Laxatives irritable bowel syndrome

Diarrhea is a common problem that is usually self-limiting and of short duration. Increased accumulations of small intestinal and colonic contents are known to be responsible for producing diarrhea. The former may be caused by increased intestinal secretion which may be enterotoxin-induced, eg, cholera and E. col] or hormone and dmg-induced, eg, caffeine, prostaglandins, and laxatives decreased intestinal absorption because of decreased mucosal surface area, mucosal disease, eg, tropical spme, or osmotic deficiency, eg, disaccharidase or lactase deficiency and rapid transit of contents. An increased accumulation of colonic content may be linked to increased colonic secretion owing to hydroxy fatty acid or bile acids, and exudation, eg, inflammatory bowel disease or amebiasis decreased colonic absorption caused by decreased surface area, mucosal disease, and osmotic factors and rapid transit, eg, irritable bowel syndrome. 

A laxative is most often prescribed for the short-term relief or prevention of constipation. Certain stimulant, emollient, and saline laxatives are used to evacuate the colon for rectal and bowel examinations. Fecal softeners or mineral oil are used prophylactically in patients who should not strain during defecation, such as after anorectal surgery or a myocardial infarction. Psyllium may be used in patients with irritable bowel syndrome and diverticular disease. Fblycarbophil may be prescribed for constipation or diarrhea associated with irritable bowel syndrome and diverticulosis. Mineral oil is... 

Noninfectious causes of acute diarrhea include drugs and toxins (Table 18-3), laxative abuse, food intolerance, irritable bowel syndrome (IBS), inflammatory bowel disease, ischemic bowel disease, lactase deficiency, Whipple s disease, pernicious anemia, diabetes mellitus, malabsorption, fecal impaction, diverticulosis, and celiac sprue. 

Laxative effect. Seed hull, taken orally by adults at a dose of 7 g/person, increased weekly fecal mass without influencing transit time or frequency . Seedcoat, administered orally to 80 patients at a dose of 6.4 g/person three times daily, was active in a blinded placebo controlled study of efficacy of extract in treatment of irritable bowel syndrome " . Water extract of the dried kernel, administered orally to 40-year-old adults of both sexes, was active . Seed powder, administered orally to adults of both sexes, was active. Biological activity reported has been patented ". Dried seeds, administered orally to adults at a dose of 0.5 g/person, were active. Placing the seeds in water increased their volume, 90% alcohol produced a decrease in volume to normal seed size, and linseed oil had no effect on volume. The seed mucilage remained in gel form and is considered preferable to the solid form because it is more easily digested " . Dried seed powder, administered orally to 35 patients with chronic constipation at a dose of 50 mg/person, was active in a controlled, double-blind study " . Fiber, administered orally to adults, was active. Psyllium fiber and sennosides were prepared into a wafer to be... 

Administration of osmotic laxatives such as lactulose to healthy subjects increases defecation frequency, producing a reversible syndrome that mimics irritable bowel syndrome. Administration of 20 ml lactulose three times per day creates a more fluid environment as indicated by increased stool water content. To examine the effect of such an environment on drug delivery we administered pulse release units (Pulsincap) containing quinine dihydrochloride (50 mg) following treatment with lactulose for 3 days. ... 

Psyllium (Plantago) The psyllium seed is a laxative and treats hemorrhoids, colitis, Crohn s disease, and irritable bowel syndrome. 

This type of laxative does not cause dependency. It can be used with diverticulosis, irritable bowel syndrome, and ileostomy and colostomy. Commonly used bulk-forming laxatives are ... 

FIGURE 36-2. Recommendations for treating chronic diarrhea. Follow these steps (1) Perform a careful history and physical examination. (2) The possible causes of chronic diarrhea are many. These can be classified into intestinal infections (bacterial or protozoal), inflammatory disease (Crohn s disease or ulcerative colitis), malabsorption (lactose intolerance), secretory hormonal tumor (intestinal carcinoid tumor or VIPoma), drug (antacid), factitious (laxative abuse), or motility disturbance (diabetes mellitus, irritable bowel syndrome, or hyperthyroidism). (3) If the diagnosis is uncertain, selected appropriate diagnostic studies should be ordered. (4) Once diagnosed, treatment is planned for the underlying cause with symptomatic antidiarrheal therapy. (5) If no specific cause can be identified, symptomatic therapy is prescribed. 

Chronic diarrhea may be due to laxative abuse, lactose intolerance, inflammatory bowel disease, malabsorption syndromes, endocrine disorders, irritable bowel syndrome and other disorders. Treatment with nonspecific antidiarrheal agents such as those listed in Table 6.2 may mask an underlying disorder. Treatment of chronic diarrhea should be aimed at correcting the cause of diarrhea rather than alleviating the symptoms. 

Powdered bulk-forming laxatives come in flavored and sugar-free preparations and should be mixed in a glass of water or juice, stirred. The patient should drink it immediately, followed by a half to a full glass of water. Insufficient fluid intake can cause the drug to solidify in the GI tract, resulting in intestinal obstruction. Bulk-forming laxatives do not cause dependence and may be used by patients with diverticulosis, irritable bowel syndrome, ileostomy and colostomy. 

Irritable bowel syndrome (IBS) is a clinical condition that has not been related to a specific-cause. The primary symptoms are constipation and abdominal discomfort and pain. Occasionally, it alternates with true diarrhea. Treatment with laxatives can lead to bloating, gas, and rebound constipation. Water and bulk are important for more normal stool movement. Sympathetic output from the thoracic region reduces peristalsis and increases sphincter tone. 

---