Constipation is used to describe a variety of symptoms, including hard stools, incomplete evacuation, excessive straining, infrequent bowel movements, bloating and abdominal pain. Constipation is a prevalent condition that severely impacts the quality of life. There are different ways for constipation management.
Constipation can be acute (typically < 1-week duration) or chronic, which typically lasts >4 weeks.
Chronic constipation is one of the most prevalent gastrointestinal condition which affects the quality of life.
Constipation in IBS, Opioid Abuse, and Childhood
- IBS with predominant constipation – Irritable bowel syndrome (IBS) with predominant constipation is a functional bowel disorder characterized by the combination of recurrent abdominal pain, pain associated with defecation, change in frequency of stool, change in the stool consistency.
- Opioid-induced Constipation – Opioid-induced constipation is characterized by new or worsening symptoms of constipation when initiating, changing or increasing opioid therapy. Symptoms include straining while passing the stools, incomplete evacuation, anorectal blockage, irregular bowel movement.
- Normal- transit constipation in children – In a toddler, diagnosis of normal- transit constipation include the presence of following symptoms – 2 or less than 2 defecations per week, history of excessive stool retention, painful or hard bowel movements
Constipation Management –
Constipation can be managed with certain changes into your lifestyle, diet along with medication if needed.
Lifestyle Modification – Dietary and lifestyle modifications are often used as first-line management strategies for patients with chronic constipation.
Fluid Intake – Although increased fluid intake is often recommended to improve symptoms in patients with constipation. But no high-quality evidence suggesting that constipation can be treated successfully by increasing fluid intake.
High Fiber Diet – Most available guidelines recommend a diet rich in fiber for patients with constipation. The recommended intake of fiber is at least 25-30gm per day.
Studies suggest taking fiber especially soluble fibers, for example, pectin, mucilages and storage polysaccharides. It is present in oat bran, barley, nuts, seeds, beans, lentils, peas, some fruits and vegetables, and psyllium fibers supplements.
Soluble fibers have high water- holding capacity and thus create pressure on the stool and provide relief from constipation.
Failure to respond to dietary fibers supplement may suggest an additional factor contributing to constipation, such as slow colonic transit.
Physical Activity – Increasing physical activity in young patients with severe constipation is rarely helpful. However, some studies suggest a positive effect on overall gastrointestinal systems and well being in patients with IBS, irrespective of the predominant bowel habit. Increased physical activity as part of an overall rehabilitation program in elderly patients with pronounced physical inactivity might be beneficial for constipation.
FODMAP – Some patients with IBS-C may respond favorably to a diet restricting the intake of poorly absorbed fermentable carbohydrates( Fermentable. oligosaccharides, disaccharides, monosaccharides, and polyol: FODMAP), although the evidence was graded as poor and further trials were deemed necessary
Read Also – Low FODMAP Diet to Improve IBS Symptoms
The classes of approved pharmacotherapies for constipation are an osmotic laxative, stimulant laxative, prosecretory agents and serotonergic 5-HT4 receptor agonist.
1.Osmotic Laxative – Patients who do not respond to diet or lifestyle modifications, an osmotic laxative is the next recommended treatment.
Osmotic laxative creates an intraluminal osmotic gradient resulting in water and electrolytes secretion into the intestinal lumen, thereby reducing stool consistency and increasing fecal volume.
PEG (Polyethylene Glycol), Lactulose, etc . are osmotic laxative.
2. Stimulant Laxative – Stimulant laxative is frequently recommended in patients who do not respond to osmotic laxative. Stimulant laxative induces water and electrolytes secretion, stimulate intestinal motility, and prostaglandin release and accelerate the colonic transition.
Bisacodyl and Sodium picosulfate.
Bisacodyl seems to be superior to the other drugs assessed in this study, including sodium picosulfate, prucalopride, lubiprostone, and linaclotide.
3. Prosecretory agents – Currently available prosecretory agents are lubiprostone, linaclotide, and plecanatide to treat constipation by increasing the fluid secretion into the intestinal lumen through direct action on intestinal epithelial cells.
Lubiprostone increase cl negative ion secretion into the lumen of small intestine and colon, followed by Na positive ion and water to maintain electrical neutrality.
In a randomized controlled trial, 4- weeks treatment with lubiprostone increased stool consistency, and frequency reduced straining and bloating and thus improve overall constipation symptoms.
4. Serotonergic Agonist- Prucalopride is highly selective 5-HT4 receptor agonist that activates signaling of the afferent neurons and increase intestinal motility. It is not currently available in the United States, prucalopride has been available in Europe since 2010 for the treatment of chronic constipation.
Prucalopride improves stool consistency, frequency, and straining while defecation.
Prucalopride is generally well tolerated with no substantial cardiovascular effects or drug interaction. The most common adverse effects are diarrhea, abdominal pain, and headache.
Complication Due To Constipation
If constipation persists for a longer period of time. It may cause one or some kind of health problems. Constipation management is very important if you want to improve your quality of life.
- Anal Fissure
- Fecal Impaction
- Rectal Prolapsed
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