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Dulcolax Laxative
Dulcolax laxative
Constipation- All you want to know about it
Constipation is a very common problem . In this article, dietary and physiological aspects of constipation and it's treatment principles shall be discussed. Today's lifestyle and eating habits have a major bearing on this problem.
The Function of the Large Intestine
The principal function of the large intestine (colon) is to remove excess water from food waste passing into it from the small intestine. When food passes through the large intestine too quickly, not enough water is absorbed by the intestine, and diarrhoea results. In contrast, if waste material is passed too slowly, too much water is absorbed. This results in hard stool and constipation, often leading to straining.
Fibre, also called roughage or bulk, is necessary to promote the wave like contractions that move food through the intestine. High fibre foods expand the inside walls of the colon, easing the passage of waste. As fibre passes through the intestine undigested, it absorbs large amounts of water, resulting in softer and bulkier stool. This fact highlights the importance of fibre in our diet.
What is constipation?
Constipation is said to be present if
- Faeces ( stools or motions) become hard, and difficult or painful to pass.
- The time spent in toilet increases compared to your usual. There is a large range of normal 'bowel habit'. Some people normally go to the toilet to pass motions 2-3 times per day whereas for others, 2-3 times per week is normal. It is a change from your usual pattern that may mean that you are constipated.
Common Causes of constipation
- Low fibre (roughage)
- Not drinking enough water
- Medicines- Painkillers (particularly those with codeine), some antacids, some antidepressants, iron tablets, morphine, but there are many others.
- Medical conditions - An under active thyroid, irritable bowel syndrome(IBS), and conditions that cause poor mobility, particularly in the elderly.
- Pregnancy-About 1 in 5 pregnant women become constipated. It is due to the hormone changes of pregnancy that slow down the gut movements.
- Emotion-There is some evidence to suggest that 'emotional problems and stress' can lead to constipation.
- Unknown cause ('idiopathic'). Some people have a good diet, drink a lot of fluid, do not have a disease which can cause constipation, but become constipated. Their bowels are said to be 'underactive'. This is quite common. Most cases occur in women. This condition tends to start in childhood or in early adulthood, and persist throughout life.
Prevention of constipation
Constipation is best avoided. It can be done by
- Eat plenty of fibre by eating plenty of fruit, vegetables, cereals, fruit juice, wholemeal bread, etc.
- Have plenty to drink - at least two litres (about 8-10 cups) of fluid per day. Most sorts of drink will do, but alcoholic drinks can be dehydrating and may not be so good.
- Exercise regularly if possible. Keeping your body active helps to keep your gut active.
- Toileting. Do not ignore the feeling of needing the toilet. Some people suppress this feeling if they are busy. It may result in hardening and backlog of faeces that may become difficult to pass later.
Treatment of constipation
Treatment with a laxative is needed only if the measures above (fibre, fluid, etc) do not work well. There are four main groups of laxatives that work in different ways:
- Bulk-forming laxatives (Fibre supplements).
- Stimulant laxatives.
- Osmotic laxatives.
- Faecal (stool) softener laxatives.
As a rule, a laxative should be used only for a short time, when necessary, to get over a bout of constipation. Once the constipation eases, you should normally stop the laxative. Some people get into the habit of taking a laxative each day to 'to keep the bowels regular' or to 'prevent constipation'. This is not advised, except for bulk forming (Fibre ) laxatives.
Bulk-forming laxatives (fibre supplements)
These increase the 'bulk' of your faeces similar to fibre. They can have some effect within 12-24 hours. However, their full effect may take some days to develop. Unprocessed bran is the cheapest. Alternatives are ispaghula husk(Isabgol), methylcellulose and sterculia.
Fibre and bulk-forming laxatives work by absorbing water (a bit like blotting paper). The combination of bulk-forming laxatives and fluid usually produces soft, bulky faeces which should be easy to pass out. Therefore intake of high amount of fluids [at least two litres per day (8-10 cups)] is mandatory with fibre laxatives. If fluid intake is insufficient, the faeces may become dry and lead to constipation instead. Sometimes high fibre intake may cause an increase in wind (flatulence) and abdominal bloating. This is normal and tends to settle down after a few months as the gut becomes used to the increase in fibre
There are two types of fiber: insoluble and soluble. Insoluble fiber is effective at increasing stool size and bulk and helps reduce constipation and thus prevents piles and fissure. Insoluble fibers also reduce the risk of colon cancer and diverticulosis. Insoluble fiber includes wheat bran, whole cereal grains and vegetables. On the other hand, soluble fiber forms a gelatin-like substance in the intestines and increases the water content in stool. Soluble fiber decreases blood cholesterol and results in a lower blood sugar after meals for diabetics. Soluble fiber is found in citrus fruit, legumes (dried beans and peas), oats, barley and "gums" which are found in oatmeal and dried beans.
Stimulant laxatives
These stimulate the nerves in the large bowel which causes the muscle in it's wall to squeeze harder than usual. This pushes the faeces along and out. Stimulant laxatives include senna (Softovac), bisacodyl, phenolphthalein, castor oil, sodium picosulphate(Cremalax) and dantron. Their effect is within 8-12 hours. Therefore, a bedtime dose is recommended so that you have the urge to go to the toilet the following morning. Stimulant laxative suppositories act more quickly (within 20-60 minutes). Possible side-effects from stimulant laxatives include abdominal cramps, and a 'weakened' bowel ('lazy bowel') with long-term use.
Osmotic laxatives
These work by retaining fluid in the large bowel by osmosis (so less fluid is absorbed into the bloodstream from the large bowel). A commonly used one is called lactulose (Loose). However, this can take up to two days to have any effect so it is not suitable for the rapid relief of constipation. Possible side-effects of lactulose include abdominal pain, bloating and an unpleasant taste. Another osmotic laxative is called polyethylene glycol (Peglec). This usually has a rapid action.
Faecal softeners
These work by 'wetting' and softening the faeces. The most commonly used is docusate sodium (Dulcolax) and liquid paraffin(Cremaffin, Agarol). Possible side-effects include seeping from the anus and irritating the skin, and interfering with the absorption of some vitamins from the gut.
When tests need to be done for constipation
- If regular constipation is a new symptom, especially in people above the age of 40 years and there is no apparent cause such as a change in diet, lifestyle, or medication.(To rule out cancer)
- If symptoms are severe and persistent.
- If associated with other symptoms like passage of blood along with motions, pain, weight loss, bouts of diarrhoea, or other unexplained symptoms in addition to constipation.
About the Author
Senior Surgeon & Internationally renowned Colo-Rectal Surgeon- Doctor
Department of Surgery, Fortis Super-specialty Hospital
Mohali (Chandigarh), Punjab
India
www.fistulacure.com
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