This document provides guidelines for treating constipation and discusses various treatment options. It defines constipation and lists its common causes such as inadequate water/fiber intake, lack of exercise, and certain medications. Symptoms include infrequent and difficult bowel movements. Treatment focuses on lifestyle changes like increasing physical activity and fiber/water intake. Herbal remedies and over-the-counter laxatives provide short-term relief but should not be used long-term. Prescription laxatives may be used under a doctor's guidance. Special considerations are given for treating constipation during pregnancy and for older individuals.

1. Pharmaceutical guidelines ofPharmaceutical guidelines of
patients with pathology ofpatients with pathology of
digestive organs.digestive organs.
SYMPTOMATIC TREATMENTSYMPTOMATIC TREATMENT
OF CONSTIPATIONOF CONSTIPATION

2. CONSTIPATIONCONSTIPATION
• Violation of bowel function, reflected inViolation of bowel function, reflected in
increasing intervals between acts ofincreasing intervals between acts of
defecation (more than 48 hours)defecation (more than 48 hours)
compared with individualcompared with individual
physiological norm or systematicallyphysiological norm or systematically
inadequate stoolinadequate stool

3. CONSTIPATIONCONSTIPATION
• Constipation occurs when bowel movementsConstipation occurs when bowel movements
become difficult or less frequent.become difficult or less frequent.
• Some people have bowel movements threeSome people have bowel movements three
times a day; others, only one or two times atimes a day; others, only one or two times a
week.week.
• Going longer than three days without aGoing longer than three days without a
bowel movement is too long. After threebowel movement is too long. After three
days, the stool or feces become harder anddays, the stool or feces become harder and
more difficult to pass.more difficult to pass.

4. CONSTIPATIONCONSTIPATION
The patient is considered constipated ifThe patient is considered constipated if
have two or more of the following for athave two or more of the following for at
least 3 months:least 3 months:
• Straining during a bowel movement moreStraining during a bowel movement more
than 25% of the time.than 25% of the time.
• Hard stools more than 25% of the time.Hard stools more than 25% of the time.
• Incomplete evacuation more than 25% of theIncomplete evacuation more than 25% of the
time.time.
• Two or fewer bowel movements in a week.Two or fewer bowel movements in a week.

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6. Common causes of constipationCommon causes of constipation
• Inadequate water intake.Inadequate water intake.
• Inadequate fiber in the diet.Inadequate fiber in the diet.
• A disruption of regular diet or routine;A disruption of regular diet or routine;
traveling.traveling.
• Inadequate activity or exercise or immobility.Inadequate activity or exercise or immobility.
• Eating large amounts of dairy products.Eating large amounts of dairy products.
• Stress.Stress.
• Resisting the urge to have a bowel movement,Resisting the urge to have a bowel movement,
which is sometimes the result of pain fromwhich is sometimes the result of pain from
hemorrhoids.hemorrhoids.
• Overuse of laxatives (stool softeners) which,Overuse of laxatives (stool softeners) which,
over time, weaken the bowel muscles.over time, weaken the bowel muscles.

7. Common causes of constipationCommon causes of constipation
(cont’d)(cont’d)
• Hypothyroidism.Hypothyroidism.
• Neurological conditions such as Parkinson's diseaseNeurological conditions such as Parkinson's disease
or multiple sclerosis.or multiple sclerosis.
• Antacid medicines containing calcium orAntacid medicines containing calcium or
aluminum.aluminum.
• Medicines (especially strong pain medicines, suchMedicines (especially strong pain medicines, such
as narcotics, antidepressants, or iron pills).as narcotics, antidepressants, or iron pills).
• Depression.Depression.
• Eating disorders.Eating disorders.
• Irritable bowel syndrome.Irritable bowel syndrome.
• Pregnancy.Pregnancy.
• Colon cancer.Colon cancer.

8. Symptoms of constipationSymptoms of constipation
• Infrequent bowel movements and/orInfrequent bowel movements and/or
difficulty having bowel movements.difficulty having bowel movements.
• Swollen abdomen or abdominal pain.Swollen abdomen or abdominal pain.
• Vomiting.Vomiting.

9. Threatening symptoms ofThreatening symptoms of
constipationconstipation
• blood in stoolblood in stool
• weight lossweight loss
• severe pain with bowel movementssevere pain with bowel movements
• constipation has lasted more than twoconstipation has lasted more than two
weeksweeks
• feverfever
• sharp abdominal distentionsharp abdominal distention

10. Blood in a bowel movementBlood in a bowel movement
• Bright red blood is usually fromBright red blood is usually from hemorrhoidshemorrhoids
or tears in the anal lining calledor tears in the anal lining called fissuresfissures..
Constipation and straining during bowelConstipation and straining during bowel
movements can be the cause.movements can be the cause.
• Maroon or tarry black blood or clots usuallyMaroon or tarry black blood or clots usually
meanmean bleeding is coming from higher in thebleeding is coming from higher in the
gastrointestinal tractgastrointestinal tract. The cause may be more. The cause may be more
serious.serious.

11. TreatmentTreatment
The success of the treatment ofThe success of the treatment of
constipation is made up of three components:constipation is made up of three components:
-the degree of completeness of identification-the degree of completeness of identification
and elimination of the causes of delay in stooland elimination of the causes of delay in stool
-patient readiness to change lifestyle, dietary-patient readiness to change lifestyle, dietary
habits, the recommendations of the physicianhabits, the recommendations of the physician
and the pharmacist (compliance)and the pharmacist (compliance)
-availability of doctors and pharmacists to-availability of doctors and pharmacists to
perform a comprehensive, individualperform a comprehensive, individual
treatment of each patienttreatment of each patient

12. Treatment Choices forTreatment Choices for
Occasional ConstipationOccasional Constipation
• It is recommended that the regular menu be filled withIt is recommended that the regular menu be filled with
plenty of fiber rich foods such asplenty of fiber rich foods such as fresh fruitsfresh fruits andand
lubricated as it passes through the intestinelubricated as it passes through the intestine vegetables,vegetables,
fruit juices, whole grain productsfruit juices, whole grain products, and others., and others.
• to increaseto increase fluid intakefluid intake which ensures that the wastewhich ensures that the waste
material is perfectly.material is perfectly.
• minimize, if possible avoid, taking foods that can causeminimize, if possible avoid, taking foods that can cause
dehydration such asdehydration such as alcohol, caffeine, and salty foodsalcohol, caffeine, and salty foods..
• Experts recommend at leastExperts recommend at least eight glasses of water dailyeight glasses of water daily
to fuel body’s demand for liquid as well as to maintainto fuel body’s demand for liquid as well as to maintain
the fluidity of stool.the fluidity of stool.
• physical activity can also contribute inphysical activity can also contribute in
experience of constipationexperience of constipation. Exercise plays a huge role in. Exercise plays a huge role in
the whole course ofthe whole course of acute constipation treatmentacute constipation treatment..
Without it, the full effect of the treatment is notWithout it, the full effect of the treatment is not

13. • This small, dried fruit hasThis small, dried fruit has
earned a big reputation asearned a big reputation as
"nature's remedy" for"nature's remedy" for
constipation. Prunes (oftenconstipation. Prunes (often
called dried plums) cancalled dried plums) can
prevent or improveprevent or improve
constipation symptoms.constipation symptoms.
They're packed withThey're packed with
insoluble fiber, as well as theinsoluble fiber, as well as the
natural laxatives sorbitolnatural laxatives sorbitol
and dihydrophenylisatinand dihydrophenylisatin..
The soluble fiber found inThe soluble fiber found in
prunes mayprunes may help lowerhelp lower
cholesterolcholesterol. And they're safe. And they're safe
for long-term consumption.for long-term consumption.
Children who don't likeChildren who don't like
prunes might eat prune juiceprunes might eat prune juice
ice pops or sip prune juiceice pops or sip prune juice
mixed with another juice tomixed with another juice to
disguise the taste.disguise the taste.

14. RecommendationsRecommendations
• Lack of physical activityLack of physical activity
can contribute tocan contribute to
constipation. Exercise,constipation. Exercise,
however, can help makehowever, can help make
bowel movements morebowel movements more
regular and can reduceregular and can reduce
stress ( at least an hourstress ( at least an hour
after eating a big mealafter eating a big meal
before exercise). It isbefore exercise). It is
recommended a 10- to 15-recommended a 10- to 15-
minute walk several timesminute walk several times
a day. Stretching anda day. Stretching and
yoga can also helpyoga can also help
constipation.constipation.

15. RecommendationsRecommendations
• coffee and othercoffee and other
diuretics such asdiuretics such as
alcohol andalcohol and
caffeinated tea andcaffeinated tea and
cola should becola should be
avoidedavoided

16. Constipation herbal remediesConstipation herbal remedies
• Aloe vera has been used since the oldenAloe vera has been used since the olden
times. It is recommended that peopletimes. It is recommended that people
suffering from constipation take aloe verasuffering from constipation take aloe vera
juice or aloe vera gel to avail of itsjuice or aloe vera gel to avail of its
laxative properties.laxative properties.
• recommends flaxseed or linseed as arecommends flaxseed or linseed as a
great alternative for constipationgreat alternative for constipation
treatments. Herbalists recommend takingtreatments. Herbalists recommend taking
three tablespoons of crushed or wholethree tablespoons of crushed or whole
flaxseed at least three times throughoutflaxseed at least three times throughout
the day. This offers an effectivethe day. This offers an effective
treatment for chronic constipationtreatment for chronic constipation.. ToTo
complement the effects of flaxseed, it iscomplement the effects of flaxseed, it is
need to drink enough amounts of liquidsneed to drink enough amounts of liquids
right after taking this herbal supplement.right after taking this herbal supplement.
Fluids will aid the movement of theFluids will aid the movement of the
flaxseed and bowel contents through theflaxseed and bowel contents through the
digestive system.digestive system.

17. If conventionalIf conventional acuteacute
constipation treatmentconstipation treatment is notis not
effectiveeffective
• Fiber supplements (in combination with anyFiber supplements (in combination with any
beverage or favorite foods)beverage or favorite foods)
• side effects - diarrhea and stomach cramps.side effects - diarrhea and stomach cramps.
• Over-the-counter laxatives are also availableOver-the-counter laxatives are also available
if that fiber supplements are not effective.if that fiber supplements are not effective.
These products provide an immediate resultThese products provide an immediate result
but it needs to be used in moderation.but it needs to be used in moderation.
• Enema is anotherEnema is another acute constipationacute constipation
treatmenttreatment
• should be used very carefully and is reservedshould be used very carefully and is reserved
for specific conditions.for specific conditions.

18. • Enemas and colon irrigationEnemas and colon irrigation
(high colonics) may(high colonics) may
temporarily remove bodytemporarily remove body
waste, but they're not anwaste, but they're not an
effective way to prevent oreffective way to prevent or
cure constipation. Enemascure constipation. Enemas
can actually causecan actually cause
constipation in older peopleconstipation in older people
who get them regularly.who get them regularly.
Colonic irrigation, which isColonic irrigation, which is
usually done by colonicusually done by colonic
hygienists or therapists, canhygienists or therapists, can
damage the colon and candamage the colon and can
lead to other issues.lead to other issues.

19. Over-the-counter laxativesOver-the-counter laxatives
• A suppository might work within an hour.A suppository might work within an hour.
• It is needed to take a bulk-forming fiberIt is needed to take a bulk-forming fiber
product every day for several days to seeproduct every day for several days to see
results.results.
• Most over-the-counter laxatives are meant forMost over-the-counter laxatives are meant for
short-term useshort-term use
• Overuse can lead to other digestive problems.Overuse can lead to other digestive problems.

20. LaxativesLaxatives
• Stool softeners prevent constipation byStool softeners prevent constipation by
allowing stools to absorb more water fromallowing stools to absorb more water from
the colon. They prevent feces from hardeningthe colon. They prevent feces from hardening
-- softer stools are easier to eliminate from the-- softer stools are easier to eliminate from the
body. Like other laxatives, stool softenersbody. Like other laxatives, stool softeners
should be taken for short-term relief.should be taken for short-term relief.
• In some cases, doctors prescribe stoolIn some cases, doctors prescribe stool
softeners for people such as surgery patients,softeners for people such as surgery patients,
who may need to avoid straining duringwho may need to avoid straining during
bowel movements. Some preparationsbowel movements. Some preparations
combine a stool softener with a stimulantcombine a stool softener with a stimulant
laxative to activate bowel movements.laxative to activate bowel movements.

21. Castor oilCastor oil
• Castor oil is a powerful laxative. But likeCastor oil is a powerful laxative. But like
other laxatives,other laxatives, it should not be used long-it should not be used long-
termterm. Overusing laxatives can hurt body's. Overusing laxatives can hurt body's
ability to absorb nutrients and someability to absorb nutrients and some
medications.medications.
• Castor oil can damage the bowel muscles,Castor oil can damage the bowel muscles,
nerves, and tissue if overused -- all of whichnerves, and tissue if overused -- all of which
can cause constipation. Uses only with acan cause constipation. Uses only with a
doctor's guidance.doctor's guidance.

22. Constipation & ageConstipation & age
• Older people are more likely to becomeOlder people are more likely to become
constipated. This can be because ofconstipated. This can be because of medicalmedical
conditions, poor nutrition, greater use ofconditions, poor nutrition, greater use of
medications, or not enough physical activitymedications, or not enough physical activity..
• Constipation is usual during pregnancy orConstipation is usual during pregnancy or
after childbirth or surgery.after childbirth or surgery.
• Pregnant women for relieving constipationPregnant women for relieving constipation
should check with your doctorshould check with your doctor

23. An excellentAn excellent pregnancypregnancy constipation remedyconstipation remedy isis
lifestyle change.lifestyle change. This is the safest and simplestThis is the safest and simplest
way of dealing with the discomforts associatedway of dealing with the discomforts associated
with pregnancy constipationwith pregnancy constipation
• Exercise is a crucial part of anyExercise is a crucial part of any pregnancypregnancy
constipation remedy.constipation remedy.
• The body requires six to eight glasses ofThe body requires six to eight glasses of
water daily towater daily to prevent constipationprevent constipation. This. This
may not even be enough for pregnantmay not even be enough for pregnant
women because of their increasedwomen because of their increased
demands. Avoid caffeinated beveragesdemands. Avoid caffeinated beverages
and soft drinks as they can causeand soft drinks as they can cause
dehydration. Some of the better choicesdehydration. Some of the better choices
areare herbal teas, vegetable juice, clearherbal teas, vegetable juice, clear
soups and fruit juices. All of these providesoups and fruit juices. All of these provide
liquid at the same time fiber.liquid at the same time fiber.
• A high fiber diet will make bowel contentA high fiber diet will make bowel content
bulkier. Some of the best food productsbulkier. Some of the best food products
include fresh fruits, vegetables and wholeinclude fresh fruits, vegetables and whole
grains.grains.

24. Pharmaceutical application forPharmaceutical application for
guardianship of laxativesguardianship of laxatives
• Laxatives containing anthraglycosides, actLaxatives containing anthraglycosides, act
within 8-12 hours after ingestionwithin 8-12 hours after ingestion
• They are not used for spastic constipation,They are not used for spastic constipation,
because they can cause pain in the colonbecause they can cause pain in the colon
• Anthraquinone glycosides pass into breastAnthraquinone glycosides pass into breast
milk, so that preparations containing themmilk, so that preparations containing them
should not be administered to nursingshould not be administered to nursing
mothersmothers
• These drugs are not recommended to useThese drugs are not recommended to use
long-termlong-term

25. Pharmaceutical application forPharmaceutical application for
guardianship of laxativesguardianship of laxatives
(cont’d)(cont’d)
• The use of sodium pikosulfate infants isThe use of sodium pikosulfate infants is
ineffectiveineffective
• With prolonged use of vaseline oil reducesWith prolonged use of vaseline oil reduces
absorption of fat-soluble vitamins (A and D)absorption of fat-soluble vitamins (A and D)
and an increased risk of malignant tumors inand an increased risk of malignant tumors in
the gastrointestinal tractthe gastrointestinal tract
• Castor oil has a laxative effect in 5-6 hoursCastor oil has a laxative effect in 5-6 hours
• When you receive laxatives containing fibers,When you receive laxatives containing fibers,
should drink per day for at least 1.5 liters ofshould drink per day for at least 1.5 liters of
fluidfluid