Bulk-Forming Laxatives Dietary fiber and bulk laxatives with adequate fluid intake are the most physiologic and safest of medical therapies. However, they may be counterproductive in patients with idiopathic slow transit constipation or with constipation associated with irritable bowel syndrome because they often worsen bloating and abdominal distension in these populations. Dietary Fiber Dietary fiber in cereals contain cell walls that resist digestion and retain water within their cellular structures, whereas those found in citrus fruits and legumes stimulate the growth of colonic flora and increase fecal mass. Wheat bran is the most effective fiber laxative with a clear dose response on fecal output. Patients with poor dietary habits may add 2 to 4 tablespoons of bran to each meal, followed by a glass of water or another beverage. A laxative effect may not be observed for 3 to 5 days. Patients should be cautioned that large amounts of bran can cause abdominal bloating or flatulence; therefore, they should start with small amounts and titrate slowly to the desired effect. Psyllium (Metamucil), Read more [...]

IBS — Irritable Bowel Syndrome Diagnosis and Definition Irritable bowel syndrome (IBS) is a common chronic intestinal disorder characterized by abdominal discomfort and altered bowel habits. These symptoms occur in the absence of "structural or biochemical abnormalities." It is estimated that up to 20% of the population of the United States has symptoms suggestive of IBS. Multiple comorbidities, the high cost of medical utilization, and diminished productivity and quality of life all may be found in association with irritable bowel syndrome. Despite extensive research, there is no specific test that can diagnose this condition. In clinical practice, a diagnosis of IBS is accomplished after performing a careful medical history, including a system assessment using established diagnostic criteria, a complete physical examination, and limited laboratory testing. A flexible sigmoidoscopy or colonoscopy is often suggested; the choice of these evaluations depends on the age and risk factors of the individual patient. The clinician must carefully assess the patient for any signs and symptoms of organic Read more [...]

(British Approved Name Modified, US Adopted Name, rINNM) Drug Nomenclature Synonyms: HTF-919; SDZ-HTF-919; Tegaserod, maleato de BAN: Tegaserod Maleate [BANM] USAN: Tegaserod Maleate INN: Tegaserod Maleate [rINNM (en)] INN: Maleato de tegaserod [rINNM (es)] INN: Tégasérod, Maléate de [rINNM (fr)] INN: Tegaserodi Maleas [rINNM (la)] INN: Тегасерода Малеат [rINNM (ru)] Chemical name: 1-{[(5-Methoxyindol-3-yl)methylene]amino}-3-pentylguanidine maleate Molecular formula: C16H23N5O,C4H4O4 =417.5 CAS: 145158-71-0 (tegaserod); 189188-57-6 (tegaserod maleate) ATC code: A03AE02 Stability and compatibility. Crushed tablets of tegaserod were found to be stable in water, and apple juice the latter may mask the taste of the drug. Orangejuice, milk, or yogurt were not recommended as vehicles because of incomplete dissolution or uncertainty about stability. Adverse Effects The most common adverse effects of tegaserod are gastrointestinal disturbances including abdominal pain, diarrhoea, nausea, vomiting, and flatulence. Diarrhoea generally occurs within the first week of treatment Read more [...]

Constipation is commonly defined as the paucity of bowel movements. However, patients may have constipation regardless of the number of bowel movements in a unit of time. The inability to satisfactorily evacuate one's colon and rectum can be manifested by different degrees of abdominal discomfort associated with "normal" bowel habits, infrequent stools, or even overflow diarrhea. In addition, many other abdominal complaints are related to constipation, including pain syndromes, bloating, fullness, and even heartburn and dyspepsia. It is not unusual for patients referred for constipation to present to the specialist having had at least one (and possibly multiple) full anatomic evaluation(s) of the bowel, including computed tomography (CT) scans, contrast studies, and colonoscopies. The reported results of these studies are usually normal, except for varying degrees of diverticulosis coli. Usually, a careful history suffices to reveal the underlying problem. Issues to be addressed in the history include bowel habits, frequency of bowel movements, ease or difficulty with evacuation, chronicity, Read more [...]