Can diuretics cause constipation. How do water pills affect cardiovascular health. What are the potential side effects of diuretics. How do diuretics impact electrolyte balance. Are there risks associated with long-term diuretic use.

Understanding Diuretics: The Double-Edged Sword of Blood Pressure Management

Diuretics, commonly known as “water pills,” are a widely prescribed medication for managing high blood pressure. While these drugs effectively lower blood pressure by increasing fluid excretion, they come with a range of potential side effects that warrant careful consideration.

The primary mechanism of diuretics involves increasing urine output, which reduces the overall fluid volume in the body. This decrease in fluid leads to lower blood pressure. However, this process can disrupt the delicate balance of electrolytes in the body, particularly sodium and potassium, potentially leading to serious health complications.

Common Side Effects of Diuretics

• Increased urination frequency
• Electrolyte imbalances
• Dehydration
• Dizziness
• Muscle cramps
• Fatigue

Do diuretics cause constipation? While not typically listed as a primary side effect, some individuals may experience constipation as a result of fluid loss and electrolyte imbalances caused by diuretics. However, it’s important to note that digestive symptoms can vary among patients.

The Impact of Diuretics on Electrolyte Balance

One of the most significant concerns associated with diuretic use is the potential for electrolyte imbalances, particularly affecting sodium and potassium levels. These imbalances can lead to a variety of symptoms and, in severe cases, may pose serious health risks.

Symptoms of Potassium Imbalance

• Bloating and constipation
• Nausea and vomiting
• Weakness and fatigue
• Muscle cramps and stiffness
• Tingling and numbness
• Heart palpitations and irregular heartbeat
• Chest pain
• Difficulty breathing

Symptoms of Sodium Imbalance

• Excessive thirst
• Lethargy
• Nausea and vomiting
• Headache
• Confusion
• Drowsiness and fatigue
• Muscle weakness and cramps
• Seizures (in severe cases)

How do electrolyte imbalances affect cardiovascular health? Electrolyte disturbances can significantly impact heart function, potentially leading to arrhythmias and other cardiovascular complications. This underscores the importance of regular monitoring for patients on diuretic therapy.

Hydrochlorothiazide: A Common Diuretic and Its Side Effects

Hydrochlorothiazide (HCTZ) is one of the most frequently prescribed thiazide diuretics for treating hypertension and edema. While effective in managing these conditions, HCTZ comes with its own set of potential side effects that patients should be aware of.

Common Side Effects of Hydrochlorothiazide

• Increased urination
• Constipation or diarrhea
• Headache
• Erectile dysfunction
• Loss of appetite
• Nausea and vomiting
• Vision problems
• Weakness

Is there a correlation between HCTZ dosage and side effect severity? Research suggests that higher doses of HCTZ (25mg or more) are associated with an increased likelihood of adverse effects. Patients taking lower doses (12.5mg) generally experience side effects at rates similar to those taking placebos.

The Link Between Diuretics and Gout

An often-overlooked side effect of diuretic use, particularly with medications like hydrochlorothiazide, is the potential for increased uric acid levels in the blood (hyperuricemia). This elevation in uric acid can precipitate the development or exacerbation of gout, a painful form of arthritis characterized by sudden joint pain, redness, and swelling.

How does hydrochlorothiazide contribute to gout? HCTZ can increase uric acid levels by reducing its excretion through the kidneys. For individuals with a history of gout or those at risk for the condition, this side effect is particularly concerning and may require careful monitoring or alternative treatment options.

Cardiovascular Risks Associated with Diuretic Use

While diuretics are primarily prescribed to manage hypertension and reduce cardiovascular risk, recent studies have raised questions about their long-term impact on cardiovascular mortality. The complex interplay between diuretic use, electrolyte balance, and heart health warrants careful consideration.

Potential Cardiovascular Complications

• Hypotension (dangerously low blood pressure)
• Arrhythmias due to electrolyte imbalances
• Increased risk of sudden cardiac events in some populations

Can diuretics paradoxically increase cardiovascular risk in certain patients? Some research suggests that long-term use of certain diuretics may be associated with an increased risk of cardiovascular events in specific patient populations. This highlights the need for personalized treatment approaches and regular monitoring of cardiovascular health in patients on diuretic therapy.

Balancing the Benefits and Risks of Diuretic Therapy

Given the potential side effects and risks associated with diuretic use, it’s crucial for healthcare providers and patients to weigh the benefits against the potential drawbacks carefully. For many patients with hypertension, the blood pressure-lowering effects of diuretics significantly outweigh the risks. However, individualized treatment plans and close monitoring are essential.

Strategies for Minimizing Diuretic-Related Risks

1. Regular electrolyte monitoring through blood tests
2. Dose optimization to find the lowest effective dose
3. Dietary adjustments to support electrolyte balance
4. Consideration of alternative antihypertensive medications when appropriate
5. Patient education on recognizing and reporting side effects

How can patients and healthcare providers work together to optimize diuretic therapy? Open communication about symptoms, regular follow-ups, and a willingness to adjust treatment plans are key to maximizing the benefits of diuretic therapy while minimizing potential risks.

The Role of Laxatives in Cardiovascular Health: An Unexpected Connection

While the primary focus of this discussion has been on diuretics, recent research has also highlighted a potential link between laxative use and cardiovascular mortality. This unexpected connection raises intriguing questions about the broader impact of medications that affect fluid and electrolyte balance on heart health.

Are there similarities between the cardiovascular effects of diuretics and laxatives? Both types of medications can influence fluid and electrolyte balance, potentially impacting cardiovascular function. However, the mechanisms and extent of these effects may differ, warranting further investigation.

Considerations for Laxative Use in Patients with Cardiovascular Concerns

• Potential for electrolyte imbalances, particularly in chronic use
• Interactions with other medications, including diuretics
• Impact on absorption of other medications
• Need for careful monitoring in patients with heart conditions

How should healthcare providers approach the use of laxatives in patients with cardiovascular risk factors? A cautious approach, considering the potential for electrolyte disturbances and drug interactions, is advisable. Regular monitoring and patient education are crucial components of safe laxative use in this population.

Future Directions in Diuretic Research and Cardiovascular Health

As our understanding of the complex relationships between diuretics, laxatives, and cardiovascular health continues to evolve, several areas of research hold promise for improving patient care and outcomes.

Emerging Research Areas

• Development of more targeted diuretics with fewer side effects
• Personalized medicine approaches to optimize diuretic therapy
• Long-term studies on the cardiovascular impact of chronic diuretic use
• Investigation of alternative approaches to fluid management in hypertension
• Exploration of the gut-heart axis and its implications for cardiovascular health

What potential breakthroughs in diuretic therapy might we see in the coming years? Advances in pharmacogenomics and precision medicine hold the promise of tailoring diuretic treatments to individual patient profiles, potentially minimizing side effects while maximizing therapeutic benefits.

The complex relationship between diuretics, laxatives, and cardiovascular health underscores the need for a nuanced approach to medication management in patients with hypertension and other cardiovascular risk factors. As research continues to shed light on these connections, healthcare providers must stay informed and adapt their treatment strategies to ensure the best possible outcomes for their patients.

Ultimately, the goal is to strike a balance between effective blood pressure management and minimizing potential risks associated with diuretic therapy. This requires ongoing collaboration between patients and healthcare providers, regular monitoring, and a willingness to adjust treatment plans as needed. By taking a comprehensive and individualized approach to cardiovascular health management, we can work towards optimizing outcomes and improving quality of life for patients relying on diuretics and other medications affecting fluid balance.

“Water Pills” Can Have Serious Side Effects

“Water pills”, or diuretics, are often used to treat high blood pressure. While they are very effective in lowering blood pressure, however, they can also have serious side effects.  These side effects are directly linked to how diuretics work.  

As anyone who has taken them knows, diuretics increase the amount of water that the body excretes. By lowering the amount of fluid in the body, diuretics lower blood pressure. However, as fluid output increases, the kidney’s ability to regulate the balance of electrolytes, including sodium and potassium, can also be affected. If the level of sodium or potassium in the body gets too low, or too high, it can cause serious side effects.  Sodium, Potassium and Health (cdc.gov)

Some of the symptoms of a potassium imbalance include:  

• • Bloating and constipation 
  • Nausea and Vomiting 
  • Weakness and Fatigue 
  • Muscle cramps 
  • Muscle aches and stiffness 
  • Tingling and Numbness 
  • Heart palpitations 
  • Chest pain 
  • Irregular Heartbeat 
  • Difficulty Breathing 
  • Collapse 

Symptoms of a sodium imbalance include: 

• • Excessive thirst 
  • Lethargy 
  • Nausea and vomiting 
  • Headache 
  • Confusion 
  • Drowsiness and fatigue 
  • Muscle weakness and cramps 
  • Seizures 
  • Coma 

When taking a diuretic, it’s important to take your medication as directed. It’s also important to be aware of the potential side effects. 

Sometimes symptoms of a sodium or potassium imbalance can appear slowly, over time. Sometimes they appear suddenly and can be severe, or life-threatening. When this occurs, it’s important to seek emergency treatment immediately. 

Hydrochlorothiazide: Common and Serious Side Effects

1. Other potential side effects
2. What is hydrochlorothiazide?
3. Hydrochlorothiazide dosage

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

A “water pill” sounds relatively harmless, but prescription diuretics like hydrochlorothiazide (HCTZ) are prescription medications. These diuretics have more potential side effects than simply making you urinate more, and you should be aware of them—as well as the potential benefits these medications offer—if you’re talking to your healthcare provider about HCTZ.

Hydrochlorothiazide is a thiazide diuretic (or “water pill”) used to treat high blood pressure or swelling by helping your body get rid of excess water, sodium, and chloride.

Common side effects of hydrochlorothiazide include more frequent urination, constipation or diarrhea, headache, erectile dysfunction, loss of appetite, nausea, vomiting, vision problems, and weakness, and higher doses are more likely to cause more side effects, past research has found. Adverse effects happened more frequently in those taking doses of 25mg or more in clinical trials. Individuals taking a lower dose (12.5mg) experienced the same rate of side effects as those given a placebo (DailyMed, 2014).

This medication may also cause high uric acid levels (hyperuricemia). The buildup of uric acid in the body can lead to the development of gout, a painful type of arthritis characterized by sudden pain, redness, and swelling of the joints (Jin, 2012). For people with a history of gout, hydrochlorothiazide may precipitate an attack (DailyMed, 2014).

Since hydrochlorothiazide is used to lower blood high blood pressure, in some cases, it can cause dangerously low blood pressure, a condition known as hypotension. Symptoms of low blood pressure include dizziness, blurred vision, fatigue, shallow breathing, rapid heart rate, and confusion, and fainting. Drinking alcohol may increase your chances of experiencing low blood pressure while taking hydrochlorothiazide (DailyMed, 2014).

People taking hydrochlorothiazide may also experience kidney problems, or, in rare cases, liver problems. These liver problems may cause jaundice, a yellowing of the skin and whites of the eyes (NIH, 2017).

Hydrochlorothiazide affects electrolyte and fluid balance in the body, which can cause serious side effects. This medication may cause low sodium levels (hyponatremia), low potassium levels (hypokalemia), and low magnesium levels (hypomagnesemia). Electrolyte imbalances can cause dry mouth, irregular heartbeats (arrhythmias), muscle aches, nausea, thirst, tiredness, vomiting, and weakness. In some cases, these conditions can be dangerous and even life-threatening (DailyMed, 2014). Low potassium levels can also increase blood sugar, something that can be particularly problematic for patients with diabetes (Sica, 2011).

If you experience any symptoms of an electrolyte imbalance such as dry mouth, weakness, restlessness, confusion, or muscle pains, seek medical help right away. You should also get medical attention if you notice blistering or peeling skin, fever, sore throat, chills, visual changes, or unusual bleeding or bruising (NIH, 2019).

Some people may have an allergic reaction to hydrochlorothiazide (FDA, 2011). People who have experienced a sulfa drug allergy should not take this medication. An allergic reaction may cause hives, shortness of breath, trouble breathing, wheezing, skin rash, or swelling of the face, tongue, or throat. Seek medical attention immediately if you experience any of these signs of an allergic reaction.

Hydrochlorothiazide, which is sold under the brand names Microzide and Oretic, is a prescription medication used to treat high blood pressure (also called an antihypertensive). It is a thiazide diuretic (a.k.a. a “water pill”), a type of medication that also includes the drug chlorothiazide. These drugs help you get rid of excess salt and water by acting on the kidneys, which help control blood pressure by getting rid of more or less water from your blood in the form of urine. Hydrochlorothiazide helps the body get rid of sodium, chloride, and water, which can also help reduce water retention in the body. 

Thiazide diuretics are just one of many types of diuretics. There are several types of diuretics, and each of these types acts on the kidneys in different ways to reduce the amount of water in the body. Thiazide diuretics are generally the first diuretics prescribed to help lower blood pressure, except for patients with chronic kidney disease (CKD). These individuals may be given loop-acting diuretics instead (Whelton, 2018).

Hydrochlorothiazide is approved by the U.S. Food and Drug Administration (FDA) to treat high blood pressure as well as swelling (edema) that’s caused by congestive heart failure or kidney disease (FDA, 2011).

Diuretics can be combined with other prescription drugs safely to further lower blood pressure. Research has shown that thiazide diuretics may be used in conjunction with beta-blockers, ACE inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers (Sica, 2011). 

HCTZ may also be used off-label to prevent kidney stones and to help people with diabetes insipidus, a medical condition characterized by an imbalance of salts and fluids in the body (MedlinePlus, 2019; UpToDate, n.d.). Diabetes insipidus (DI) is not the same as diabetes mellitus (high blood sugar). Patients with DI lose too much water in their urine, resulting in low blood pressure. HCTZ can be used to regulate this condition and alleviate excess water loss for these patients (Bichet, 2019).

Hydrochlorothiazide is available as a generic drug or as the brand name medications Microzide and Oretic. Each of these versions is available as tablets in 12.5mg, 25mg, and 50mg dosages. These medications are typically taken once a day. You may also find HCTZ combined with other blood pressure medications (like amlodipine, lisinopril, valsartan) in the same pill. 

This medication should be stored at room temperature out of the reach of children. In the case of a missed dose, the dose should be taken as soon as possible unless it’s almost time for the next dose. In that case, only take the next dose as scheduled (NIH, 2019).

1. Bichet, D. (2019). Treatment of nephrogenic diabetes insipidus. In J.P. Forman (Ed.), UpToDate. Retrieved on Sep. 9, 2020 from https://www.uptodate.com/contents/treatment-of-nephrogenic-diabetes-insipidus
2. DailyMed. (2014). Hydrochlorothiazide capsule. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a7510768-8a52-4230-6aa0-b0d92d82588f
3. Food and Drug Administration (FDA). (2011, May). HYDROCHLOROTHIAZIDE TABLETS, USP 12.5 mg, 25 mg and 50 mg Label. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/040735s004,040770s003lbl. pdf 
4. Jin, M., Yang, F., Yang, I., Yin, Y., Luo, J. J., Wang, H., et al. (2012). Uric acid, hyperuricemia and vascular diseases. Frontiers In Bioscience (Landmark edition), 17, 656–669. doi:10.2741/3950. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3247913/ 
5. MedlinePlus. (2019). Hydrochlorothiazide. Retrieved on Sep. 1, 2020 from https://medlineplus.gov/druginfo/meds/a682627.html
6. National Institutes of Health (NIH). (2017). Thiazide Diuretics In LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK548680/ 
7. National Institutes of Health (NIH). (2019, May 15). Hydrochlorothiazide: MedlinePlus Drug Information. Retrieved Sep. 10, 2020 from https://medlineplus.gov/druginfo/meds/a682571.html 
8. Sica, D. A., Carter, B., Cushman, W., & Hamm, L. (2011). Thiazide and Loop Diuretics. The Journal of Clinical Hypertension, 13(9), 639-643. doi:10.1111/j.1751-7176.2011.00512.x. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/j.1751-7176.2011.00512.x 
9. UpToDate. (n.d.). Hydrochlorothiazide: Drug information (n.d.). Retrieved on Sep. 1, 2020 from https://www.uptodate.com/contents/hydrochlorothiazide-drug-information?search=hydrochlorothiazide&source=panel_search_result&selectedTitle=1~148&usage_type=panel&kp_tab=drug_general&display_rank=1#F179571
10. Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Himmelfarb, C. D., et al. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Journal of the American College of Cardiology, 71(19), E127-E248. doi:10.1016/j.jacc.2017.11.006. Retrieved from https://www.sciencedirect.com/science/article/pii/S0735109717415191 

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.

Constipation in cats – treatment and prevention. Veterinary clinic “Zoostatus”

• Causes of constipation
• What to look out for
• Diagnosis
• Treatment of constipation in cats
  
• Physician’s advice

Constipation is a common occurrence in cats. It usually appears as infrequent or incomplete bowel movements with difficult passage of dry and hard stools. The disease can cause severe discomfort or pain in the animal, and with complete intestinal obstruction, it can lead to serious consequences for the cat’s health.

1. Unbalanced diet.

High protein foods with low levels of plant fiber can cause constipation in animals. Bones, cartilage, hair, and feathers can also cause difficulty in defecation in cats that feed on birds and mice.

2. Taking certain drugs (antacids, diuretics, antihistamines, antispasmodics).

3. Mechanical obstruction.

Bowel tumors and foreign objects in the bowel can cause constipation and stool obstruction.

4. Neurological diseases and disorders of the innervation of the large intestine (for example, due to spinal injuries, rabies, lead poisoning, hereditary dysautonomia).

5. Metabolic and endocrine diseases (hyperparathyroidism, low potassium levels and high calcium levels in the cat’s body).

6. Trichobezoars (wool accumulations).

7. Sinusitis (inflammation of the anal glands).

8. Prostatitis, cysts and tumors of the prostate in cats.

9. Congenital or idiopathic megacolon

10. Pain when taking a position for defecation.

For example, with injuries to the hind limbs, pelvis or spine, the cat cannot or does not want to take the desired position in the toilet, which can lead to constipation.

11. For severe dehydration.

When dehydrated, the stools can become harder, resulting in problems with defecation.

12. Lymphadenopathy.

Enlargement of intestinal lymph nodes can lead to its compression and narrowing of the lumen.

It is worth contacting your veterinarian if you often notice in your cat:

• Defecation strain
• Hard dry faeces
• Infrequent bowel movements (less than once a day)
• Sometimes vomiting
• Lack of appetite
• Depression
• Blood in anus or stool
• Vocalization during defecation
• Long stay of a cat in the toilet
• Feces in the form of small balls
• Presence of hairballs in feces

On examination by a veterinarian, the animal’s paraanal glands are examined, the abdomen is palpated to determine the presence of feces in the intestines, pain in the abdominal wall. Examine the degree of dehydration of the animal, the presence of tumors in the rectum. After examination, additional diagnostic methods may be required.

• Biochemical blood test (to study electrolyte levels, kidney and liver function),
• Clinical blood test (to obtain a general picture of the animal’s blood, the presence of anemia, dehydration),
• Abdominal x-ray (to exclude megacolon, fecal obstruction, tumors, foreign objects in the intestine),
• X-ray of the musculoskeletal system (to exclude pelvic injuries, disorders in the area of ​​the hip joints, injuries of the spinal column, diagnosis of alimentary hyperparathyroidism),
• Ultrasound of the abdominal cavity (to assess the structure of the kidneys, liver, prostate, intestinal motility, exclude the tumor process),
• Colonoscopy (endoscopy).

This is a non-invasive way to assess the internal condition of the colon, to rule out the presence of a tumor, structure, or other damage, and to take samples of intestinal tissue.

Treatment

Your veterinarian may prescribe symptomatic treatment for constipation, which will include:

• A diet high in dietary fiber (methylcellulose, bran, etc.).
• Deep enema (may require sedation).
• Discontinuation of drugs taken by the cat that could cause constipation.
• Taking laxatives that make the stool softer (eg Lactusan or Duphalac).
• Taking vaseline oil to lubricate the intestinal wall and improve the passage of feces.
• Preparations that promote the removal of hair from the intestines of the animal.
• Surgical treatment – removal of tumors or foreign bodies.
• Treatment of sinusitis.

Recommendations

It is worth monitoring the stool in pregnant animals, in cats that do not drink enough fluids, in animals with chronic renal failure or diagnosed hyperparathyroidism. It is not recommended to allow the cat to eat mice and birds, to eat foreign objects (hair, stones, filler, etc.). The cat should always have access to water and have a balanced diet, not just one meat. If the cat is constipated for more than two days or chronic constipation, the cat needs to see a veterinarian.

(c) Veterinary center for the treatment and rehabilitation of animals “Zoostatus”.

Warsaw highway, 125 building 1. tel. 8 (499) 372-27-37

Drug constipation | Fitomucil Norm

Drug constipation
Drug constipation | Phytomucil Norm
Constipation after medication is a fairly common side effect. And we are talking about both prescription and over-the-counter drugs. About medical constipation and the consequences of taking certain laxatives – in the article. Fitomucil Norm
Fitomucil Norm

Constipation after medication is a fairly common side effect. And we are talking about both prescription and over-the-counter drugs. Candidate of Medical Sciences Volkova N. N. emphasizes that “the presence of concomitant diseases is associated with the necessary intake of medications that can contribute to the development of constipation” (Volkova N. N., 2015, p. 1044). But sometimes the consequences are associated with the self-administration of certain drugs without a doctor’s prescription.

Delayed bowel movements are said to be in cases where there is no stool or it is observed in a small volume. Also, constipation is indicated by the need for straining in more than ¼ of all bowel movements, dense fragmented feces, a feeling of incomplete emptying of the intestine. If such symptoms appear on the background of the use of certain drugs, it is important to discuss with the doctor the issue of adjusting the treatment.

Symptoms of drug-induced constipation

The so-called drug-induced constipation may be accompanied by the following symptoms:

• pain in the abdomen, mostly cramping, in the form of spasms;

• pain in the anus and near it, as well as in the rectum;

• bloating, feeling of heaviness and discomfort;

• feeling of fullness in the abdomen;

• absence of sounds in the abdomen as a symptom of reduced peristalsis;

• nausea, vomiting;

• lack of urge to defecate;

• feeling of incomplete emptying of the intestine after the act of defecation;

• feeling of blockage of contents in the rectum;

• pain during bowel movements;

• hard, dry feces

In many cases, the mechanism for the development of constipation after tablets and other forms of drugs is a decrease in intestinal motility. This can be manifested by signs of varying intensity from mild discomfort to severe painful spasms.

An important criterion indicating a decrease in peristalsis is considered to be a decrease in pain after passing gases and defecation. The pain usually increases immediately after eating, during stress. There may be bloating, increased gas formation.

It is important to understand that the onset of the development of such a side effect as constipation can be variable. Sometimes problems with the stool begin immediately after the start of therapy, in other cases, violations of bowel movement occur after a certain time of taking the medicine.

Diagnostic features

It is very important to distinguish constipation after medication from stool retention associated with other conditions and diseases, because the treatment tactics in these cases will be completely different. The physician should consider the presence or absence of dehydration, including that not associated with the use of any drugs. Take into account the presence of diabetes mellitus, structural changes and intestinal diseases, diverticulosis, diseases of the endocrine system, irritable bowel syndrome. This may require different diagnostic methods:

• laboratory clinical studies of blood and urine;

• blood chemistry;

• Ultrasound of the abdominal organs;

• irrigoscopy;

• digital examination of the rectum;

• colonoscopy etc.

To select a suitable set of studies, the doctor will ask a series of questions: he will collect a complete history, ask about already known chronic diseases, proctological pathologies, and changes that precede the appearance of an unpleasant symptom.

It is necessary to pay attention to eating habits, as well as the features of the morning toilet ritual, if there is reason to suspect that constipation has developed in connection with the suppression of urges.

The specialist will form a complete list of medicines that the patient is taking, and the doctor needs to be informed about all drugs, dietary supplements and over-the-counter products, herbal preparations.

If possible, you should prepare for the diagnosis using a special diary indicating the frequency, shape of the stool, and the presence of impurities in it. This is especially true for short-term courses of treatment, this method will allow you to establish a relationship with the use of a particular drug.

Sometimes it’s not constipation pills that are to blame for stool retention, but dehydration and a sedentary lifestyle. The specialist will find out these features.

The following accompanying symptoms should alert the doctor:

• weight loss not related to diet;

• too severe pain in the abdomen, not amenable to painkillers and antispasmodics;

• traces of blood in the stool, a positive fecal occult blood test;

• anemia, aggravated heredity – cases of colorectal cancer in the family.

With these symptoms, the doctor will prescribe endoscopic examinations or CT scans to rule out tumors.

Drug List

Medications that cause constipation belong to different groups. For example, Candidate of Medical Sciences Volkova N. N. notes that the drugs that most often cause stool retention include “opiates, narcotic analgesics, antipsychotics, tranquilizers, antispasmodics, cephalosporins, diuretics, antiparkinsonian, antihypertensive drugs, iron preparations, antacids containing aluminum hydroxide or calcium carbonate, etc.” (Volkova N. N., 2015, p. 1044).

All drugs have different mechanisms of action, and some have several of them at once, while others have not been studied at all. Let’s take a closer look at each group of funds.

Painkillers

Many doctors refer to drugs that cause constipation, opiates. These are prescription, narcotic analgesics with multiple mechanisms of action. They affect the receptor apparatus of the intestine, nerve endings, cells of the mucous membrane and muscles. This weakens peristaltic activity, delays gastric emptying, increases the absorption of water, which makes the stool dry and dense and makes it difficult to move the contents of the intestine.

It should be remembered that opioids act both systemically and locally, while the side effect develops quickly and depends on the dose. Another mechanism is the suppression of the urge to defecate.

But some researchers insist that constipation can be caused not only by narcotic drugs, but also by non-steroidal anti-inflammatory drugs – painkillers, which we often take without a doctor’s prescription to relieve certain symptoms. For example, Doctor of Medical Sciences A. I. Parfenov classifies all “analgesics: opiates, tramadol, NSAIDs” as drugs that cause drug constipation (Parfenov A. I., 2011, p. 13).

Over-the-counter pain relievers or NSAIDs can increase stomach acid production, alter mucus production, and relax the smooth muscles of the gastrointestinal tract.

Anticholinergics

This group of drugs includes some types of antidepressants, antipsychotics, as well as medicines used to treat Parkinson’s disease, antihistamines (antiallergic) drugs, antispasmodics. Such drugs can suppress the activity of the parasympathetic nervous system, reduce intestinal motility and tone due to the effect on its receptors.

Antidepressants and antipsychotics

Constipation from antidepressants is observed quite often, forcing a dose adjustment or a change in treatment regimen. Monoamine oxidase inhibitors, or MAOIs, are a group of antidepressants that can relax the smooth muscles of the intestine and increase the time it takes for the contents to move through it. When taking tricyclic antidepressants, this side effect also occurs, and quite often.

Among antipsychotics, phenothiazines have a pronounced side effect. They can block the receptors for certain neurotransmitters, histamine, leading to constipation. There are known cases of stretching of the colon, accompanied by severe constipation.

Antiparkinsonian drugs

In the question of what drugs cause constipation in elderly patients, the doctor always pays attention to the presence of such a chronic disease as Parkinson’s disease. A number of patients with this disease are prone to constipation due to the disease itself, and the problem is exacerbated by the use of agents for its treatment that inhibit intestinal motility.

Anticonvulsants

Anticonvulsants can also affect intestinal motility. Structurally, some of them are similar to some antidepressants, so they affect motility and contribute to stool retention.

Calcium and aluminum preparations

Antacids – means to reduce the acidity of gastric juice – are used as part of the treatment of gastritis and not only. However, aluminum has a certain astringent effect, so at high doses of such a drug, intestinal obstruction may develop.

The drugs turn into insoluble salts that are not absorbed by the intestines and cause stool retention. Therefore, to prevent such a complication, the doctor may prescribe drugs in combination with magnesium carbonate, to obtain the opposite effect.

Preparations for normalizing blood pressure and heart rhythm

Antihypertensive drugs, namely calcium channel blockers, can cause constipation, but the mechanism of action on the intestines is not fully understood. The drugs appear to decrease colonic peristalsis, increasing water absorption and slowing down transit.

As part of the treatment of arterial hypertension, diuretics, or diuretics, are used. They contribute to dehydration, resulting in stool retention.

Diarrhea preparations

With diarrhea, a person may take a drug that affects intestinal motility. This helps to get rid of an unpleasant symptom, but sometimes leads to the fact that there is no stool for some time after therapy. For example, constipation may occur after taking Loperamide.

Iron preparations

A well-known side effect of iron salts is stool retention, which may be due to the effect of the drug on the intestinal microflora.

Antibiotics

Antibacterial drugs act delayed. Usually, long-term use or a combination of several drugs leads to an imbalance in the intestinal microflora, which leads to a malfunction in the intestines.

Contraceptives

Many women experience constipation while taking birth control pills. Indeed, the doctor of medical sciences Klyaritskaya I. L. and co-authors in their scientific work single out in the list of drugs that provoke the disorder, “gestagens: allylestrenol, medrogeston” (Klyaritskaya I. L., Maksimova E. V., Stilidi E. I., 2016, p. 28).

Laxatives

Laxatives are less likely than others to cause the development of constipation. The consequences of taking laxatives based on senna, in particular, may be a loss of muscle tone, a weakening of peristalsis, and the development of the so-called lazy intestine.

Treatment and prevention of drug-induced constipation

Treatment of drug-induced constipation consists mainly in correcting the treatment regimen, but you must remember that you cannot stop the drug yourself or reduce the dosage. If possible, the doctor will cancel the remedy and select an alternative with no such side effect. If this is not possible, then adjust the dosage or prescribe symptomatic treatment.

It is important to reconsider the lifestyle in order to reduce the harmful effects of drugs on the intestines: it is better to eat more fresh fruits and vegetables, other sources of fiber, it should be at least 25 g per day. Drink plenty of fluids and be physically active as much as you can.

The source of fiber can be drugs and various dietary supplements. For example, the “Fitomucil Norm” remedy has a completely natural composition – the shell of psyllium seeds and the pulp of the fruit of the plum tree. The drug is a source of soluble and insoluble dietary fiber, gently stimulates intestinal motility, absorbs water and changes the consistency of the stool. This allows you to ensure regular bowel movements without spasms, pain and swelling. “Fitomucil Norm” is made in the UK, is compatible with other drugs, is not addictive and can be used for a long time.

Minimize the likelihood of drug-induced constipation by following a few guidelines:

• increased physical activity;
• high fiber diet;
• establishing a morning stool, refusing to restrain urges;
• drinking at least 30 ml of water per kg of body weight per day;
• individual selection of the dose of the drug with the attending physician.

It is important to receive treatment from a qualified specialist who will take into account age, health status, existing bowel problems, kidney and liver function.

It is important to consult your doctor about drug constipation. There may be certain limitations, and only a specialist will tell you how to deal with the problem.
The article is for informational purposes only. The authors are not responsible for the quality of services provided by third parties and for possible complications.

References

• Volkova N. N. The main causes and principles of treatment of constipation in the elderly // RMJ “Medical Review”. – 2015. – No. 17. – S. 1044.

• Klyaritskaya I. L., Maksimova E. V., Stilidi E. I. Management of patients with constipation // Crimean Therapeutic Journal. – 2016. – No. 2. — pp. 27–31.

• Parfenov AI Strategy and tactics of treatment of chronic constipation // Medical Council. – 2011. – No. 9(10). — S. 12−17.

Volkova N. N. The main causes and principles of treatment of constipation in the elderly // RMJ “Medical Review”. – 2015. – No. 17. – S. 1044.

Klyaritskaya I. L., Maksimova E. V., Stilidi E. I. Tactics of managing patients with constipation // Crimean Therapeutic Journal. – 2016. – No. 2. — pp. 27–31.

Parfenov A.