Constipation medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

In people without medical problems, the main intervention is to increase the intake of fluids (preferably water) and dietary fiber. The latter may be achieved by consuming more vegetables and fruit and whole meal bread, and by adding linseeds to one's diet. The routine non-medical use of laxatives is to be discouraged as this may result in bowel action becoming dependent upon their use. Enemas can be used to provide a form of mechanical stimulation.

In alternative and traditional medicine, colonic irrigation, enemas, exercise, diet and herbs are used to treat constipation.

Medical Therapy

Chronic Constipation

EXCLUDE: • Inadeqate fiber intake • Medication • Cancer • Stricture • Systemic or neurologic disease

No clinical response

Fiber supplement, Simple laxatives

Clinical response

Normal

• Anorectal manometry • Balloon expulsion test

Colonic transit time

Unclear diagnosis

Evacuation disorder

Normal

Delayed

• Barium enema • MR proctography

• Pelvic floor retraining • Psychology • Diet

• Fiber supplement • Osmotic laxatives • Secretagogues • Prokinetics

Clinically significant structural disorder

Clinical response

No clinical response

Rectal surgery

Colonic manometry

Normal

Colonic inertia

Consider colectomy plus ileorectostomy

Physical Intervention

Constipation that resists all other measures requires physical intervention. Manual disimpaction (the physical removal of impacted stool) is done by patients who have lost control of their bowels secondary to spinal injuries. Manual disimpaction is also used by physicians and nurses to relieve rectal impactions. Finally, manual disimpaction can occasionally be done under sedation or a general anesthetic—this avoids pain and loosens the anal sphincter.

Many of the products are widely available over-the-counter. Enemas and clysters are a remedy occasionally used for hospitalized patients in whom the constipation has proven to be severe, dangerous in other ways, or resistant to laxatives. Sorbitol, glycerin and arachis oil suppositories can be used. Severe cases may require phosphate solutions introduced as enemas

Pharmacotherapy

Laxatives

Main article: laxative

Laxatives may be necessary in people in whom dietary intervention is not effective or is inappropriate. Most laxatives can be safely used long-term, although some are associated with cramping and bloatedness and can cause the phenomenon of melanosis coli.

Contraindicated medications

Constipation medical therapy is considered an absolute contraindication to the use of the following medications:

• Alosetron

References

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