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What is Constipation? How is it caused? What are its remedies? Which drugs are used for its treatment?

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  1. 1. Constipation
  2. 2. What is Constipation?• Passage of hard, dry bowel movements,usually fewer than three times a week• Symptoms:– painful bowel movements– bloated– uncomfortable– sluggish
  3. 3. • As a rule, if more than three dayspass without a bowel movement,the intestinal contents may harden,and a person may have difficulty oreven pain during elimination.Straining during bowel movementsor the feeling ofincomplete evacuation may also bereported as constipation
  4. 4. What are Some Common MisconceptionsAbout Constipation?• that a bowel movement every day isnecessary.• that wastes stored in the body areabsorbed and are dangerous to healthor shorten the life span.These misconceptions have led to amarked overuse and abuse of laxatives.
  5. 5. Is Constipation Serious?• it may signal and be the only noticeablesymptom of a serious underlyingdisorder such as cancer.Complications• Hemorrhoids• Fissures
  6. 6. Constipationis a symptomnot a disease.
  7. 7. What Causes Constipation?• Eating too little fiber• Not drinking enoughliquids• Lack ofexercise/physicalactivity
  8. 8. What Causes Constipation?• Change in routine–travel• Older age–Slower metabolism• Frequent use oflaxatives• Certain diseases orconditions
  9. 9. What Causes Constipation?–pain (narcotics)–antacidscontainingaluminum–antidepressants–iron supplements–diuretics (“water”pills)• Medications
  10. 10. Other causes• Imaginary constipation• Irritable bowel syndrome• Poor bowel habits• Hormonal disturbances• Pregnancy• Fissures and hemorrhoids• Mechanical compression
  11. 11. What Can You Do?• Eat more fiber–More beans, wholegrains and brancereals, fresh fruits,vegetables–Limit foods with nofiber (cheese, meat,sweets, processedfoods)
  12. 12. What Can You Do?• Drink more water andother liquids–Be sure to drink at least 8to 10 glasses of watereveryday–Liquid helps keep thestool soft
  13. 13. What Can You Do?Become morephysicallyactive
  14. 14. What Can You Do?• Allow yourself enough time tohave a bowel movement–If you get in a hurry andignore the urge to have abowel movement, it cancause constipation
  15. 15. What Can You Do?• Fiber supplements are best choice–Absorb water and make stoolsofter–Safe to use everyday
  16. 16. What Can You Do?• Give laxatives only if reallynecessary• Laxatives can cause:• Poor absorption of vitamins andminerals• Loss of water, sodium andpotassium• Damage to your intestines
  17. 17. Pharmacological managementof constipation• Laxatives• Cathartics• Purgatives
  18. 18. Laxatives/cathartics/PurgativeLaxatives:• promote a soft stoolCathartics• Results in a soft to watery stool withsome crampingPurgative:• is a harsh cathartic causing a waterystool with abdominal cramping
  20. 20. According to their mode of action.• Bulk forming laxatives• Osmotic laxatives• Stimulant laxatives• Fecal softeners andlubricants
  21. 21. Bulk forming
  22. 22. Bulk forming laxatives• Natural: plant gum: agar, psyllium,and bran.• Synthetic: cellulose compoundsmethylcellulose andcarboxy methylcellulose.Polysaccharide polymers
  23. 23. MOA• Absorb water into the intestineincreasing fecal bulk andperistalsis• Dissolve or swell in the intestines------- stimulate peristalsis
  24. 24. • Onset of action: 8-24 hours• Peak action: 3 days
  25. 25. The benefits of bulk-forming laxatives arenot absorbed from the intestines intothe body safe for long-term use.• safe for elderly patients.• Helpful in patients with irritable bowelsyndrome, diverticulosis, andcolostomies.
  26. 26. • Should be mixed in a glass of water orjuice, stirred and drunk immediatelyfollowed by a half to a full glass ofwater.• Why with water or juice?Because• Insufficient fluid intake cause the drugto solidify in GI tract results inintestinal obstructionPrecaution
  27. 27. Precautions for using bulk-forminglaxatives.----- may not be appropriate for patients whomust restrict oral fluid intake (such aspatients with kidney failure).• Patients with narrowing of the digestive tract(including esophageal stricture, intestinalstricture, or severe adhesions)• ----- risk of blockage of the intestine or theesophagus.
  28. 28. Osmotic laxatives
  29. 29. Osmotic laxativesInclude• Salts or saline products• Lactulose• glycerin
  30. 30. Osmotic laxatives• Glycerin• Lactulose• Saline products Magnesium citrate Magnesium hydroxide (milk of magnesia) Magnesium oxide Magnesium sulphate Sodium biphospahte (Kleen enema) Sodium phosphate
  31. 31. MOAHyperosmolar salts or saline products :insoluble, remain in lumen pull water into colonand increase water in the feces to increase bulk –increase peristalsisLactulose:• draws water into intestine and promotes water andelectrolytes retention• Decreases serum ammonia levelGlycerin• acts like Lactulose increases water in the feces inlarge intestine
  32. 32. Therapeutic Uses• Preparation of bowel forcolonoscopy, sigmoidoscopy, andbarium enema.• Lactulose: liver disease (Hepaticencephalopathy)
  33. 33. SIDE EFFECTS• HYPERMAGNESEMIA :• drowsiness, weakness, paralysis,complete heart block, hypotension,flushing, respiratory depression.• Lactulose :flatulence, diarrhea, abdominal cramps,nausea, vomiting, disturbance indiabetes
  34. 34. Precaution• Patients with congestive heartfailure, kidney disease, and highblood pressure, should not uselaxatives that contain sodium.
  35. 35. Stimulant or Irritant laxatives
  36. 36. Stimulant or Irritant laxativesCastor oilAnthraquinone:• Senna• Cascara sagradaDiphenylmethanes• Bisacodyl• Phenophthalein
  37. 37. MOA• Increasing water and electrolytesecretion by the mucosa• By increasing peristalsis ---- bystimulating sensory nerveendings in GI mucosa
  38. 38. • The feces are movedthrough the bowel toorapidly to allow colonicabsorption of fecal waterso a watery stool iseliminated
  39. 39. Bisacodyl (Dulcolax)• Can be given: orally ,suppository or enema.Onset of action• Oral form : 6 to 10 hours.• Suppository: 15 to 30 min
  40. 40. Senna,Cascarasagrada, Aloe• Drug passes unchanged into the colon• laxatives into activecompounds (anthracene derivative emodin).• The active compounds then absorb and have adirect stimulant effect on myenteric plexus ----------------------------- contraction of colon muscles.• Onset of action: 6 to 8 hours.bacteria
  41. 41. Castor oilIs hydrolyzed in upper smallintestine to ricinoleic acid aLocal irritant that increasesIntestinal motility• Onset of action: usuallywithin 2 to 6 hours.
  42. 42. Therapeutic UseCleansing the colon forcolonoscopies, bariumenemas, and intestinalsurgeries.
  43. 43. Side effects• Phenophthalein: Nausea, abdominal cramps,weakness, reddish brown urine)• Bisacodyl: Fluid and electrolyte imbalance(Potassium and calcium)Mild cramping, and diarrheaCastor oil: stimulates uterine contraction ----spontaneous abortionSenna: damage nerves--- loss of intestinalmuscular tone
  44. 44. Precaution• Chronic, long-term use ofstimulant laxatives can lead to:• loss of colon function (catharticcolon).• Consequently, constipationbecomes increasingly worse andunresponsive to laxatives.
  45. 45. Stool softeners /Lubricants
  46. 46. Stool Softeners (Emollient laxatives)• The active ingredient inmost stool softeners is amedicine called docusate.
  47. 47. MOA• prevent hardening of the feces byadding moisture to the stool.• Become emulsified with stool.• They decrease surface tension ofthe fecal mass to allow water topenetrate into the stool.•
  48. 48. Therapeutic use• Used to prevent constipation• commonly recommended for patients whoshould avoid straining while defecating,including:Patients who are recovering from abdominal, pelvic, or rectal surgery, childbirth, or a heart attack; persons with severe high blood pressure orabdominal hernias; and patients with painful hemorrhoids and/or analfissures.
  49. 49. Mineral oil• Lubricant laxative• coats and softens stool• Soften stool by retarding colonicabsorption of fecal water• Exact mechanism is unknown
  50. 50. Therapeutic use• Used by patients who need toavoid straining hernia repair, hemorrhoid surgery, heart attacks, and childbirth.
  51. 51. Precautions for using lubricant laxatives• Mineral oil should be avoided in patients takingblood thinners, such as Coumadin.• Mineral oil decreases the absorption of vitamin K(important in forming clotting factors in the blood)from the intestines.• Mineral oil should not be taken during pregnancysince it may inhibit vitamin absorption anddecrease the availability of vitamin K to the fetus.• Mineral oil can cause pneumonia if it leaks into thelungs.
  52. 52. Enemas and Suppositories
  53. 53. Therapeutic Uses• to relieve constipation and rectal fecalimpaction(blockage of the rectum by hard,compacted stool).• in conjunction with oral laxatives incleansing the colon in preparation forbarium enema studies.
  54. 54. Examples of enemas andsuppositories• Microenema, which containsdocusate,• Ducolax Suppository, whichcontains bisacodyl,• Kleen Enema, which containssodium biphosphate.