Reducing stool

Antimotility agents should be expected to reduce stool frequency and control diarrhea. 

Laxatives are used to increase stool frequency and reduce stool viscosity. Even with long-term use, bulk laxatives and pure osmolar laxatives do not predispose patients to formation of a cathartic-type colon and should be the initial agents used for chronic constipation after a structural obstructing lesion has been excluded. Laxatives are also used before radiological, endoscopic, and abdominal surgical procedures such preparations quickly empty the colon of fecal material. Nonabsorbable hyperosmolar solutions or saline laxatives are used for this purpose. Classification and comparison of representative laxatives are provided in Table 40.1. 

For chronic abdominal pain, low doses of tricyclic antidepressants (eg, amitriptyline or desipramine, 10-50 mg/d) appear to be helpful (see Chapter 30). At these doses, these agents have no effect on mood but may alter central processing of visceral afferent information. The anticholinergic properties of these agents also may have effects on gastrointestinal motility and secretion, reducing stool frequency and liquidity. Finally, tricyclic antidepressants may alter receptors for enteric neurotransmitters such as serotonin, affecting visceral afferent sensation. 

Cholera Doxycycline (300 mg as a single dose) is effective in reducing stool volume and eradicating Vibrio cholerae from the stool within 48 hours. Antimicrobial agents are not substitutes for fluid and electrolyte replacement in this disease, and some strains of V. cholerae are resistant to tetracyclines. 

Mihatsch WA, Hoegel J, Pohlandt F. Prebioitc oligosaccharides reduce stool viscosity and accelerate gastrointestinal transport in preterm infants. Acta Paediatr 2006 95 843-848. 

Formulas tend to contain isolates as the protein source to eliminate or reduce the presence of carbohydrates that ate the cause of flatulence and abnormal stools. Care is taken to provide adequate nutrition and to use proteins processed in such a way as to minimize or eliminate any antinutritional factors. The formulation of a typical soy-based infant formula is also given in Table 17. 

Abd Soft, non-distended, mild diffuse tenderness, (+) bowel sounds, (-) hepatosplenomegaly, (-) masses, heme (+) stool MS Point tenderness over sacral area, (-) erythema, reduced lower back ROM... 

Also known as surfactants and stool softeners, emollients (e.g., salts of docusate) act by increasing the surface wetting action on the stool leading to a softening effect. They reduce friction and make the stool easier to pass. These agents are not recommended for treating constipation of long duration. 

Increased motility results in decreased contact between ingested food and drink and the intestinal mucosa, leading to reduced reabsorption and increased fluid in the stool. Diarrhea resulting from altered motility is often established after other mechanisms have been excluded. IBS-related diarrhea is due to altered motility. 

Attapulgite adsorbs excess fluid in the stool with few adverse effects. Calcium polycarbophil is a hydrophilic polyacrylic resin that also works as an adsorbent, binding about 60 times its weight in water and leading to the formation of a gel that enhances stool formation. Neither attapulgite nor polycarbophil is systemically absorbed. Both products are effective in reducing fluid in the stool but can also adsorb nutrients and other medications. Their administration should be separated from other oral medications by 2 to 3 hours. Psyllium and methylcellulose products may also be used to reduce fluid in the stool and relieve chronic diarrhea. 

Loperamide stimulates enteric nervous system receptors, inhibiting peristalsis and fluid secretion. It improves stool consistency and reduces the number of stools.21 Consequently, it is most useful in patients who have diarrhea as a prominent symptom. However, it can occasionally aggravate abdominal pain. 

The cornerstone of cholera treatment is fluid replacement. Without treatment, the case-fatality rate for severe cholera is approximately 50%. For cholera, rice-based ORT is better than glucose-based ORT because it reduces the number of stools.21 Patients with significant disease should receive a short antibiotic course, 1 to 3 days, to shorten the duration of illness and decrease the number of stools. Doxycycline 300 mg once daily is the drug of choice. Other antibiotics shown to be effective include erythromycin, azithromycin, trimethoprim-sulfamethoxazole, and ciprofloxacin.2 Antibiotic resistance has been documented in V cholerae since 1977.2 Antibiotic prophylaxis is not warranted. 

Blanke RV, Fariss MW, Guzelian PS, et al. 1978. Identification of a reduced form of chlordecone (Kepone) in human stool. Bull Environ Contam Toxicol 20 782-785. 

The healthy small intestine contains only a small bacterial population, unlike the colon. However, an acute infection of the mucosa by a virus, bacterium or other parasite can reduce its motility, allowing a huge proliferation of the resident bacteria. Absorption of both macro- and micronutrients is impaired, resulting in the disorder known as sprue. Folic acid is particularly poorly absorbed, causing reduced rates of repair of mucosal cells. Hence, the damage persists and worsens to create a vicious circle. Treatment involves administration of an antibiotic to kill the bacteria and folic acid to allow damaged tissue to recover. The clinical presentation includes bulky stools, steatorrhoea (fatty faeces) and weight loss. 

The mechanistic basis of the anti-neoplastic activity of UDCA and the explanation for the significant difference in bioactivity of UDCA compared with DCA despite marked similarity in chemical structure remain unresolved. UDCA administration in healthy volunteers and colorectal adenoma patients has been demonstrated to decrease the proportion of DCA in aqueous phase stool. Therefore, one possible mechanism of the chemopreventative activity of UDCA is reduction of mucosal secondary bile acid exposure. Consistent with this idea, UDCA administration has been demonstrated to reduce the incidence of K-ras mutations and decrease Cox-2 expression in AOM-induced tumors, which is the opposite of the reported effects of DCA in the same model. However, it is clear that exogenous administration of UDCA has direct anti-neoplastic activity on human CRC cells in vitro, either alone or in combination with DCA, including anti-proliferative and anti-apoptotic effects, as well as induction of cell senescence. " ... 

Adults - 30 to 45 mL 3 or 4 times daily. Adjust dosage every day or two to produce 2 or 3 soft stools daily. Hourly doses of 30 to 45 mL may be used to induce rapid laxation in the initial phase of therapy. When the laxative effect has been achieved, reduce dosage to recommended daily dose. Improvement may occur within 24 hours, but may not begin before 48 hours or later. Continuous long-term therapy is indicated to lessen severity and prevent recurrence of portal-systemic encephalopathy. 

Elevated concentrations of TNF have been found in the joints of RA patients and the stools of Crohn disease patients and correlate with elevated disease activity. In Crohn disease, infliximab reduces infiltration of inflammatory cells and TNF production in inflamed areas of the intestine and reduces the proportion of mononuclear cells from the lamina propria able to express TNF and interferon. In RA, treatment with infliximab reduced infiltration of inflammatory cells into inflamed areas of the joint as well as expression of molecules mediating cellular adhesion and vascular cell adhesion molecule-1, chemoattraction, and tissue degradation. After treatment with infliximab, patients with Crohn disease or RA have decreased levels of serum IL-6 and C-reactive protein compared with baseline. 

With initiation of therapy with an SSRI, some patients describe anxiety or agitation. This can usually be overcome by reducing the dose and titrating upward more slowly. Insomnia can be a persistent activating side effect that can limit therapy or require the addition of a sedating agent at bedtime. Nausea and loose stools... 

A combination of neomycin and nonabsorbable erythromycin base given orally prior to colorectal surgery can markedly reduce the incidence of postoperative wound infection. Orally administered neomycin is sometimes used to suppress the facultative flora of the gut in patients with hepatic encephalopathy. It is unclear how this improves coma, but one theory is that it reduces systemic absorption of the bacterial metabo-htes that allegedly cause hepatic encephalopathy. Although more than 95% of an oral dose of neomycin is excreted unchanged in the stool of normal subjects, the bioavaUabUity of neomycin may be much higher in patients with an abnormal gastrointestinal mucosa. 

Mechanism of Action An antacid that reduces gastric acid by binding with phosphate in the intestine, and then is excreted as aluminum carbonate in feces. Aluminum carbonate may increase the absorption of calcium due to decreased serum phosphate levels. The drug also has astringent and adsorbent properties. Therapeutic Effect Neutralizes or increases gastric pH reduces phosphates in urine, preventing formation of phosphate urinary stones reduces serum phosphate levels decreases fluidity of stools. 

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