This document discusses constipation, including its symptoms, causes, and treatment options. Constipation is defined as passing hard, dry bowel movements less than 3 times per week. Common causes include low fiber diet, dehydration, lack of exercise, and certain medications. Treatment involves increasing fiber and water intake, exercise, and various laxatives if needed. Laxative types include bulk forming, osmotic, stimulant, and stool softeners. Bulk formers and osmotics work by adding bulk or pulling water into the intestines. Stimulants directly stimulate bowel movements. Stool softeners add moisture to stools.

1. PRESENTED BY
ASHUTOSH B. MAHALE
M.PHARMACY IST YEAR ( PHARMACOLOGY )
UNIVERSITY DEPARTMENT OF PHARMACEUTICAL SCIENCES,
R.T.M NAGPUR UNIVERSITY , NAGPUR.

2. CONSTIPATION
• Passage of hard, dry bowel movements, usually fewer than three times
a week
• Constipation or irregularity is a condition of the digestive system in
which a person experiences difficulty in defecation
• Obstipation is used for severe constipation that prevents passage of
both stools and gas
• As a rule, if more than three days pass without a bowel movement, the
intestinal contents may harden, and a person may have difficulty or
even pain during elimination
• Constipation is a symptom not a disease

3. Symptoms
1. A desire to defecate
2. Pain and intestinal discomfort
3. Swelling in the abdomen, cramps and colic
4. In some cases up to several days without being able to defecate
with grave harm and body poisoning
5. Constipation is one of the main causes of hemorrhoids and
appendicitis, as well as acne and general intoxication of the body

4. Causes
COMMON CAUSES OF CONSTIPATION
• Eating too little fiber
• Not drinking enough liquids
• Lack of exercise/physical activity
• Change in routine –travel
• Older age –Slower metabolism
• Frequent use of laxatives
• Certain diseases or conditions

5. PHARMACOLOGICAL CAUSESE OF
CONSTIPATION
• Hardening of the feces
Insufficient intake of dietary fiber
Dehydration from any cause or inadequate fluid intake
Medication, e.g. diuretics and those containing iron, calcium,
aluminum
• Paralysis or slowed transit, where peristaltic action is diminished
◦ Hypothyroidism (underactive thyroid gland)
◦ Hypokalemia
◦ Injured anal sphincter
◦ Medications, such as opioids (e.g. codeine & morphine)
◦ Lactose Intolerance

8. Non- Pharmacological
management of constipation
• Eat more fiber –More beans, whole grains and bran
cereals, fresh fruits, vegetables Eat more fibers
• Drink more water and other liquid
• Become more physically active
• Allow yourself enough time to have a bowel
movement
• Fiber supplements are best choice
• Give laxatives only if really necessary

9. Pharmacological management of
constipation
• Laxatives: promote a soft stool
• Cathartics: Results in a soft to watery stool with some cramping
• Purgative: is a harsh cathartic causing a watery stool with
abdominal cramping
TYPES OF LAXATIVES
• Bulk forming laxatives
• Osmotic laxatives
• Stimulant laxatives
• Fecal softeners and lubricants

10. • Natural: plant gum: agar, psyllium, and bran.
• Synthetic: cellulose compounds methylcellulose
• Absorb water into the intestine increasing fecal bulk and peristalsis
The benefits of bulk-forming laxatives
• They are not absorbed from the intestines into the body safe for
long-term use.
• Safe for elderly patients.
• Helpful in patients with irritable bowel syndrome
Precaution
• Should be mixed in a glass of water or juice, stirred and drunk
immediately followed by a half to a full glass of water
• may not be appropriate for patients who must restrict oral fluid
intake (such as patients with kidney failure)
Bulk forming laxatives

11. Osmotic laxatives
• Glycerin
• Lactulose
• Saline products
Hyperosmolar salts or saline products : insoluble, remain in lumen pull
water into colon and increase water in the feces to increase bulk –
increase peristalsis
 Lactulose: draws water into intestine and promotes water and
electrolytes retention
• Decreases serum ammonia level
 Glycerin : acts like Lactulose increases water in the feces in large
intestine
Side effects : Flatulance is common cramps may occurs

12. Stimulant or Irritant laxatives
• Castor oil
• Anthraquinone: Senna, Cascara sagrada
• Diphenylmethanes : Bisacodyl, Phenophthalein
MOA
• Increasing water and electrolyte secretion by the mucosa
• They increasing peristalsis by stimulating sensory nerve endings
in GI mucosa
Anthraquinone
• Drug passes unchanged into the colon
• laxative into active compounds (anthracene derivative emodin).
• The active compounds then absorb and have a direct stimulant
effect on myenteric plexus contraction of colon muscles

13. Castor oil
• Is hydrolyzed in upper small intestine to ricinoleic acid a Local
irritant that increases Intestinal motility
• Side effects: stimulates uterine contraction lead to spontaneous
abortion
Mineral oil
• Lubricant laxative and coats & softens stool e.g-liquid paraffin
• Soften stool by retarding colonic absorption of fecal water
Enemas and Suppositories
• To relieve constipation and rectal fecal impaction(blockage of the
rectum by hard, compacted stool)
• In conjunction with oral laxatives in cleansing the colon in
preparation for barium enema studies

14. Stool Softeners (Emollient
laxatives)
• The active ingredient in most stool softeners is a medicine called docusate
• prevent hardening of the feces by adding moisture to the stool Become
emulsified with stool.
• They decrease surface tension of the fecal mass to allow water to penetrate
into the stool
• Therapeutic use :-
• Used to prevent constipation
• commonly recommended for patients who should avoid straining while
defecating, including: Patients who are recovering from abdominal, pelvic, or
rectal surgery,
• childbirth
• patients with painful hemorrhoids and/or anal fissures