      • Must take with plenty of water/fluids
    • Side effects:  gas, bloating, risk of choking if you don’t drink enough fluids, failure to respond
    • At risk: people with restricted fluid intake, kidney problems, elderly, swallowing problems, kids under 6
    • Metamucil (most are powdered natural psyllium husks)
      • Clear metamucil is inulin fiber rather than the psyllium husks like all the other metamucils
        • Inulin fiber is taste/flavor free  (can mix w/ other stuff better)
        • Psyllium husk fiber is supposed to have other effects like lowering cholesterol
  • Stimulant Laxatives
    • Bisacodyl (dulcolax), senna & sennosides (ex-lax), cascara sagrada, castor oil
    • Stimulate bowel muscles by direct gut irritation  (directly stimulate intramural nerve plexus)
    • Side effects: diarrhea, stomach cramping, yellow-brown urine
    • Don’t use stimulant laxatives in ppl with bowel obstruction, prego, rectal bleeding, appendicitis
    • Castor oil– rarely used due to unpleasant taste
    • Cascara– no longer commonly used, long-term use may cause dark spots on an X-ray of the bowel
    • Mineral oil– aka greased pig effect. “oils” the tube & stool mass to aid passage of stool.
      • Very young & old may aspirate the oil into their lungs causing oil pneumonitis
      • Can interfere with oral contraceptives, cause problems with the absorption of fat soluble vitamins (A, D, E, K)
      • May cause rectal leakage
  • (Hyper)Osmotic laxatives
    • Glycerin, polyethylene glycol
    • Draw fluid into bowel to provide moisture and soften stool
    • Side effects: farts, borborygmi (noisy/growling sounds)
    • Miralax (polyethylene glycol)– mix w/ 4-8 ounces of fluid QD for no more than 7 days
      • Don’t use in ppl under 16 or prego/breastfeeding
      • Usually bowel movement in 1-3 days
  • Saline Laxatives
    • Mg salts (Mag sulfate, Mag hydroxide, mono-/di-basic phosphate solutions)
      • Salt form affects speed (sulfate works faster than hydroxide; enemas work faster than oral)
      • Mag Sulfate & citrate are very rapid in action, can cause severe cramping & shouldn’t be used without a doctor’s approval
    • Attract and retain water in the intestinal lumen, softening the stool & increasing intra-bowel pressure to stimulate parastalsis
    • Cramping is observed more than with other laxatives
    • Avoid saline laxatives in patients with kidney problems or her are prego
  • Fleet Enema should produce a bowel movement within 1-5 minutes
  • Pedia-Lax Enemas can be used for ages 2-11
  • Stool Softeners (emollients)
    • Docusate (Ca, K, Na salts) (colace, dulcolax)
    • Surface active agents–act like soaps
    • Allow water and fat to penetrate the stool
      • Due to this increase absorption of fats into the stool, you don’t want to use these with oil laxatives (mineral oil)
    • SLOW ACTING (24-48 hours)–long term use, very few side effects
    • Some times used in combination with a stimulant laxative (which are faster acting) such as senna
  • Don’t want to use any laxatives for longer than 7 days & you should avoid being on the toilet for longer than 5-10 minutes

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