Q. I occasionally have a problem with constipation, and fortunately it usually clears up by itself. But if I ever should need to take something for it, what should I take? I've noticed all kinds of laxatives, stool softeners and other treatments for constipation at the drug store, but I'm not sure what works best. Also, should I ever be concerned about what's causing the constipation? A.Many people have constipation from time to time, and it's usually not a sign of anything wrong. Every now and then, however, it can be a clue to an underlying problem with your intestines, even something as serious as cancer. So if your constipation is severe or persistent, check with your doctor to make sure nothing serious is going on. Oddly enough, there's no universally accepted definition of constipation. For some people, it means moving your bowels less often than usual; for some it means having painful or difficult bowel movements. And for others, it's both. Even excluding serious problems, there can be many reasons why you're constipated. These include being inactive, not drinking enough fluids Read more [...]

Constipation is defined as the difficulty of passing stools, incomplete passage, or infrequent passage of hard stools. It can be further defined as having less than three stools per week for women and five for men despite a high residual diet, or a period greater than 3 d without a bowel movement. It can be caused by gastrointestinal disorders, metabolic and endocrine disorders, pregnancy, neurogenic and psychogenic problems, or it could be drug induced. Laxative Mechanisms of Action Laxatives promote bowel evacuation by decreasing water and electrolyte absorption, increasing intraluminal osmolarity, or increasing hydrostatic pressure in the gut. Chronic use of laxatives, particularly stimulants, may lead to laxative dependency. Laxative dependency, in turn, may result in fluid and electrolyte imbalances, steatorrhea, osteomalacia, and vitamin and mineral deficiencies. Known as laxative abuse syndrome (LAS), it is difficult to diagnose. Laxative abuse syndrome is often seen in women with anorexia nervosa, depression, and personality disorders and also in elderly patients with quasimedical concerns Read more [...]

Lactulose is a synthetic disaccharide osmotic laxative used in the treatment of constipation and in hepatic encephalopathy. Preparations UK: Duphalac; Lactugal; Lemlax; Regulose US: Cephulac; Cholac; Chronulac; Constilac; Constulose; Duphalac; Enulose; Kristalose Drug Approvals (British Approved Name, US Adopted Name, rINN) Synonyms: Lactulosa; Lactulosum; Laktulóz; Laktuliozė; Laktuloosi; Laktulos; Laktulosa BAN: Lactulose USAN: Lactulose INN: Lactulose [rINN (en)] INN: Lactulosa [rINN (es)] INN: Lactulose [rINN (fr)] INN: Lactulosum [rINN (la)] INN: Лактулоза [rINN (ru)] Chemical name: 4-O-β-d-Galactopyranosyl-d-fructose Molecular formula: C12H22O11 =342.3 CAS: 4618-18-2 ATC code: A06AD11 Pharmacopoeias. In Europe and Japan. China only contains specifications for a solution. US only contains specifications for a solution and a concentrated liquid. European Pharmacopoeia, 6th ed. (Lactulose). A white or almost white, crystalline powder. Freely soluble in water sparingly soluble in methyl alcohol practically insoluble in toluene. European Pharmacopoeia, 6th Read more [...]

Four days after discharge from the hospital, a patient with a recent diagnosis of advanced lung cancer arrived in the emergency department of a Montreal hospital with abdominal pain, nausea and vomiting, and urinary retention. His large bowel was grossly distended with stool, and he required numerous enemas and manual disimpactions to dislodge the large quantities of hard feces. The patient presented a classic example of constipation resulting from narcotic analgesic administration, without any concomitant laxative program. An unnecessary hospital admission, a great deal of discomfort for the patient, and an unpleasant task for the nursing staff could all have been avoided. As a physician working in palliative care, I have been continually confronted with patients' problems of constipation. No other preventable symptom produces so much distress for the patient and the caring family. It is common for physicians either to omit completely any prescription for laxatives or to write a prescription for laxatives "as needed" or 'laxative of choice" and to leave further management to nurses. The implication Read more [...]

Table 3 presents a classification of commonly used oral laxatives. TABLE 3 Oral Laxatives Stimulant Laxatives 1. Anthraquinone Laxatives senna (eg. Senokot) cascara (eg. together with aloe in Nature's Remedy) danthron (eg. Modane) 2. Diphenylmethane Laxatives phenolphthalein (eg. Ex-lax, Feen-a-mint) bisacodyl (eg. Dulcolax) 3. Castor oil Saline Laxatives magnesium hydroxide (eg. Milk of Magnesia) magnesium citrate (eg. Citro-Mag) Emollient Laxatives dioctyl sodium sulfosuccinate (eg. Colace) dioctyl calcium sulfosuccinate (eg. Surfak) Bulk-forming Laxatives bran psyllium preparations (eg. Metamucil) methylcellulose, sodium carboxymethylcellulose Lactulose (eg. Chronulac) Stimulant laxatives are thought to act on the intramural nervous plexus or intestinal smooth muscle. There is some reason to be concerned that prolonged use of any of the stimulant laxatives may damage the myenteric plexus, thereby impairing bowel function. However, at this point there is no direct evidence to Read more [...]

Over-the-counter (OTC) sales of laxatives generate $400 million annually in the United States. Because approximately 30% of healthy elderly people use laxatives regularly, the elderly contribute substantially to this $400 million market. Indeed, laxatives are second only to analgesics as the OTC medications most widely used by the elderly. According to Harari et al. (Harvard Medical School Division on Aging), many of these people do not regard themselves as constipated, but simply in need of a regular purgative. Many of those people who do regard themselves as constipated do not have true constipation (defined as fewer than three bowel movements a week, straining at stool, or both). Risk Factors The major risk factors for constipation in the elderly are the same as in younger people: low-fiber diet and low fluid intake. Other risk factors include lack of exercise, drug therapy, depression, and dementia (possibly because the patient ignores the urge to defecate), diabetes (probably because of autonomic neuropathy), stroke, metabolic imbalances (hypokalemia, hypercalcemia), and chronic laxative Read more [...]