4. A. Bulk purges
*It is a high residue foot which contain a high
content of cellulose, which is not digested or
absorbed and thus increase the bulk of the
intestinal contents.
*Examples:
1-green vegetable, fruits and whole meal bread.
2-bran which contain fiber made up of cellulose, so
they take up water and thus increase the bulk of
feces.
3-methylcellulose as tablets.
4-Ispaghula husk (Regulan®) (Isogel®(.
5. B. Stool softeners
1.Liquid paraffin:
*it is odorless, tasteless and facilitate evacuation.
*Long term use side-effects:
1.leaking via the anal sphincter.
2.interfere with the absorption of vitamin A, D
and K.
6. B. Stool softeners
2-Docusate sodium:
*available as tablet or syrup and also as a micro-
enema to treat fecal impaction.
7. C. Osmotic purges
1.Saline purges:
*the mostly used is magnesium salts (Epsom
salt®), increase the osmotic pressure inside the
intestine which made the content more liquefied
and more bulk.
*given on empty stomach. (before breakfast(
*it is dissolved in water and the concentration
shouldn’t exceed 8g of Epsom salt in 120ml of
water (more conc. Will lead to closure of
pyloric sphincter(
*Effective within 1-2 hours.
8. C. Osmotic purges
2.Lactulose (Duphalac®(:
*it is a sugar that is breaking down by the large
bowel bacteria so produce acid that make the
bowel content more liquid.
*given as powder or liquid and it takes days to
act and may cause flatulence and distention.
*it is used in long-term treatment of constipated
elderly patients.
9. D. Stimulant purges
All members of this group take 8-12 hour to act
so they best be given at bed time.
1.Bisacodyl (Dulcolax®(:
*stimulate the activity of colon when it comes
in contact with the wall of the bowel.
*as tablet or suppositories.
2.Sodium picosulphate.
10. D. Stimulant purges
Side effects of purges:
1.Diarrhea with loss of fluid and electrolytes.
2.Damage to the bowel.
3.Abdominal pain.
11. Notes
For patients who have been constipated for
2-4 days, stimulant purges tablet at night
followed by glycerin suppository the next day are
sufficient.
In chronic constipation, Bran or the use of bulk
purgatives such as methylcellulose lose, high
fluid intake and exercise are also helpful.
12. Enemas:
*It maybe used to soften the stool.
*To promote evacuation a phosphate enema
run thru the rectum (useful before
sigmoidscopy(.
*In ulcerative colitis, steroids (prednisolone or
hydrocortisone) can be introduced into the
rectum and retained if possible for at least 1
hour.
