Constipation?modern laxative therapy

Abstract

It is estimated that one third of the population in Western industrial countries suffers from constipation at least from time to time. Constipation may have somatopathic or functional causes. Furthermore, a great number of substances are known to cause medication-induced constipation, i.e. opioid-induced constipation is caused by linkage of the opioid to opioid receptors in the bowel and the central nerve system. Whenever possible, causal therapy should be undertaken. Patients in palliative care mostly suffer from chronic functional constipation. The treatment consists of basic measures and the application of laxatives. According to their mode of action, they are divided into bulk-forming laxatives, osmotic laxatives, stimulant laxatives, lubricating agents and others. Bulk-forming laxatives are not recommended for use in palliative care patients, for such patients are normally not able to take in the required amount of fluids. Osmotic laxatives are divided into (magnesium) salts, saccharine, alcohols and macrogols. Lactulose is the most popular saccharine laxative. Because of its side effects (flatulence, bloating and abdominal cramping), lactulose is not a laxative of our choice; instead, we prefer to give macrogol. Orally administered, macrogol is not metabolised and pH value and bowel flora remain unchanged. Macrogol hydrates hardened stools, increases stool volume, decreases the duration of colon passage and dilates the bowel wall that then triggers the defecation reflex. Even when given for some time, the effectiveness of macrogol will not decrease. Because of its high effectiveness and commonly good tolerance, macrogol has become the laxative of first choice in palliative care patients with all kinds of chronic constipation, if these patients are able to take in the necessary amount of fluids. From the general medical point of view, lubricating agents have become obsolete. In palliative care patients, however, they are still important laxatives for prophylactic treatment or therapy of constipation. Due to clinical experience, in palliative care a laxative ladder has proven successful.

Toxicology and safety of the tincture of Operculina alata in patients with functional constipation

“…The occurrence of only female patients is due to the high prevalence of women with constipation. This is justified by studies that report that constipation is more common in women (Pasricha, 2005;Klaschik et al, 2003). The prevalence may be three times higher in females than in males, mainly associated with cultural factors (Higgins, Johanson, 2004).…”

Are we able to Manage Effectively Opioid-Induced Bowel Dysfunction?

“…Other groups of laxatives are faecal lubricants (liquid paraffin), stool softeners (surfactants: sodium docusate); however they are usually ineffective when administered alone. The use of bulk-forming agents such as fibre, bran, methylcellulose and psyllium seeds has limited role in patients with OIBD and advanced disease as enough fluids (at least 2 l per day) should be co-administered and may lead to viscous mass formation and pseudo obstruction development [9]. Castor oil is not recommended due to its sudden stimulating effect on bowel motility and the risk of developing strong abdominal cramps.…”

Methylnaltrexon

“…Hierzu gehören die Sicher stellung einer ausreichenden Flüssigkeits zufuhr, ballaststoffreiche Ernährung, Ver zicht auf konstipierende Nahrungsmittel und ausreichende körperliche Bewegung [13,15].…”