With these laxatives in hand, there is no constipation that cannot be cured

In clinical practice, do you often worry about your patients’ poop? The patient cannot defecate, and he is even more anxious than you. How should we choose laxatives for special groups such as the elderly, diabetics, pregnant women, and children? There are 8 main types of cathartic drugs for treating functional constipation, namely bulk laxatives, osmotic laxatives, stimulant laxatives, lubricating laxatives, prokinetics, secretagogues, suppository laxatives and probiotics. Let's take a look at each of them.

Bulk-forming laxatives

Including wheat bran, glucomannan, etc. They are all large molecular substances that are not absorbed by the intestines. They have a laxative effect by absorbing water, increasing the water content and volume of feces. It is mainly used for patients with mild constipation, especially for the elderly.

Wheat cellulose

Dosage and Administration:

Adults: 3.5 g at a time, 2 to 3 times a day, for at least 1 week, then gradually reduce the dose to 2 or 1 time a day; the medicine should be taken every morning.

Children over 6 months old: 1.75 g at a time, 1 to 2 times a day for at least 1 week, then gradually reduce the dose to once a day; the medicine should be taken every morning.

It can be taken with food or drink. For best results, take it with about 200 mL of liquid each time.

Glucomannan

Dosage and Administration:

Adults: 0.6-1.2 g at a time, three times a day.

Children: 0.3-0.6 g at a time, three times a day. The first dose can be doubled.

After the effect is seen, the maintenance dose is 0.9 to 1.8 g per day, which can be taken all at once. Take with 150 mL of warm water on an empty stomach.

For diabetes and hyperlipidemia, take 0.9-1.2 g at a time, three times a day.

Tips:

The medication should be taken with adequate fluids so that it takes 24 hours to take effect.

Osmotic laxatives

Including disaccharide preparations, saline laxatives, and polyethylene glycol.

(1) Disaccharide preparations

Unabsorbed sugars can increase the volume of feces in the intestinal cavity and stimulate intestinal peristalsis. It can be broken down into lactic acid and acetic acid in the colon, promoting the growth of physiological bacteria.

Lactulose

Used for the treatment of mild to moderate constipation. Large doses should be used with caution in patients with diabetes.

Dosage and Administration:

Take 10 to 20 g orally once a day. It may take 24 to 48 hours for the effect to take effect. If necessary, increase to 40 g per day.

(2) Saline laxatives

Incomplete absorption in the intestine allows water to seep into the intestinal lumen. Overdose may cause electrolyte imbalance and should be used with caution in the elderly and those with impaired renal function.

Magnesium sulfate

Dosage and Administration:

Crystalline powder: 5-20 g at a time, taken on an empty stomach in the morning, drinking 100-400 mL of water at the same time, or dissolved in water before taking

Solution: 10-40 mL at a time, take on an empty stomach in the morning.

(3) Polyethylene glycol

It is not absorbed or metabolized by the intestines after oral administration, but can absorb moisture from the intestines. It does not contain salt or sugar, has few adverse reactions, and is suitable for the elderly and children over 8 years old.

Polyethylene glycol

Dosage and Administration:

Take 10 g each time, 1 to 2 times a day; or take 20 g once a day. Dissolve the contents of each sachet in a glass of water.

Stimulant laxatives

These include bisacodyl, phenolphthalein, anthraquinones (plant-based laxatives such as rhubarb, senna, and aloe vera), and castor oil. It acts on the enteric nervous system, enhances intestinal motility and stimulates intestinal secretion, reduces absorption and promotes defecation.

This type of laxative is prone to adverse reactions such as drug dependence and electrolyte imbalance, and long-term use may also lead to irreversible intestinal nerve damage. Long-term use of anthraquinone laxatives can cause melanosis of the colon. Animal experiments have also found that phenolphthalein may be carcinogenic.

Applicable population: terminally ill patients or patients who have not responded to dietary changes or osmotic or bulk laxatives.

Bisacodyl

Dosage and Administration:

5-10 mg, once a day, orally. Do not take with milk or antacids.

Tips:

Short-term, intermittent use of stimulant laxatives is recommended.

Lubricant laxatives

The representative drug is paraffin oil, which used to be the main treatment for chronic constipation and fecal incontinence. It has now been mainly replaced by osmotic laxatives.

Paraffin oil

Lubricates and stimulates the intestinal lining, softens stool, and makes it easier to pass. Do not take it for a long time, otherwise it will easily cause malabsorption of fat-soluble vitamins and affect the absorption of calcium and phosphorus.

Prokinetic drugs

It acts on intestinal nerve endings, releases motility neurotransmitters, antagonizes inhibitory neurotransmitters or directly acts on smooth muscles to increase intestinal motility, and has a good effect on slow-transmission constipation.

Prucalopride

For the treatment of chronic idiopathic constipation in adult women who are refractory to laxatives and opioid-induced constipation in patients with chronic pain (non-cancer).

Dosage and Administration:

Can be taken at any time of the day, 2 mg, once daily, orally.

Tips:

It is contraindicated in patients with severe renal insufficiency and severe gastrointestinal inflammatory diseases. Not recommended for use by persons under 18 years of age.

Secretagogues

Including lubiprostone and linaclotide, which can stimulate intestinal fluid secretion and promote defecation. It is not yet available in our country.

Suppository laxative

It stimulates gastrointestinal reflexes, stimulates rectal peristalsis to promote defecation, and acts as a lubricant. It is suitable for temporary use by patients with difficulty in defecation and little urge to defecate, and patients with dry stool and fecal impaction.

Enema

Dosage and Administration:

Remove the cap of the container, apply a little grease, slowly insert it into the anus, and then squeeze the medicine into the rectum.

Adults take 1 stick at a time; children take 0.5 stick at a time.

Probiotics

It regulates intestinal microecology and inhibits the reproduction of pathogenic bacteria. It is suitable for both young and old. It should not be used in combination with antacids, antibacterial drugs and drugs with adsorption effect, such as bismuth agents, montmorillonite powder, etc.

Factors that may cause constipation

1. Eating less or the food lacks fiber or water, which reduces the stimulation to colon movement.

2. Normal bowel habits are disturbed by work stress, fast pace of life, changes in work nature and time, and mental factors.

3. Caused by colon motility disorder, which is common in irritable bowel syndrome, it is caused by spasm of the colon and sigmoid colon. In addition to constipation, there are also abdominal pain or bloating. Some patients may experience alternating constipation and diarrhea.

4. Insufficient tension in the abdominal and pelvic muscles leads to insufficient force for defecation, making it difficult to expel feces from the body.

5. Abuse of laxatives leads to drug dependence and constipation.

6. Difficulty in defecation due to physical weakness, lack of activity, intestinal spasms, or due to an elongated colon.