Constipation medical therapy: Difference between revisions
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****Alternative regimen (1): Surfak 240 mg PO daily | ****Alternative regimen (1): Surfak 240 mg PO daily | ||
***1.1.4 '''''Lubricants''''' | ***1.1.4 '''''Lubricants''''' | ||
****Preferred regimen (1): Fleet 19 g dissolved in 118-197 mL water | ****Preferred regimen (1): Fleet 19 g dissolved in 118-197 mL water enema per rectum daily | ||
****Preferred regimen (2): Zymenol | ****Preferred regimen (2): Zymenol 133 mL enema per rectum once | ||
***1.1.5 '''''Stimulants''''' | ***1.1.5 '''''Stimulants''''' | ||
****Preferred regimen (1): | ****Preferred regimen (1): Correctol 5-10 mg PO daily | ||
****Preferred regimen (2): Dulcolax | ****Preferred regimen (2): Dulcolax 5-15 mg PO daily | ||
****Preferred regimen (3): Milk of Magnesia 30-60 mL PO daily | ****Preferred regimen (3): Milk of Magnesia 30-60 mL PO daily | ||
****Alternative regimen (1): | ****Alternative regimen (1): Senokot 100 mg PO daily | ||
* | **'''1.2 Prescription medicines''' | ||
*'''1.2 Prescription medicines''' | ***1.2.1 '''''Chloride channel activators''''' | ||
**1.2.1 '''''Chloride channel activators''''' | ****Preferred regimen (1): Lubiprostone (Amitiza) 24 mcg PO q12h with food and water | ||
*** | ***1.2.2 '''''Guanylate cyclase-C agonists''''' | ||
**1.2.2 '''''Guanylate cyclase-C agonists''''' | ****Preferred regimen (1): Linaclotide (Linzess) 145 mcg PO daily | ||
* '''2 Pediatrics''' | * '''2 Pediatrics''' | ||
| Line 115: | Line 115: | ||
****Alternative regimen (1): Surfak 50 mg PO q12h | ****Alternative regimen (1): Surfak 50 mg PO q12h | ||
***1.1.4 '''''Lubricants''''' | ***1.1.4 '''''Lubricants''''' | ||
****Preferred regimen (1): Fleet | ****Preferred regimen (1): Fleet 9.5 g dissolved in 59 mL water enema per rectum daily | ||
****Preferred regimen (2): Zymenol | ****Preferred regimen (2): Zymenol 51.5 mL enema per rectum once | ||
***1.1.5 '''''Stimulants''''' | ***1.1.5 '''''Stimulants''''' | ||
****Preferred regimen (1): | ****Preferred regimen (1): Correctol 5 mg PO daily | ||
****Preferred regimen (2): Dulcolax | ****Preferred regimen (2): Dulcolax 5 mg PO daily | ||
****Preferred regimen (3): Milk of Magnesia 30 | ****Preferred regimen (3): Milk of Magnesia 15-30 mL PO daily | ||
****Alternative regimen (1): | ****Alternative regimen (1): Senokot 50 mg PO daily | ||
**** | **'''2.2 Prescription medicines''' | ||
***2.2.1 '''''Chloride channel activators''''' | |||
****Preferred regimen (1): Lubiprostone (Amitiza) not approve for pediatrics | |||
***2.2.2 '''''Guanylate cyclase-C agonists''''' | |||
****Preferred regimen (1): Linaclotide (Linzess) not approve for pediatrics | |||
| | === Probiotics === | ||
* Probiotics are live microorganisms that are eaten to improve the gasterointestinal tract function. Recently, using probiotics in food industry is growing.<ref name="pmid22114754">{{cite journal| author=Liu LW| title=Chronic constipation: current treatment options. | journal=Can J Gastroenterol | year= 2011 | volume= 25 Suppl B | issue= | pages= 22B-28B | pmid=22114754 | doi= | pmc=3206558 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22114754 }}</ref> | |||
* ''Bifidobacterium'' and Lactobacillus are most evaluated organisms as probiotics.<ref name="pmid20039451">{{cite journal |vauthors=Chmielewska A, Szajewska H |title=Systematic review of randomised controlled trials: probiotics for functional constipation |journal=World J. Gastroenterol. |volume=16 |issue=1 |pages=69–75 |year=2010 |pmid=20039451 |pmc=2799919 |doi= |url=}}</ref> | |||
* It is found that probiotics significantly improve the chronic constipation symptoms in patients.<ref name="pmid20697291">{{cite journal |vauthors=Del Piano M, Carmagnola S, Anderloni A, Andorno S, Ballarè M, Balzarini M, Montino F, Orsello M, Pagliarulo M, Sartori M, Tari R, Sforza F, Capurso L |title=The use of probiotics in healthy volunteers with evacuation disorders and hard stools: a double-blind, randomized, placebo-controlled study |journal=J. Clin. Gastroenterol. |volume=44 Suppl 1 |issue= |pages=S30–4 |year=2010 |pmid=20697291 |doi=10.1097/MCG.0b013e3181ee31c3 |url=}}</ref> | |||
==References== | == References == | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 17:13, 19 December 2017
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Constipation Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Constipation On the Web |
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American Roentgen Ray Society Images of Constipation |
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
- General principles of medical therapy in patients with chronic constipation are as following:[1]
| 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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Chronic constipation management
- Chronic constipation treatment includes both behavioral and pharmacological interventions.
- Behavioral management mostly consists of life style and dietary modification, while pharmacological interventions are mostly based on laxatives.
Lifestyle modification
- Increasing physical activity is postulated to improve constipation and colonic transit time in patients with constipation.[2]
- Moderate physical exercise as much as 32 min per day showed significant improvement of quality of life but no significant decrease in laxative need for treatment.[3]
- Moderate to vigorous training (20-60 min, 3-5 times per week) revealed significant improvement in constipation symptoms in patients with irritable bowel syndrome (IBS).[4]
Dietary interventions
- Fiber supplementation is the main primary therapeutic intervention for every patients with constipation.
- The polysaccharide fibers are the agents that increase the weight of stool and and improve the stool consistency through absorbing and retaining water.[5]
- The most common used bulking organic polysaccharide in Canada is Psyllium. Psyllium is found to significantly decrease colonic transit and improve stool consistency, as well as lactulose.[6][7]
Biofeedback treatment
- The most important behavioral treatment for constipation is biofeedback, consisting of teaching the patients how to use their abdominal and pelvic muscles during defecation.
- During the biofeedback patients receive feedback upon their abdominal and pelvic floor muscle contractions recording by means of surface electromyogrphy (EMG).
- Based on the biofeedback, patients are been taught how to increase intra-abdominal pressure and also relax their pelvic floor muscles to have a coordinated evacuation.[1]
- Regarding the outcomes, the biofeedback behavioral therapy is the choice treatment for functional defecation disorder.[8]
Pharmacological intervention
Constipation
- 1 Adult
- 1.1 Over the counter medicines
- 1.1.1 Bulk forming agents
- Preferred regimen (1): Citrucel 500 mg PO q8-12h
- Preferred regimen (2): FiberCon 625 mg PO q6-12h
- Preferred regimen (3): Konsyl 5 g (1 tablespoon) dissolved in 250 mL water PO q8-24h
- Alternative regimen (1): Metamucil 1000 mg PO q8-12h
- 1.1.2 Osmotic agents
- Preferred regimen (1): Cephulac 5 g (1 tablespoon) dissolved in 250 mL water PO q6-8h
- Preferred regimen (2): Fleet Phospho-Soda 15 mL dissolved in 250 mL water PO q6-8h
- Preferred regimen (3): Milk of Magnesia 30-60 mL PO daily
- Alternative regimen (1): Miralax 34 g dissolved in 250 mL water PO daily
- Alternative regimen (1): Sorbitol 30-150 mL (70% solution) once
- 1.1.3 Stool softeners
- Preferred regimen (1): Colace 100-300 mg PO daily
- Preferred regimen (2): Docusate
- Docusate sodium: 50-300 mg PO daily
- Docusate calcium: 240 mg PO daily
- Alternative regimen (1): Surfak 240 mg PO daily
- 1.1.4 Lubricants
- Preferred regimen (1): Fleet 19 g dissolved in 118-197 mL water enema per rectum daily
- Preferred regimen (2): Zymenol 133 mL enema per rectum once
- 1.1.5 Stimulants
- Preferred regimen (1): Correctol 5-10 mg PO daily
- Preferred regimen (2): Dulcolax 5-15 mg PO daily
- Preferred regimen (3): Milk of Magnesia 30-60 mL PO daily
- Alternative regimen (1): Senokot 100 mg PO daily
- 1.1.1 Bulk forming agents
- 1.2 Prescription medicines
- 1.2.1 Chloride channel activators
- Preferred regimen (1): Lubiprostone (Amitiza) 24 mcg PO q12h with food and water
- 1.2.2 Guanylate cyclase-C agonists
- Preferred regimen (1): Linaclotide (Linzess) 145 mcg PO daily
- 1.2.1 Chloride channel activators
- 1.1 Over the counter medicines
- 2 Pediatrics
- 2.1 Over the counter medicines
- 2.1.1 Bulk forming agents
- Preferred regimen (1): Citrucel 500 mg PO daily
- Preferred regimen (2): FiberCon 625 mg PO daily
- Preferred regimen (3): Konsyl 2.5 g (1/2 tablespoon) dissolved in 250 mL water PO q8-24h
- Alternative regimen (1): Metamucil 500 mg PO q8-12h
- 1.1.2 Osmotic agents
- Preferred regimen (1): Cephulac 2.5 g (1/2 tablespoon) dissolved in 250 mL water PO q6-8h
- Preferred regimen (2): Fleet Phospho-Soda 5-10 mL dissolved in 250 mL water PO q6-8h (not for < 5 years of age)
- Preferred regimen (3): Milk of Magnesia 5-15 mL PO daily
- Alternative regimen (1): Miralax 17 g dissolved in 250 mL water PO daily
- Alternative regimen (1): Sorbitol 2 mL/kg (as 70% solution) once
- 1.1.3 Stool softeners
- Preferred regimen (1): Colace 100 mg PO daily
- Preferred regimen (2): Docusate
- Docusate sodium
- < 2 years: Not recommended
- 2-12 years: 50-150 mg PO daily
- >12 years: 50-300 mg PO daily
- Docusate calcium
- < 12 years: Not recommended
- >12 years: 240 mg PO daily
- Docusate sodium
- Alternative regimen (1): Surfak 50 mg PO q12h
- 1.1.4 Lubricants
- Preferred regimen (1): Fleet 9.5 g dissolved in 59 mL water enema per rectum daily
- Preferred regimen (2): Zymenol 51.5 mL enema per rectum once
- 1.1.5 Stimulants
- Preferred regimen (1): Correctol 5 mg PO daily
- Preferred regimen (2): Dulcolax 5 mg PO daily
- Preferred regimen (3): Milk of Magnesia 15-30 mL PO daily
- Alternative regimen (1): Senokot 50 mg PO daily
- 2.1.1 Bulk forming agents
- 2.2 Prescription medicines
- 2.2.1 Chloride channel activators
- Preferred regimen (1): Lubiprostone (Amitiza) not approve for pediatrics
- 2.2.2 Guanylate cyclase-C agonists
- Preferred regimen (1): Linaclotide (Linzess) not approve for pediatrics
- 2.2.1 Chloride channel activators
- 2.1 Over the counter medicines
Probiotics
- Probiotics are live microorganisms that are eaten to improve the gasterointestinal tract function. Recently, using probiotics in food industry is growing.[9]
- Bifidobacterium and Lactobacillus are most evaluated organisms as probiotics.[10]
- It is found that probiotics significantly improve the chronic constipation symptoms in patients.[11]
References
- ↑ 1.0 1.1 Camilleri M, Bharucha AE (2010). "Behavioural and new pharmacological treatments for constipation: getting the balance right". Gut. 59 (9): 1288–96. doi:10.1136/gut.2009.199653. PMC 3189401. PMID 20801775.
- ↑ Meshkinpour H, Kemp C, Fairshter R (1989). "Effect of aerobic exercise on mouth-to-cecum transit time". Gastroenterology. 96 (3): 938–41. PMID 2604760.
- ↑ Chin A Paw MJ, van Poppel MN, van Mechelen W (2006). "Effects of resistance and functional-skills training on habitual activity and constipation among older adults living in long-term care facilities: a randomized controlled trial". BMC Geriatr. 6: 9. doi:10.1186/1471-2318-6-9. PMC 1562427. PMID 16875507. Vancouver style error: missing comma (help)
- ↑ Johannesson E, Simrén M, Strid H, Bajor A, Sadik R (2011). "Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial". Am. J. Gastroenterol. 106 (5): 915–22. doi:10.1038/ajg.2010.480. PMID 21206488.
- ↑ Emmanuel AV, Tack J, Quigley EM, Talley NJ (2009). "Pharmacological management of constipation". Neurogastroenterol. Motil. 21 Suppl 2: 41–54. doi:10.1111/j.1365-2982.2009.01403.x. PMID 19824937.
- ↑ Ashraf W, Park F, Lof J, Quigley EM (1995). "Effects of psyllium therapy on stool characteristics, colon transit and anorectal function in chronic idiopathic constipation". Aliment. Pharmacol. Ther. 9 (6): 639–47. PMID 8824651.
- ↑ Dettmar PW, Sykes J (1998). "A multi-centre, general practice comparison of ispaghula husk with lactulose and other laxatives in the treatment of simple constipation". Curr Med Res Opin. 14 (4): 227–33. doi:10.1185/03007999809113363. PMID 9891195.
- ↑ Chiarioni G, Salandini L, Whitehead WE (2005). "Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation". Gastroenterology. 129 (1): 86–97. PMID 16012938.
- ↑ Liu LW (2011). "Chronic constipation: current treatment options". Can J Gastroenterol. 25 Suppl B: 22B–28B. PMC 3206558. PMID 22114754.
- ↑ Chmielewska A, Szajewska H (2010). "Systematic review of randomised controlled trials: probiotics for functional constipation". World J. Gastroenterol. 16 (1): 69–75. PMC 2799919. PMID 20039451.
- ↑ Del Piano M, Carmagnola S, Anderloni A, Andorno S, Ballarè M, Balzarini M, Montino F, Orsello M, Pagliarulo M, Sartori M, Tari R, Sforza F, Capurso L (2010). "The use of probiotics in healthy volunteers with evacuation disorders and hard stools: a double-blind, randomized, placebo-controlled study". J. Clin. Gastroenterol. 44 Suppl 1: S30–4. doi:10.1097/MCG.0b013e3181ee31c3. PMID 20697291.