Bulk-forming laxatives constipation

For some bedridden or geriatric patients, or others with chronic constipation, bulk-forming laxatives remain the first line of treatment, but the use of more potent laxatives may be required relatively frequently. Agents that may be used in these situations include milk of magnesia and lactulose. 

Constipation bulk-forming laxatives by increasing faecal mass tend to soften stools and relieve constipation, and have value in a range of symptomatic problems associated with anal fissure, haemorrhoids, and with ileostomy and colostomy dysfunction. Faecal softeners, lactulose and macrogols (polyethylene glycol) retain fluid in the bowel. Stimulant laxatives, such as the anthraquinone, senna, and bisacodyl, increase motility and can cause colic verdoses can cause diarrhea and electrolyte depletion. Chronic treatment for constipation is seldom needed, but may be in children with a tendency to faecal impaction, specialist advice should be sought. 

Bisacodyl is a stimulant laxative that does not take long to act and is therefore useful in acute constipation. The bulk-forming laxative ispaghula husk takes longer to act when compared with bisacodyl but is useful for long-term administration. Lactulose, which is an osmotic laxative, has a lag time of about 48 hours before onset of action. Loperamide and kaolin and morphine mixture are antidiarrhoeals used in acute diarrhoea. 

Since clear advantages accrue from a high-bran diet (a reduction in both constipation and diverticulitis) and since there is no associated toxicity, a bulk-forming laxative is the laxative of choice for constipated patients. 

C Calcium and iron supplementation are common causes of constipation. Polycarbophil, a bulk-forming laxative, exerts its therapeutic effect by increasing the mass and water content of stool and by speeding transit time in the colon. Cascara sagrada and sennosides are cathartics, which speed colonic transit time and alter water and electrolyte transport across the colonic mucosa. Sodium biphosphonate is a saline cathartic, which increases intestinal peristalsis by osmotic properties. Docusate sodium is a stool... 

Ispaghula husk, a bulk-forming laxative, is licensed for the treatment of IBS as well as for constipation and diarrhoea. It may aggravate bloating. 

The foundation of treatment of constipation is dietary fiber or bulk-forming laxatives that provide 10 to 15 g/day of raw fiber. 

For some bedridden or geriatric patients, or others with chronic constipation, bnlk-forming laxatives remain the first line of treatment, but the use of more potent laxatives may be required relatively frequently. Fiber shonld be avoided in bedridden patients who are cognitively impaired. When other than bulk-forming laxatives are used, they should be administered in the lowest effective dose and as infreqnently as possible to maintain regular bowel function (more than three stools per week). Agents that may be used in these situations inclnde diphenylmethane and anthraquinone derivatives, milk of magnesia, and sorbitol or lacmlose. Mineral oil should be avoided. 

The German Commission E does not recommend that aloe be used for more than 1-2 wk when used as a laxative in self-treatment of constipation (Blumenthal, 1998). It should be used only after failure of dietary modification or a bulk-forming laxative. 

Bulk-forming laxatives increase fiber, which will help decrease constipation, but they do not cause laxative abuse. 

Bulk-forming laxatives that contain mucilage have additional minor benefits complementing their primary effect of relieving constipation. Mucilaginous herbs are demulcent, meaning that they are soothing to inflamed mucosal surfaces (Brunton et al. 2006). Demulcents form... 

When prescribing strong opioids as analgesics for severe pain, it is even recommended to combine the treatment with prophylactic use of laxatives to avoid constipation. The effect of opioids on the bowel is to cause almost no movement at all in the bowels and therefore it is unavoidable to use stimulating laxatives sometimes combined with bulk forming preparations. 

A 45-year-old woman comes into the clinic reporting constipation for the past 2 weeks. She recently started calcium carbonate supplementation per her doctor s advice for the prevention of osteoporosis. She would like to start one of the "natural" laxatives. Which of the following is a bulk-forming agent ... 

MethylceUulose, an absorbent and bulk-forming substance with laxative properties (one tablespoon powder in 240 mL water daily), is indicated in the treatment of chronic constipation. 

Psyllium seed has laxative properties due to the swelling of its husk in water to form a gelatinous mass, thus keeping the feces hydrated and soft. The resulting bulk promotes peristalsis aud laxation and is thus useful in the treatment of chronic constipation (Goodman and gu.-majj 10,11 psyjjjyjjj jjas recently been reported to reduce postoperative pain and tenesmus. 

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