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Docusate constipation: Side Effects, Dosages, Treatment, Interactions, Warnings

Содержание

Docusate – StatPearls – NCBI Bookshelf

Continuing Education Activity

Docusate is a medication used in the management and treatment of constipation. It is in the stool softener class of drugs. This activity reviews the indications, action, and contraindications for docusate in the treatment and management for constipation. This activity will highlight the mechanism of action, adverse event profile, and other key factors (e.g., off-label uses, dosing monitoring, relevant interactions) pertinent for members of the interprofessional team in the care of patients with constipation and related conditions.

Objectives:

  • Describe the mechanism of action of docusate in patients with constipation.

  • Identify the contraindications/precautions to using docusate.

  • Outline the indications for docusate use in routine clinical practice.

  • Review the role of interprofessional communication between the patient and physician regarding education, prevention, and medication (including docusate) use in case of constipation.

Earn continuing education credits (CME/CE) on this topic.

Indications

Constipation is a common complaint encountered in the clinical practice with a prevalence of 16% in all adults and 33% in adults older than 60 years. There is no universally applicable definition of constipation. Most physicians consider constipation as infrequent bowel movements, typically less than three per week. However, patients report constipation with a broader set of symptoms that may include difficulty in passing stool, harder stool consistency, abdominal cramping, and incomplete stool evacuation.[1]

The non-pharmacological management of chronic constipation starts with patient education and modifying dietary and lifestyle habits. It is essential to clarify to patients that not having a daily bowel movement is not abnormal or necessary. Increased physical activity is associated with lower rates of constipation.[2] The dietary changes must encourage increased consumption of fluid and fiber-rich foods. If all these modulations do not overcome constipation, then the laxative use comes into play.

There are different classes of laxatives used in the treatment of constipation:

  • Bulk-forming laxatives (methylcellulose, psyllium)

  • Osmotic agents (polyethylene glycol, lactulose, magnesium citrate)

  • Stimulant laxatives (Bisacodyl, Senna)

  • Surfactants/stool softeners (docusate, liquid paraffin)

  • Lubricants (mineral oil)

  • Prokinetic agents (tegaserod, cisapride)

  • Newer Agents [3][4]:
    • Linaclotide: guanylate cyclase-C agonist, stimulates peristalsis through increased fluid secretion and reduced visceral hypersensitivity.

    • Lubiprostone: chloride channel activator, stimulates intestinal secretion, and improves motility.

Docusate or dioctyl sulfosuccinate is available in two salt preparations for the oral route – docusate sodium and docusate calcium. Docusate carries a “Human Over The Counter” (OTC) drug label and has the marketing status of  “OTC monograph not final” under the U.S National Library of Medicine, DailyMed resource. The FDA has not approved the drug, and the medication is not in the FDA list of approved drugs.

There no FDA approved indications for docusate.

According to the product monograph, indications for docusate include avoiding difficult or painful defecation, when peristaltic stimulants are contraindicated.

Docusate eases the passage of hard stools. This property can be helpful in patients with painful anorectal conditions or cardiac comorbidities. Stool softening occurs within 12 to 72 hours following initiation of therapy.

Docusate sodium is also used off-label as a ceruminolytic.[5] 

Mechanism of Action

Docusate is an emollient stool softener (surfactant laxatives). By lowering the surface tension of the oil-water interface of the stool, it allows the passage of water and lipids into the stool mass. As a result, the stool softens and passes easily through the intestinal tract.[6]

Numerous systematic reviews have investigated the efficacy of docusate and found no significant evidence to support its use.[7][8][9][10] Despite that, docusate remains one of the most prescribed of all laxatives.[11]

Administration

Docusate is administered either orally (in the form of a tablet, capsule, liquid, syrup) or rectally (suppositories, enema).[12]

Oral docusate sodium is administered once daily or in divided doses, while docusate calcium dosing is once a day.

Rectal enema dosing can be one to three times daily.

As a ceruminolytic, the liquid docusate is administered intra-aurally via a syringe and can require irrigation with luke-warm saline.[5]

Adverse Effects

The adverse effects of docusate are generally mild. Anorexia, diarrhea, and vomiting are usually associated with excess doses of medication. Abdominal cramping is a reported adverse effect. A rash can present but is rare.[6] Syrup and liquid formulation can cause throat irritation and bitter taste. Therefore administration with adequate amounts of water is recommended. Mixing with milk or fruit juice may alleviate throat irritation. 

Docusate use is not associated with adverse outcomes in pregnancy, and therefore it is considered safe to use.[13][14]

However, in one case report, chronic docusate sodium intake in pregnancy showed a correlation with symptomatic hypomagnesemia in the neonate.[15]

Contraindications

Contraindications and precautions related to docusate are:

  • Hypersensitivity reaction to any of the docusate ingredients.

  • Avoid concomitant use of mineral oil. Increased absorption of the oil may result. 

  • Nausea or vomiting. Due to the need to drink a lot of fluid with the use of docusate.

  • Intestinal obstruction, symptoms of appendicitis, acute abdominal pain, fecal impaction, especially in children. The use of docusate may mask the underlying problem.

  • Self-medicating for longer than 7-days  (excessive use of the medication may lead to dependency).[12]

Monitoring

Excess use of docusate may cause dependence on bowel function. The patients with anorexia nervosa, bulimia, or the elderly that use the laxatives for constipation are at risk for dependency and abuse. Alternating diarrhea with constipation can be a presentation in laxative abuse.  Excessive bowel movements induced by a laxative can lead to fluid and electrolyte losses via the gastrointestinal tract. This condition can manifest with hypokalemia, hypomagnesemia, and non-anion gap metabolic acidosis. Hypovolemia can lead to acute kidney injury. The treatment of laxative abuse is to stop the offending agent. Rebound signs and symptoms like constipation, weight gain, and edema can occur after stopping a laxative. Diuretics can be used cautiously in such cases to treat edema.[6][16][17][18]

Toxicity

Docusate has been in use in the U. S. since the 1950s. It has a well-documented safety and tolerability profile.

Docusate undergoes metabolism in the liver and undergoes extensive first-pass metabolism to both active and inactive metabolites. Despite its hepatic metabolism and high plasma protein binding, there are no drug-drug interactions or reports of clinically apparent hepatoxicity.[19]

Enhancing Healthcare Team Outcomes

Constipation is one of the most common complaints in outpatient clinics and hospitalized patients. The patients may present with symptoms of nausea vomiting, abdominal pain, or urinary retention. The causes of constipation may be due to a myriad of underlying diagnoses, including neurological, metabolic, obstructing lesions of the gastrointestinal tract, including colorectal cancer and endocrine-related problems such as diabetes or hypothyroidism. Psychiatric disorders such as anorexia nervosa can also contribute to constipation.  Inadequate amounts of fluid and fiber intake are risk factors for developing constipation.  

A primary care physician may initially encounter and manage most cases of constipation. However, referral to a  sub-specialist may be required in some cases, depending on the underlying cause, as noted above. The involvement of a surgeon, gastroenterologist, neurologist, psychiatrist, or an endocrinologist can be necessary. A radiologist can provide valuable information through imaging studies about bowel pathology by collaboratively working with a physician or a surgeon. A dietician plays a vital role in modifying dietary risk factors. The pharmacist will ensure that the patient is not on any medication that can worsen constipation and suggest appropriate alternatives. The nurses are critical members of the interprofessional group as they are involved in direct patient care, education, and counseling both in the outpatient and hospital setting.

Overall, interprofessional care coordination by physicians, nurses, pharmacists, and dieticians is vital in improving patient experience and outcomes.  

Continuing Education / Review Questions

References

1.
American Gastroenterological Association. Bharucha AE, Dorn SD, Lembo A, Pressman A. American Gastroenterological Association medical position statement on constipation. Gastroenterology. 2013 Jan;144(1):211-7. [PubMed: 23261064]
2.
Dukas L, Willett WC, Giovannucci EL. Association between physical activity, fiber intake, and other lifestyle variables and constipation in a study of women. Am J Gastroenterol. 2003 Aug;98(8):1790-6. [PubMed: 12907334]
3.
Layer P, Stanghellini V. Review article: Linaclotide for the management of irritable bowel syndrome with constipation. Aliment Pharmacol Ther. 2014 Feb;39(4):371-84. [PMC free article: PMC4305214] [PubMed: 24433216]
4.
Li F, Fu T, Tong WD, Liu BH, Li CX, Gao Y, Wu JS, Wang XF, Zhang AP. Lubiprostone Is Effective in the Treatment of Chronic Idiopathic Constipation and Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Mayo Clin Proc. 2016 Apr;91(4):456-68. [PubMed: 27046523]
5.
Singer AJ, Sauris E, Viccellio AW. Ceruminolytic effects of docusate sodium: a randomized, controlled trial. Ann Emerg Med. 2000 Sep;36(3):228-32. [PubMed: 10969225]
6.
Roerig JL, Steffen KJ, Mitchell JE, Zunker C. Laxative abuse: epidemiology, diagnosis and management. Drugs. 2010 Aug 20;70(12):1487-503. [PubMed: 20687617]
7.
Candy B, Jones L, Larkin PJ, Vickerstaff V, Tookman A, Stone P. Laxatives for the management of constipation in people receiving palliative care. Cochrane Database Syst Rev. 2015 May 13;(5):CD003448. [PMC free article: PMC6956627] [PubMed: 25967924]
8.
Paré P, Fedorak RN. Systematic review of stimulant and nonstimulant laxatives for the treatment of functional constipation. Can J Gastroenterol Hepatol. 2014 Nov;28(10):549-57. [PMC free article: PMC4234355] [PubMed: 25390617]
9.
Ramkumar D, Rao SS. Efficacy and safety of traditional medical therapies for chronic constipation: systematic review. Am J Gastroenterol. 2005 Apr;100(4):936-71. [PubMed: 15784043]
10.
Hurdon V, Viola R, Schroder C. How useful is docusate in patients at risk for constipation? A systematic review of the evidence in the chronically ill. J Pain Symptom Manage. 2000 Feb;19(2):130-6. [PubMed: 10699540]
11.
Lee TC, McDonald EG, Bonnici A, Tamblyn R. Pattern of Inpatient Laxative Use: Waste Not, Want Not. JAMA Intern Med. 2016 Aug 01;176(8):1216-7. [PubMed: 27323235]
12.
Bashir A, Sizar O. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Sep 23, 2020. Laxatives. [PubMed: 30725931]
13.
Jick H, Holmes LB, Hunter JR, Madsen S, Stergachis A. First-trimester drug use and congenital disorders. JAMA. 1981 Jul 24-31;246(4):343-6. [PubMed: 7241780]
14.
Trottier M, Erebara A, Bozzo P. Treating constipation during pregnancy. Can Fam Physician. 2012 Aug;58(8):836-8. [PMC free article: PMC3418980] [PubMed: 22893333]
15.
Schindler AM. Isolated neonatal hypomagnesaemia associated with maternal overuse of stool softener. Lancet. 1984 Oct 06;2(8406):822. [PubMed: 6207396]
16.
Oster JR, Materson BJ, Rogers AI. Laxative abuse syndrome. Am J Gastroenterol. 1980 Nov;74(5):451-8. [PubMed: 7234824]
17.
Copeland PM. Renal failure associated with laxative abuse. Psychother Psychosom. 1994;62(3-4):200-2. [PubMed: 7531354]
18.
Shirasawa Y, Fukuda M, Kimura G. Erratum to: Diuretics-assisted treatment of chronic laxative abuse. CEN Case Rep. 2014 Nov;3(2):215-216. [PMC free article: PMC5413666] [PubMed: 28509204]
19.
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda (MD): Jan 9, 2018. Docusate. [PubMed: 31643530]

Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Colace and Dulcolax are two over-the-counter (OTC) medications that help treat constipation. Constipation is a gastrointestinal condition characterized by having three or fewer bowel movements per week, hard or lumpy stools, stools that are difficult to pass, or the feeling that you have not completely passed the stool. Bowel habits do vary from person to person. Patients experiencing constipation may describe the feeling of bloating or pressure in their bowels.

Constipation is common and can affect infants, children, and adults. It is estimated that 16 out of every 100 Americans suffer from constipation. There are certain groups of patients who tend to suffer from more constipation. These include older adults, women, non-Caucasians, patients who eat a low-fiber diet, and patients on certain other medications.

While this article will only compare Colace and Dulcolax, there are obviously a variety of over-the-counter laxatives. Seek the medical advice of a healthcare professional to determine which type of laxative one may be right for you.

What are the main differences between Colace and Dulcolax?

Colace (docusate sodium) is an over-the-counter medication used to treat and relieve the symptoms of constipation. Colace acts as a surfactant and lowers the surface tension of oil and water in the stool. This allows lipids and moisture to penetrate the stool, producing a softer stool that can move more easily through the gastrointestinal tract. Colace is classified as a stool softener but is not considered a laxative because it does not directly stimulate motility. It may take one to three days for stool softening to occur therefore Colace will not typically provide quick relief of constipation symptoms. Colace (What is Colace?) is available in 50 mg and 100 mg oral softgel capsules, and 10 mg/ml and 60 mg/15ml oral solutions. There are also glycerin suppositories and stool softener and laxative combinations available under the Colace trade name.

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Dulcolax (bisacodyl EC) is an over-the-counter medication used to treat and relieve the symptoms of constipation. Dulcolax is a laxative and works by directly stimulating peristaltic movement by irritating the mucosa of the intestine. This stimulation physically moves the stool through the tract. Dulcolax produces its desired effect more quickly than Colace, typically within 8-12 hours with oral administration. Dulcolax (What is Dulcolax?) is available in enteric-coated 5 mg and 10 mg tablets as well as a 10mg rectal suppository. There are stool softeners and other products available under the Dulcolax trade name.

What are the main differences between Colace and Dulcolax?
Drug class Stool softener Stimulant laxative
Brand/generic status Brand and generic available Brand and generic available
What is the generic name? Docusate sodium Bisacodyl EC
What form(s) does the drug come in? Oral softgel, oral solution Oral enteric-coated tablets, rectal suppository
What is the standard dosage? One 100 mg softgel twice daily, max 300 mg per day One 10 mg suppository once daily, max of 3 days per week
How long is the typical treatment? One week or less, unless otherwise directed by a healthcare provider One week or less, unless otherwise directed by a healthcare provider
Who typically uses the medication? Children 2 years of age and older, adults Children 6 years of age and older, adults

Conditions treated by Colace and Dulcolax

Colace is indicated in both the treatment of constipation and its prevention. Occasional constipation should resolve within one week. Colace is generally safe to be taken long term with the guidance of a healthcare provider and may be prescribed to prevent constipation associated with other medications or conditions known to cause constipation.

Dulcolax is indicated only in the treatment of occasional constipation. Its mechanism of stimulating motility may cause some discomfort. It should only be used for up to one week unless otherwise directed by a healthcare professional.

Prevention of constipation Yes No
Treatment of constipation Yes Yes (occasional)

Is Colace or Dulcolax more effective?

The active ingredients in Colace and Dulcolax have not been compared in a direct comparison clinical trial for efficacy in treating constipation.

There are several factors about each drug to keep in mind when selecting what is right for you. One factor would be how quickly you expect relief. Dulcolax suppositories typically work within a few hours but may cause some discomfort. Dulcolax tablets typically provide relief overnight, within 8 to 12 hours. Colace may take one to three days to produce a bowel movement.

Dosage form is an important factor as well. For some patients, inserting a rectal suppository may be difficult or more uncomfortable than they can stand. While suppositories work quickly, patients may prefer to take an oral dosage form.

Only your healthcare professional can decide what is right for you. Colace and Dulcolax should not be taken for more than one week without the consent of a doctor.

Coverage and cost comparison of Colace vs. Dulcolax

Colace is an over-the-counter medication that is typically not covered by commercial or Medicare drug insurance plans. On average, a bottle of Colace will cost over $15. If you have a prescription you could pay as little as $4.26 with a coupon from SingleCare.

Get the SingleCare prescription discount card

Dulcolax is an over-the-counter medication that is typically not covered by commercial or Medicare drug insurance plans. The average retail price of a 12-count box of Dulcolax suppositories is almost $12. You could pay as little as $6.10 with this coupon from SingleCare, if you get a prescription from your healthcare provider.

Typically covered by insurance? No No
Typically covered by Medicare Part D? No No
Standard dosage 100, 100 mg softgels 12, 10 mg suppositories
Typical Medicare copay N/A N/A
SingleCare cost $4-$14 $5-$15

Common side effects of Colace vs. Dulcolax

Adverse events are rare with Colace. Mild gastrointestinal cramping may occur. With higher doses and/or prolonged use, diarrhea and loose stools may occur. The liquid preparation may cause irritation to the lining of the throat if not diluted per manufacturer’s instructions.

Dulcolax at normal doses for short durations of treatment may cause mild gastrointestinal cramping, faintness, nausea, and vomiting. Dulcolax used long term is likely to cause diarrhea and lead to fluid and electrolyte loss. This can lead to hypokalemia (low potassium levels) which may be dangerous. Prolonged use can also lead to dependency, and rebound constipation may occur when the medication is stopped.

This list may not include all potential side effects. Please consult your healthcare professional for a complete list.

Side effect Applicable? Frequency Applicable? Frequency
Gastrointestinal cramping Yes Not defined Yes Not defined
Diarrhea Yes Not defined Yes Not defined
Faintness No N/A Yes Not defined
Nausea No N/A Yes Not defined
Vomiting No N/A Yes Not defined
Electrolyte imbalance No N/A Yes Not defined

Source: Colace (DailyMed)  Dulcolax (DailyMed)

Drug interactions of Colace vs.

Dulcolax

Colace and Dulcolax should be used cautiously in patients on loop diuretics such as furosemide or torsemide. These diuretics are potassium wasting, and that potassium loss combined with the potential electrolyte imbalance that can result from diarrhea when taking Colace or Dulcolax could lead to hypokalemia.

Colace should not be taken with mineral oil because it can increase systemic absorption of mineral oil. Inflammation of the intestine, liver, spleen, and lymph nodes could occur from mineral oil deposits at these sites leading to a foreign body reaction.

Dulcolax is enteric coated and designed to have delayed dissolution. Taking Dulcolax with antacids, h3 blockers, and proton inhibitors may cause the enteric coating to dissolve prematurely leading to stomach irritation or dyspepsia. Dulcolax should be spaced away from the administration of these drugs by at least one hour.

This is not intended to be an all-inclusive list of potential drug interactions. Please consult your pharmacist or healthcare professional for a complete list.

Warnings of Colace and Dulcolax

You should consult your doctor before using Colace or Dulcolax if you are experiencing nausea, vomiting, or stomach pain. You should also consult your healthcare provider if you have had a sudden change in bowel movements that have lasted for more than two weeks.

When taking Dulcolax, cramping and abdominal discomfort may occur. Do not crush or chew Dulcolax tablets, and do not take Dulcolax within one hour of antacids or milk. If you have no bowel movement or experience rectal bleeding after taking Dulcolax, stop taking it and call your doctor.

Frequently asked questions about Colace vs. Dulcolax

What is Colace?

Colace is an over-the-counter stool softener used in the prevention and treatment of constipation. Colace is available in 50 mg and 100 mg oral softgel capsules, and 10 mg/ml and 60 mg/15ml oral solutions.

What is Dulcolax?

Dulcolax is a stimulant laxative used in the treatment of occasional constipation. Dulcolax is available in enteric-coated 5 mg and 10 mg tablets as well as a 10mg rectal suppository.

Are Colace and Dulcolax the same?

While both Colace and Dulcolax are used to treat constipation, they are not the same and do not work in the same way. Colace, a stool softener, helps soften the stool to make it easier to pass. Dulcolax, a stimulant laxative, works by simulating the physical movement of the stool through the digestive tract.

Is Colace or Dulcolax better?

Dulcolax produces a bowel movement more quickly than Colace, with the suppository form working within an hour or so of administration. Colace is typically gentler and causes less discomfort, but may take up to three days to provide relief.

Can I use Colace or Dulcolax while pregnant?

The Food and Drug Administration (FDA) has not assigned a pregnancy safety category to Colace. Colace has been associated with some cases of fetal malformation, and therefore should only be used when benefits clearly outweigh the risks. Dulcolax has not shown any undesirable effects and is considered relatively safe for short term use in pregnancy. The risk of dehydration and electrolyte imbalance should be weighed when deciding on constipation treatment in pregnant women, and their healthcare provider should always be consulted.

Can I use Colace or Dulcolax with alcohol?

While there are no direct interactions with alcohol, the effects of alcohol on the digestive system may increase the risk of dehydration, and caution should be used when taking Colace or Dulcolax while consuming alcohol.

Is Dulcolax a stool softener?

Dulcolax formulations containing bisacodyl are considered stimulant laxatives, not stool softeners. There are stool softeners available under the Dulcolax trade name.

What is the difference between a stool softener and a laxative?

A stool softener works by decreasing the surface tension of oil and water in the stool. This draws extra moisture into the stool, making it softer and easier to pass. Laxatives work by physically increasing the motility of the digestive tract, which mechanically moves the stool through the digestive tract.

Is it safe to take a stool softener every day?

Stool softeners can be taken every day under the supervision of a healthcare professional for the prevention and treatment of chronic constipation. It is important to monitor for signs of dehydration and ongoing diarrhea.

Docusate Sodium; Senna tablets or capsules

What is this medicine?

DOCUSATE SODIUM; SENNA (doc CUE sayt SOE dee um; SEN na) contains a stool softener and a laxative. It is used to treat constipation.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Colace, Dok Plus, Laxacin, Peri-Colace, Senexon-S, Senna Plus, Senna-S, Senna-Time-S, SennaLax-S, Senohot-S, SenoSol-SS, Stool Softener with Laxative

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

  • blockage in your bowel
  • inflammatory bowel disease
  • stomach or intestine problems
  • sudden change in bowel habits lasting more than 2 weeks
  • vomiting
  • an unusual or allergic reaction to docusate, senna, other medicines, foods, dyes, or preservatives
  • pregnant or trying to get pregnant
  • breast-feeding

How should I use this medicine?

Take this medicine by mouth with a full glass of water. Follow the directions on the product label. Take exactly as directed. Do not take your medicine more often than directed.

Talk to your pediatrician regarding the use of this medicine in children. While this medicine may be prescribed for children as young as 2 years for selected conditions, precautions do apply.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medicine?

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Do not use for more than 1 week unless otherwise directed by your doctor or health care professional.

Stop using this medicine and contact your doctor or health care professional if you have rectal bleeding or do not have a bowel movement after use. These could be signs of a more serious condition.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

  • allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
  • bloody or black, tarry stools
  • breathing problems
  • muscle weakness
  • stomach pain
  • unusually weak or tired
  • vomiting

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

  • discolored urine (red or orange)
  • gas
  • throat irritation
  • upset stomach

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

Amazon.com: Good Sense Stool Softener Softgels for Constipation Relief, Docusate Sodium 100mg, 60 Count: Health & Personal Care

Safety Information

Do not use if you are presently taking mineral oil, unless told to do so by a doctor. Ask a doctor before use if you have: stomach pain; nausea; vomiting; noticed a sudden change in bowel habits that lasts over 2 weeks. Ask a doctor or pharmacist before use if you are taking any other drug. Take this product two or more hours before or after other drugs. Laxatives may affect how other drugs work. When using this product do not exceed the maximum recommended daily dosage in a 24-hour period. Stop use and ask a doctor if: you have rectal bleeding or fail to have a bowel movement after use of a laxative. These could be signs of a serious condition; you need to use a laxative for more than 1 week. If pregnant or breast-feeding, ask a health professional before use. Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center right away. (1-800-222-1222)

Indications

Uses:
relieves occasional constipation (irregularity)
generally produces bowel movement in 12 to 72 hours.

Ingredients

Active ingredient (in each softgel), Purpose: Docusate sodium 100 mg, Stool softener laxative. Inactive ingredients: D&C red no. 33, edible ink, FD&C blue no. 1, FD&C red no. 40, FD&C yellow no. 6, gelatin, glycerin, polyethylene glycol, purified water, sorbitol sorbitan solution, titanium dioxide

Directions

Take only by mouth. Doses may be taken as a single daily dose or in divided doses. Adults and children 12 years and over: take 1 – 3 softgels daily; children 2 to under 12 years of age: take 1 softgel daily; children under 2 years: ask a doctor

Legal Disclaimer

Statements regarding dietary supplements have not been evaluated by the FDA and are not intended to diagnose, treat, cure, or prevent any disease or health condition.

Treating Constipation with Laxatives | Gastrointestinal Society

Before heading to the laxative aisle at your local pharmacy to self-treat constipation, it’s important to be informed. With the many varieties and types of laxatives and therapies available, choosing the best one for your body’s needs, while avoiding those that are too aggressive, requires knowledge and understanding. Also, as with all treatments, proper use will help to avoid unwanted side effects.

Normally, if you’re eating a diet high in insoluble fibre, drinking at least 6-8 cups (250mL or 8oz) of liquids a day, and exercising daily, this is enough to maintain a healthy, constipation-free digestive system. Of course, many of us sometimes deviate from this and find that constipation is a problem. Some people with conditions such as diabetes or Parkinson’s disease are more likely to experience constipation. Additionally, some drugs cause constipation, for example, the codeine contained in many combination-type pain medications (e.g., Tylenol® #1, 2, or 3). However, when chronic constipation occurs, it’s possible that diet and lifestyle regimes may not be enough to remain symptom free without the assistance of over-the-counter or prescription laxatives.

Whether you need a short-term solution for constipation in an otherwise normal digestive tract, or you need relief on a regular basis, as prescribed by a healthcare professional for a specific situation, the following is a list of the different types of laxatives and treatments available. It’s best if your decision is guided by your healthcare provider so you can make an informed choice that is most suitable for you.

Bulk-Forming

Your body does not digest bulk-forming laxatives; instead, the fibre they contain absorbs and retains a large quantity of fluid, thereby forming a soft, bulky stool (formed feces). The bulky size stimulates the intestinal muscles to naturally contract (peristalsis), causing digestive contents to move along, leading to an easier bowel movement. It can take anywhere from about 12 hours to 3 days for bulk-forming laxatives to show results, depending on individual digestive system transit times, so this laxative type will not provide immediate relief of constipation. They are best to use for ongoing digestive regularity and are helpful for conditions such as diverticular disease, irritable bowel syndrome, and hemorrhoids. Although bulk-forming laxatives are safe for long-term use and are usually well tolerated, sometimes these products can cause bloating, intestinal gas, cramping, and/or increased constipation, especially if you don’t consume enough water. To help prevent side effects, start consuming these products slowly, gradually increasing each dose while making sure to drink plenty of extra water. Examples of bulk-forming laxatives are psyllium (Metamucil®), inulin (Metamucil® Simply Clear), wheat dextrin (Benefibre®), methylcellulose (Citrucel®), and polycarbophil (FiberCon®, Prodiem®).

Stool Softeners

Stool softeners enable easier incorporation of water into the stool to keep it soft and easier to pass. By making the stool softer, it reduces or eliminates the need to strain, so stool softeners may be recommended after childbirth or surgery, or during a bout of hemorrhoids. Some individuals may form a tolerance to softeners and may require higher doses over time. Stool softeners do not directly affect the digestive tract muscles and are safe to use in pregnant women and elderly people. Some experts do not classify stool softeners as laxatives. An example of a stool softener is docusate sodium (Colace®). Long-term use, if bowel movements remain comfortable, is acceptable.

Lubricants

Lubricant laxatives simply coat the colon and stool in a waterproof film allowing it to remain soft and easier to slip through the intestine while retaining its moisture, usually within 6-8 hours. Don’t use these products for longer than a week, as some have been shown to cause vitamin deficiencies and they might also interact with some medications by affecting how the body absorbs them. Pregnant women and persons who have difficulty swallowing should avoid lubricant laxatives. An example of a lubricant laxative is mineral oil.

Stimulants

Stimulants increase muscle contractions of the digestive system (peristalsis) to move contents along, facilitating a shorter colonic transit time. Although individuals often use this type of laxative as a form of self-treatment, they should be reserved for use in extreme conditions and only under the recommendation or supervision of a pharmacist or physician. A risky side effect is that they may cause the colon to stop functioning correctly (cathartic colon), which often occurs with daily use after which the body becomes dependent on the stimulant laxative for normal peristaltic activity. Stimulants taken orally often take 6-10 hours to have an effect. For patients who have chronic constipation caused by irritable bowel syndrome, stimulants may be the only solution but, even then, should only be used for a short term. This form of laxative is not recommended for pregnant women. Examples of stimulants are bisacodyl (Ex-lax®, Dulcolax®), castor oil, and senna (Senokot®).

Hyperosmotics

Osmotic laxatives encourage bowel movements by drawing water into the bowel from the nearby tissue (intestinal lumen) thereby softening the stool. Some of these laxatives can cause electrolyte imbalances as they draw out nutrients and other contents with the water, which increases thirst and dehydration. There are four main types of hyperosmotics: saline, lactulose, polymer, and glycerine.

Saline laxatives are essentially salts in liquid; they rapidly empty all the contents of the bowel and are not intended for long-term use or for pregnant women. These generally work within 30 minutes to 3 hours. Examples of saline laxatives are citrate salts (Royvac®), magnesium preparations (Phillips’® Milk of Magnesia), sulfate salts, and sodium phosphate.

Lactulose laxatives are a sugar-like agent that work similarly to the saline laxatives but at a much slower rate and are sometimes used to treat chronic constipation. Often they will have an effect in 6 hours, but can take up to 2 days. Lactulose comes in a liquid form taken orally and several manufacturers make it.

Polymer laxatives consist of large molecules that cause the stool to hold and retain water. They are usually non-gritty, tasteless and are well-tolerated for occasional constipation. Results can be expected within 6 hours, but it can take longer depending on the dose. An example of a polymer laxative is polyethylene glycol (Lax-A-Day®, PegaLAX®, RestoraLax®).

Glycerine is available as a suppository and mainly has a hyperosmotic effect but it may also have a stimulant effect from the sodium stearate used in the preparation. Glycerine is available as a laxative through several manufacturers.

Enema

An enema may be preferred occasionally to relieve severe constipation or to empty the bowel prior to surgery. This method involves insertion of liquid, usually water or hyperosmolar salt solution, described above, which acts as a mechanical stimulant and osmotic, into the rectum via the anus. You can purchase prepared enemas, an enema bulb, or fountain syringe at your local pharmacy to use for this sole purpose. Typically, after holding the liquid in place for a few minutes, there is an intense urgency to move the bowels. An enema may cause uncomfortable bloating and cramping; however, it usually leads to urgent elimination of the contents of the rectum and colon, doing away with constipation.

Colonic Irrigation

It is important to note that although many holistic advertising campaigns recommend colonic irrigation to ‘re-program the bowel’s motility and assist in the reduction of constipation’, there is no medical evidence that colonic irrigation or colon cleansing is effective in either of those claims, or the myriad of other cure-alls promoted on late-night television shows. Physicians and other healthcare providers associated with the GI Society do not recommend the use of colonic irrigation. In fact, these procedures could negatively affect the natural pH balance of the colon, cause electrolyte imbalances, upset the natural bacterial and yeast milieu necessary for good digestion, and could even cause permanent physical damage to the bowel. This approach may worsen existing digestive conditions.

Pregnancy and Childbirth

A common complication of pregnancy is constipation. If making the appropriate dietary and lifestyle adjustments to reduce constipation for a pregnant or nursing woman do not work, then her primary physician may recommend either stool softeners or bulk-forming laxatives, depending on the frequency and duration of constipation. It is very important that she drink plenty of water while taking a laxative, as some can be high in salt and might dehydrate the expectant or nursing mother. Others require sufficient fluid intake to work properly, as with bulk-forming laxatives. Always consult a pharmacist or physician before taking medications while pregnant or nursing, as some formulas of over-the-counter or prescription laxatives can negatively affect the infant. By preventing straining during a bowel movement, dietary fibre and bulk-forming laxatives can also assist in the prevention of hemorrhoids, a common pregnancy and delivery concern.

Proper Use of Laxatives

It is important for individuals to follow the instructions given by a healthcare provider and those supplied by the product manufacturer when taking an over-the-counter laxative. Unless otherwise directed by a medical professional, remember that over-the-counter and prescription laxatives are only intended for short-term use and you should not exceed the dosage on the label.

With all types of laxatives, it is important to consume at least 6-8 cups (250mL or 8oz) of liquids (preferably water) every day plus an additional glass with every laxative dose taken, unless otherwise advised by your healthcare provider. As described above, laxatives often draw fluid into the digestive system to soften the stool and/or pass it out with the bowel movement. Ensure plenty of fluid intake to prevent dehydration.

Laxative abuse can lead to serious dysfunction of bowel motility such as intestinal paralysis, cathartic colon, lazy or laxative gut, irritable bowel syndrome, pancreatitis, and other problems. Using laxatives regularly, except for bulk-forming agents and stool softeners, can lead to these problems. Therefore, it is important to use laxatives in moderation and under the supervision of a physician or other regulated healthcare provider. If you have chronic constipation, where it is a daily issue or occurs more than once a week, then seek the care of a medical professional before self-treating with over-the-counter laxatives.


Alan Low, BSc. (Pharm.), Pharm. D., RPh, ACPR, FCSHP, CCD
Pharmacist and Clinical Associate Professor,
Faculty of Pharmaceutical Sciences, UBC

First published in the

 Inside Tract® newsletter issue 174 – 2010

Image: Mizianitka from Pixabay.com

Docusate Sodium – MotherToBaby

This sheet talks about using docusate sodium in a pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare provider.

What is docusate sodium?

Docusate sodium is the main ingredient in some stool softeners such as Colace® and Surfak® which are used to treat constipation. Constipation affects the number of bowel movements a person usually has, and can cause gas and bloating. Docusate sodium is also found in many drugs and cosmetics. It may also be found in multivitamins and in some prenatal vitamins. In general, docusate sodium is thought to stay in the gut with very little getting into the blood stream. If the medication is not in the blood stream, it does not cross the placenta and the fetus/baby would not be exposed.

I take docusate sodium. Can it make it harder for me to get pregnant?

Studies have not been done to see if docusate sodium could make it harder for a woman to get pregnant.

I just found out I am pregnant. Should I stop taking docusate sodium?

If you were prescribed docusate sodium by your healthcare provider, talk with them before making any changes in how you take this medication. It is important to consider the benefits of treating constipation symptoms during pregnancy. Your healthcare provider may want to confirm a diagnosis of constipation and see how dietary and other lifestyle therapies may help.

Does taking docusate sodium during my pregnancy increase the chance of miscarriage? 

Miscarriage can occur in any pregnancy. Ducosate sodium has not been studied for a risk of miscarriage.

Does taking docusate sodium during the first trimester increase the chance of birth defects?

In every pregnancy, a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk. Few studies have been done to look at use of docusate sodium during pregnancy. However, the available studies show that when used in recommended doses docusate sodium is not expected to increase the chance of birth defects.

Could taking docusate sodium in the second or third trimester cause other pregnancy complications?

When used in recommended doses, docusate sodium is unlikely to cause problems during pregnancy. However, when more than the recommended amount of this product is used, it can lower the levels of magnesium in a person’s blood. There is one reported case of low magnesium levels in a newborn that was linked to the mother overusing docusate sodium. The baby’s main symptom was jitteriness, which went away by the second day of life. There have been no reported problems linked to the use of recommended levels of docusate sodium in pregnancy.

Does taking docusate sodium in pregnancy cause long-term problems in behavior or learning for the baby?

There are no studies looking at possible long-term problems in behavior or learning for the baby while docusate sodium is used during pregnancy.

Can I breastfeed while taking docusate sodium?

Ducosate sodium use while breastfeeding has not been studied. While some of the docusate sodium is absorbed by the mother, the amount that passes into milk is likely low. There have been no reports of problems in children that are breastfeeding while the mother is taking docusate sodium. Be sure to talk to your healthcare provider about all of your breastfeeding questions.

If a man takes docusate sodium, could it affect his fertility (ability to get partner pregnant) or increase the chance of birth defects?

There are no studies looking at possible problems with conceiving or risks to a pregnancy when the father takes docusate sodium. In general, exposures that fathers have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/pdf/.

MotherToBaby is currently conducting a study looking at functional constipation and the medications used to treat it in pregnancy. If you are interested in learning more about this study, please call 1-877-311-8972 or visit https://mothertobaby.org/join-study.

Please click here for references.

OTIS/MotherToBaby recognizes that not all people identify as “men” or “women.” When using the term “mother,” we mean the source of the egg and/or uterus and by “father,” we mean the source of the sperm, regardless of the person’s gender identity.

View PDF Fact Sheet

Docusate Types, Uses & Side Effects

What Is Docusate?

Docusate (Colace®) is a medication used to treat and prevent constipation (dry or hard stools) in children who have undergone liver transplantation. It works by incorporating water and fat into your stool.

People taking this medication usually feel relief one to two days after the first dose, but three or four days may pass before docusate is effective. Notify your transplant coordinator if your child has not had a bowel movement for five days, or if your child develops diarrhea.

To prevent constipation, your child should drink plenty of fluids, eat foods with fiber, and exercise regularly.

Docusate Dosage

Docusate is taken by mouth and is available as a liquid and as tablets and capsules (in 100-mg doses and other amounts).

How to Properly Take Docusate

Docusate can be taken with or without food. If your child is taking this medication, he or she should get plenty of fluids. This will increase the effectiveness of docusate.

Missed Doses

If your child misses a dose of docusate, take it as soon as you or your child remembers. If you remember within two hours of the next scheduled dose, skip the missed dose and resume your child’s usual dosing schedule. Do not double the dose to catch up.

Docusate Side Effects

Side effects while taking docusate may include abdominal pain or stomach discomfort that ranges from cramps or aches to nausea and vomiting.

In rare cases, people taking docusate experience:

  • skin rash
  • rectal bleeding
  • dehydration
  • muscle cramps, muscle weakness or dizziness (These symptoms suggest loss of essential nutrients.)

If any of these side effects continues or becomes bothersome, inform your child’s doctor or transplant coordinator.

Docusate Drug Interactions

Tell your doctor or pharmacist about any prescription or over-the-counter medication your child is taking, so that you can be warned of undesirable interactions and prevent them.

Precautions for Children

Using docusate for a long time may cause the loss of normal bowel function or laxative dependence.

Drug information changes periodically. For the most updated information on drugs, visit www.drugs.com.

90,000 A Natural Approach to Treating Constipation – Blog

Constipation – irregular bowel movements or difficult bowel movements – is a common problem that worries 20% of people. With constipation, the bowel is emptied less than three times a week. A condition is considered chronic if it persists for two weeks or longer.

Constipation is very common but should not be ignored. In each case, it is necessary to establish the cause of the constipation, especially if the symptoms persist after a few weeks.It is important to check with your doctor to make sure your constipation is not caused by a serious medical condition.

Main causes of constipation:

A sedentary lifestyle Constipation can be caused by lack of physical activity, as a result of which normal intestinal motility is disrupted.

Nutrition – A low fiber diet – one that is low in legumes, vegetables and fruits. Eating a lot of fiber can help normalize healthy gut microflora and promote regular bowel movements.

Constipation can be caused by processed foods – fried foods, cakes, candy, baked goods, pasta and bread. Cheese is also a common cause of constipation. If you suspect a certain food or foods are causing your gut problems, start keeping a food journal to find out the cause of your constipation.

Dehydration , often from not drinking enough water or drinking too much coffee and tea, can interfere with bowel movements.Certain medications, such as pressure diuretics, can also lead to dehydration.

As you know, constipation is caused by some medications – drugs for allergies (diphenhydramine, loratadine, fexofenadine, etc.) and opiate drugs (hydrocodone, oxycodone, morphine, etc.) for chronic pain.

Food additives – calcium and iron – can also contribute to constipation. Calcium in a daily dose of more than 1000 mg per day can cause constipation if not taken with sufficient amounts of magnesium.Likewise, constipation can be triggered by iron supplements, which are often taken for iron deficiency anemia (should be diagnosed by a doctor). However, if you take iron with vitamin C, it can help the absorption of iron and prevent constipation.

Irritable bowel syndrome (IBS) – IBS sometimes presents with diarrhea, but often constipation. In some patients with IBS, constipation alternates with diarrhea. For those with constipation predominant with IBS, doctors often prescribe medications if diet and lifestyle changes are not enough.

Small intestine bacterial overgrowth (SIBO) – An overgrowth of bacteria that produce methane gas has been reported to increase the risk of constipation due to methane gas, which slows intestinal transit time.

Hypothyroidism – hypofunction of the thyroid gland, which affects up to 10% of the inhabitants of the Earth. With this disease, the transit of food through the gastrointestinal tract slows down, which leads to constipation.

Frequent use of antibiotics – Disruption of the gut microbiome can be caused by antibiotics.In some cases, this can cause diarrhea. This disrupts the beneficial microflora, which can lead to chronic constipation or SIBO, as mentioned above.

Stress – each of us reacts to stress differently. For some, stress can lead to constipation. To maintain mental and physical health, it is important to find a healthy way to reduce internal stress. As I said before, constipation arises from containment, literally. Therefore, reducing stress, biofeedback and restoring normal work and rest will help to improve the regularity of the stool.

Chronic diseases such as Parkinson’s disease, colon cancer, spinal cord injury and sometimes even stroke can lead to chronic constipation.

Complications of chronic constipation:

  • Pain during bowel movements
  • Increased risk of diverticulosis (small pockets in the colon) and eventually diverticulitis (infection of the pockets)
  • Blood in the stool
  • Development of hemorrhoids
  • Leaky intestine (More details)
  • Increased exposure to intestinal toxins and bacterial growth in the intestine
  • Difficulty urinating (due to stool pressure on the urethra)

Have you been tested for colon cancer?

Most doctors recommend that people over the age of 50 get tested for colon cancer.This can be done with a colonoscopy, sigmoidoscopy, or stool testing for blood or DNA from cancer cells.

Those with a family history of colon cancer may need to be screened at age 40 or even earlier. Talk to your doctor and read medical advice based on your age and family risk factors.

Prescription drugs:

If no underlying or reversible cause of constipation is identified, doctors often prescribe sodium docusate (Colace), polyethylene glycol (PEG or Miralax), lactulose (enulose), or sorbitol.

Other medications are prescribed for chronic constipation, including linaclotide (lenses, constella), plecanatid (trulance), and lubiprostone (amitiza).

If an opiate drug is the cause of constipation (constipation is a common side effect for this class of drugs), pharmaceutical companies have developed drugs (methylnaltrexone) to address this side effect.

Natural approach

Many people want to avoid taking prescription drugs because of the side effects they cause.Listed below are the natural approaches to constipation that are preferred by many patients looking to relieve constipation symptoms and help the body get regular bowel movements. Diet and lifestyle are decisive factors underlying normal bowel function. It is always worth starting with them. True, sometimes this is not enough.

Physical Education – To stimulate regular bowel movements, it is important to be as active as possible. Doctors recommend that most people do moderate physical activity for a total of at least 150 minutes per week.It promotes normal functioning and regular bowel movements. A simple 30 minute walk every day can be very beneficial to your health. For some, yoga also helps.

A lot of fiber in the diet is very important. Doctors advise eating at least 25 grams of fiber a day, for this you need to eat 5-9 servings of vegetables and fruits. For example, one avocado has 13 grams of fiber, an average apple has 4 grams, and a banana has 3 grams. Berries are not only rich in fiber, but they also help protect the body against colon cancer, according to a 2016 study published in Molecules.Chia seeds are also a good product – just one teaspoon of chia seeds contains almost 6 grams of fiber. There are as many as 15 grams of fiber in a glass of black beans.

Herbal products will help normalize stool frequency. Plant foods have a number of other health benefits, including increased absorption of vitamins A, K, and E, as well as vitamin C and other antioxidant-rich phytonutrients.

A 2015 study found fiber to be effective for mild to moderate constipation and constipation caused by IBS.A diet high in plant foods is associated with a reduced risk of colon cancer and has a beneficial effect on beneficial gut microflora. A 2012 study published in the World Journal of Gastroenterology found that fiber helps increase stool frequency in adults.

Foods with probiotics – probiotics are beneficial bacteria. They can be very effective in restoring the balance of the gut microbiome, especially if this balance has been imbalanced due to antibiotics or chronic use of acid-lowering drugs.

Restoring the population of healthy bacteria (such as lactobacilli, bifidobacteria) and other important and beneficial microorganisms is important for promoting general health and treating constipation. A 2017 study published in Advances in Nutrition showed a downward trend in the population of these vital bacteria in chronic constipation.

Eating fermented and fermented foods and beverages such as sauerkraut, miso soup, tempeh, yogurt, and kombucha (kombucha) can also be beneficial in restoring this natural balance.A 2016 study in Iran found that constipated pregnant women improved with daily yogurt consumption. Many also take probiotic supplements. We will talk about them a little later.

The best food supplements for constipation

Magnesium – Magnesium is an ubiquitous trace element that participates in more than 350 biochemical reactions throughout the body. Magnesium deficiency is one of the most common nutritional deficiencies and can manifest as headaches, palpitations, muscle cramps, and even constipation.

Therefore, magnesium supplements can be effective for those with constipation. If a laxative effect is observed while taking magnesium, the dosage of magnesium should be reduced. Patients with advanced kidney disease should consult their doctor. A 2017 study published in Magnesium Research assessed the condition of patients undergoing open heart surgery. Magnesium helped prevent not only constipation, but also arrhythmias, especially atrial fibrillation.

A study published in 2014 in Clinical Gastroenterology and Hepatology involved French women with constipation. The researchers found that constipation symptoms were significantly reduced with daily consumption of magnesium-rich mineral water.

Vitamin C – Usually found in citrus fruits and peppers. Taking vitamin C is important for preventing scurvy. Helps vitamin C and constipation.

Psyllium husk – Psyllium husk can be very effective for chronic constipation.It can also help control blood sugar in diabetes. A 2018 study published in Complementary Therapies in Medicine found that constipated patients with type 2 diabetes not only lost weight, but also improved glucose control when taking psyllium husks. And a 2016 study published in Appetite found that taking psyllium seed shells increased satiety, which allowed subjects not to feel hungry between meals.

Prebiotics – Prebiotics are nutrients and / or foods consumed by beneficial bacteria in the gut. By introducing prebiotics such as inulin into the diet, it is possible to provide adequate nutrition for beneficial intestinal bacteria, helping to restore a harmonious balance in the gastrointestinal tract.

Prebiotics include foods such as apples, asparagus, banana, barley, chicory root, dandelion greens, flaxseed, and garlic. Learn more about prebiotics.

A 2019 study demonstrates the benefits of optimizing prebiotic intake in the treatment of constipation.A similar 2017 study published in the American Journal of Medical Sciences found that a prebiotic alone and in combination with probiotics can improve stool frequency and reduce symptoms of tension and bloating.

Probiotics – over the years, many of my patients have noticed that when taking probiotics, their constipation has disappeared. The authors of a 2017 study published in the Archives of Gerontology and Geriatrics compared a probiotic supplement to a placebo pill and found that probiotics reduced constipation in 10-40% of patients.

Another 2017 study of constipated Asian children found probiotics helped increase stool frequency. A 2018 study also demonstrated the effectiveness of probiotics in treating constipation in patients with Parkinson’s disease.

Medicinal herbs for constipation

Cascara sagrada (buckthorn ) – buckthorn is a medicinal plant that has been used for centuries as a remedy for chronic constipation. The name of the plant is translated as “sacred bark”.This plant was an important healing agent among the indigenous peoples. Scientists have discovered that the active ingredient in the plant is anthraquinone. It is this substance that has beneficial properties for the intestines.

Triphala – Triphala is often used as a remedy for constipation, but I have not been able to find studies to support its effectiveness in constipation. But I did find research proving the positive effects of triphala on the gut microbiome, which may explain its effectiveness in treating constipation.

Aloe – The aloe cactus has been used for centuries for a variety of purposes in Asia and Mexico. There are many reports of its effectiveness in the treatment of chronic constipation. Studies proving the benefits of aloe were conducted back in 1974 (and the most recent – in 2008). Aloe can be taken as a juice or as a dietary supplement.

Senna has been used for millennia. Senna’s efficacy has been amply demonstrated in a 2017 study of constipated children.Another 2018 study showed that senna is not only effective but also safe. It can be taken as a tea or dietary supplement.

Rhubarb – The Chinese have been using rhubarb for almost 3000 years for medicinal purposes, in particular as a laxative. Modern science supports the ancient uses of this plant. A 2018 study found that rhubarb may be beneficial for people who experience constipation while in hospital. Rhubarb can be eaten ready-made or taken as a dietary supplement.

Other funds:

An ancient Ayurvedic medicine can be useful – a glass of warm milk with ghee. I recommend adding ghee to coffee or tea – this drink is called armor-piercing coffee or tea.

Licorice root powder can also be beneficial if diluted in warm water.

Prunes and prune juice are a well-known folk remedy for constipation, which many consider effective. In a 2011 study, it was found that prunes are more effective for constipation than plantain.

You can also stimulate bowel movements by regularly drinking a cup of warm herbal tea, such as black tea, chamomile tea, green tea, ginger tea, mint tea, or senna extract.

Sources :

  1. Paré P, Fedorak RN. Systematic review of stimulant and nonstimulant laxatives for the treatment of functional constipation. Can J Gastroenterol Hepatol. 2014; 28 (10): 549-57.
  2. Molecules. 2016 Jan 30; 21 (2): 169. doi: 10.3390 / molecules21020169.
  3. Aliment Pharmacol Ther. 2015 Jun; 41 (12): 1256-70. doi: 10.1111 / apt.13167. Epub 2015 Apr 22.
  4. Cancer Causes Control. 1997 Jul; 8 (4): 575-90.
  5. World J Gastroenterol. 2012 Dec 28; 18 (48): 7378-83. doi: 10.3748 / wjg.v18.i48.7378.
  6. Dimidi E, Christodoulides S, Scott SM, Whelan K. Mechanisms of Action of Probiotics and the Gastrointestinal Microbiota on Gut Motility and Constipation. Adv Nutr. 2017; 8 (3): 484-494. Published 2017 May 5.doi: 10.3945 / an.116.014407
  7. Iran Red Crescent Med J. 2016 Oct 1; 18 (11): e39870. doi: 10.5812 / ircmj.39870. eCollection 2016 Nov.
  8. Clinical Gastroenterology and Hepatology. 2014 Aug; 12 (8): 1280-7. doi: 10.1016 / j.cgh.2013.12.005. Epub 2013 Dec 14.
  9. Complementary Therapies in Medicine. 2018 Oct; 40: 1-7. doi: 10.1016 / j.ctim.2018.07.004. Epub 2018 Jul 10.
  10. Appetite. 2016 Oct 1; 105: 27-36. doi: 10.1016 / j.appet.2016.04.041. Epub 2016 May 7.
  11. Ohkusa T, Koido S, Nishikawa Y, Sato N. Gut Microbiota and Chronic Constipation: A Review and Update. Front Med (Lausanne). 2019; 6:19. Published 2019 Feb 12. doi: 10.3389 / fmed.2019.00019
  12. Am J Med Sci. 2017 Mar; 353 (3): 282-292. doi: 10.1016 / j.amjms.2016.09.014. Epub 2016 Oct 4.
  13. Arch Gerontol Geriatr. 2017 Jul; 71: 142-149. doi: 10.1016 / j.archger.2017.04.004. Epub 2017 Apr 14.
  14. Huang R, Hu J. Positive Effect of Probiotics on Constipation in Children: A Systematic Review and Meta-Analysis of Six Randomized Controlled Trials.Front Cell Infect Microbiol. 2017; 7: 153. Published 2017 Apr 28. doi: 10.3389 / fcimb.2017.00153
  15. Pedrosa Carrasco AJ, Timmermann L, Pedrosa DJ. Management of constipation in patients with Parkinson’s disease. NPJ Parkinsons Dis. 2018; 4: 6. Published 2018 Mar 16.doi: 10.1038 / s41531-018-0042-8
  16. Benefits of Aloe, accessed March 5th, 2019. https://www.ncbi.nlm.nih.gov/books/NBK92765/
  17. Aliment Pharmacol Ther. 2011 Apr; 33 (7): 822-8. doi: 10.1111 / j.1365-2036.2011.04594.x. Epub 2011 Feb 15. (Prunes better than Psyllium)

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A pathological condition characterized by impaired bowel movement is called constipation or constipation.Gastroenterologists and proctologists are involved in the treatment of this disease.

General information

Constipation is a short-term or permanent violation of bowel movements that prevents complete bowel movement. Situational constipation, triggered by stress or drug side effects, is not a pathology. The criterion for the disease is the absence of stool within 48-72 hours. In this case, the patient may complain of strong urge to defecate, abdominal pain and general malaise.Violent straining does not lead to relief or is accompanied by the release of hard, round stools without complete emptying of the intestines. Possible complications of constipation, doctors include anal fissure, intoxication of the body and the formation of hemorrhoids.

Constipation is one of the most common diseases of the gastrointestinal tract. Many doctors call constipation a symptom, however, in the international classification of diseases, this condition is designated as an independent pathology (code K59.0). In most cases, the elderly suffer from constipation.Treatment of constipation should primarily focus on improving nutrition. If necessary, drug therapy is used.

Constipation symptoms

The symptoms of constipation depend on the cause of the condition. The absence of stool can be observed for three days in a row or occur intermittently. The accumulation of feces in the large intestine is accompanied by increased absorption of fluid, hardening of the stool and the penetration of toxins into the bloodstream. Hard stools damage the intestinal mucosa, and harmful substances adversely affect the patient’s well-being.

Other symptoms and signs:

  • Feeling of heaviness in the abdomen;
  • Discharge of stools in the form of hard black or dark brown balls;
  • Paroxysmal abdominal pain;
  • Strong, irresolvable urge to defecate;
  • Constant straining is required to empty the intestines;
  • Discharge of large amounts of mucus along with hard stools;
  • A feeling of incomplete bowel movement;
  • Bloating;
  • Lack of appetite;
  • Constant belching;
  • Weakness and fatigue;
  • Sleep disturbance.

If you experience these symptoms, we advise you to make an appointment with your doctor. Timely consultation will prevent negative consequences for your health. Phone for appointment +7 (495) 292-39-72

Stool retention adversely affects the intestinal microflora, therefore, patients complain of increased gas production. A sign of damage to the intestinal mucosa with hard stools may be the release of blood with feces.

Causes of constipation

The activity of the gastrointestinal tract directly depends on the lifestyle of a person.Your intestines need a sufficient amount of fiber to form normal stools and bowel movements. This substance is found in many fruits and vegetables. A monotonous diet can be accompanied by chronic constipation and the formation of hard stools. In addition, doctors include low physical activity, chronic stress, disturbed sleep patterns and insufficient water intake as risk factors for constipation. In some cases, constipation occurs even with a healthy lifestyle against the background of a pathological condition.

Other reasons:

  • Irritable bowel syndrome. This disease is characterized by impaired bowel function. The patient may complain of recurrent constipation followed by diarrhea;
  • Intestinal obstruction during the growth of tumors, penetration of foreign bodies into the organ, parasitic infection, adhesion or other pathological condition;
  • Intestinal motility disorders. The movement of feces in the intestine is provided by wave-like contractions of the muscle tissues of the organ.Violation of the rhythm of the intestinal muscles can lead to constipation;
  • Diseases of the nervous system. Intestinal functions depend on nervous regulation, therefore, pathologies of the spinal cord and peripheral nerves can cause defecation disorders;
  • Unfavorable mental state, accompanied by anxiety and severe stress.

The effectiveness of the treatment of constipation directly depends on the successful determination of the cause of this condition.

Diagnostics of constipation in “SM-Clinic”

With a constant violation of defecation, you must make an appointment with a proctologist. The doctor of our clinic conducts a consultation, during which he asks the patient in detail about the complaints and examines the anamnesis. It is important for the physician to determine how often the patient has stool retention. In addition, the proctologist needs to exclude the presence of intestinal obstruction, which requires urgent treatment. Severe bloating and absence of gas indicate a bowel obstruction.Additional examinations can clarify the diagnosis and identify the cause of constipation.

Applied diagnostic methods in “SM-Clinic”:

  • Irrigoscopy – a method of X-ray examination of the large intestine. The doctor injects the contrast solution into the patient’s intestines using an enema. Then an X-ray examination is carried out, during which the specialist sees the change in the shape of the intestine and the extensibility of its walls in real time. Taking several pictures in different positions allows the doctor to clarify the cause of constipation and exclude the presence of intestinal obstruction;
  • Colon endoscopic examination (colonoscopy).The doctor inserts a flexible tube equipped with a camera and a light source into the patient’s rectum. During the study, a specialist examines the features of the intestinal contents and the condition of the mucous membrane of the organ, looking at the monitor. During the procedure, if necessary, a painless collection of cells from the mucous membrane of the organ is performed for histological examination of the material in the laboratory. To eliminate discomfort, colonoscopy is performed under general anesthesia;
  • Anorectal manometry.The proctologist orders this test to assess the muscle tone of the intestines and the strength of contraction of the rectal sphincters. A flexible tube is inserted into the intestine, after which the specialist fills the balloon at the end of the tube with air. The results of the study make it possible to detect the pathology of the muscles of the organ;
  • Investigation of the process of defecation using magnetic resonance imaging (defecography). This is the most highly informative method for diagnosing chronic constipation, allowing the doctor to evaluate the work of the pelvic floor muscles and the process of defecation in general.Obtaining a volumetric image of the pelvic organs is carried out using a special apparatus. The doctor asks the patient to remove all metal jewelry and lie on the tomograph table. Before the examination, a contrast agent is injected into the intestine using an enema. After removing the contrast from the intestine, a second scan is performed with functional tests, such as straining or relaxing the pelvic muscles;
  • Blood test. In the treatment room, the nurse draws a small amount of blood from the patient’s vein and sends the material to the laboratory.Based on the results of a blood test, a malfunction of the thyroid gland and other causes of constipation are excluded. Our own laboratory “CM-Clinic” allows you to carry out this study quickly and get reliable results.

The proctologist himself determines which studies are necessary for the patient. In most cases, diagnosing constipation is limited to a few procedures.

Treatment of constipation in the “CM-Clinic”

Based on the results of the diagnostics, the doctors of our clinic select a treatment regimen for constipation.The prescribed therapy eliminates the cause of the pathology and normalizes the intestinal activity. The gastroenterologist necessarily prescribes a special diet for the patient to restore intestinal motility and the formation of a stool of the correct consistency. If a mechanical obstruction or other dangerous pathology is found, urgent treatment is carried out.

Methods for the treatment of constipation in the “SM-Clinic”:

  • Prescription of preparations containing dietary fiber. The gastroenterologist prescribes metamucil or another agent to the patient that normalizes stool formation and facilitates defecation;
  • The use of drugs that improve intestinal motility.The doctor prescribes the patient a short course of bisacodyl or other remedy;
  • The use of osmotic laxatives that eliminate excess water absorption by the intestinal walls. These are lactulose, magnesium hydroxide or magnesium citrate;
  • Use of stool softening drugs. The doctor prescribes the patient docusate sodium or another agent that reduces the absorption of water in the large intestine;
  • Use of enemas and anal suppositories.The proctologist explains how to properly wash the intestines at home. The doctor also prescribes suppositories based on glycerin or bisacodyl to facilitate bowel movements.

The proctologists of our clinic eliminate chronic constipation in a patient without long-term use of laxatives that negatively affect bowel function. The main task is to improve nutrition and eliminate negative factors from the patient’s daily life. The doctor controls all stages of treatment and achieves an optimal result.

Prevention of constipation

A healthy lifestyle will help a person avoid constipation or other bowel disruption.

The main methods of prevention:

  • Eating a sufficient amount of foods containing dietary fiber and fat;
  • Consumption of at least 2 liters of liquid per day;
  • Moderate physical activity;
  • Elimination of stress factors.

The gastroenterologists of our clinic conduct consultations to explain the methods of disease prevention.

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How to get rid of constipation at home, remedies for adults

What is constipation

Constipation is considered to be stool retention for more than two days. This condition is also characterized by incomplete emptying of the intestines, accompanied by unpleasant sensations, a change in the consistency of feces and the need for excessive straining during bowel movements.

People who neglect the rules of healthy eating and lead a sedentary lifestyle are most often susceptible to constipation. Constipation is classified according to two criteria: etiology (cause of occurrence) and pathogenesis (mechanism of development).

According to the etiology, constipation is divided into:

  • Primary. They arise as a result of congenital or acquired pathologies of the colon.
  • Secondary. They are the result of another disease, injury, as well as side effects of pharmacological drugs.
  • Idiopathic. This definition hides the impossibility of finding out the exact cause of the intestinal dysfunction. Constipation of unknown etiology is also called cryptogenic.

Classification by pathogenesis:

  • Alimentary. It develops in violation of the diet and a decrease in water consumption.
  • Mechanical. It is caused by neoplasms in the large intestine. They can be both tumors and polyps or lymph node clots, as well as adhesions or kinks.
  • Dyskinetic. It occurs due to a violation of intestinal motility, which is the result of nervous tension. This type of constipation is also called neurogenic.

Symptoms of constipation

Strictly speaking, constipation itself is a symptom or side effect. At least, modern medicine does not consider it as an independent disease, although constipation is formally included in the list of diseases according to ICD-10. If we talk about concomitant manifestations (not to be confused with the criteria), then they include:

  • Feeling of heaviness and discomfort in the lower abdomen and rectum;
  • 90,061 decreased appetite;

  • loss of strength, irritability, depression;
  • 90,061 bloating, flatulence;

  • feeling of incomplete emptying of the intestines.

When to see a doctor?

Constipation as an episodic phenomenon should not cause undue concern. Often the reason lies in poor nutrition, stress or a change in environment (moving, business trips, etc.), and eliminating the provoking factors solves the problem. However, if constipation continues on a regular basis, this may mean that there are health problems, so in such a situation, you should not postpone a visit to a gastroenterologist.

Particular attention should be paid to this problem for pregnant women, since excessive straining is contraindicated for them.In addition, constipation is fraught with the development of intoxication of the body, which is also completely useless for a pregnant woman.

People prone to gastrointestinal diseases should also consider increasing constipation as a signal from the body that the course of the disease is worsening. Therefore, one should not expect that the problem will be solved by itself – in such situations, the help of a doctor is needed.

Where does constipation come from

Stool retention periodically occurs in all people, regardless of age, gender and political views.Constipation can occur for a variety of reasons. Let’s consider them in more detail.

Stress

Any situations associated with nervous tension can cause stool retention, since the nervous system regulates all vital processes in the body, including intestinal motility. Stress can affect digestive function in an unpredictable manner, as there is a vast network of neurons in the human gut that provide connections to the central nervous system.

That is why situations involving emotional discomfort, whether it be a minor domestic conflict or chronic nervous overstrain associated with work, can lead to constipation. Separately, mention should be made of the change of scenery: very often problems of this kind arise when moving to a new place of residence or in field conditions.

Pregnancy

Constipation occurs quite often in pregnant women for several reasons:

  • In the first half of pregnancy, hormonal changes occur, as a result of which the synthesis of progesterone increases.This hormone lowers the tone of the uterus and helps prevent premature birth. However, it also weakens the tone of smooth muscles, thereby impairing intestinal motility.
  • Around the end of the second trimester, the constantly enlarging uterus puts pressure on the rectum, which also hinders peristalsis and leads to regular stool retention.
  • The effect of medications. Many women are prescribed antispasmodics during pregnancy, as well as iron and calcium supplements.One of the side effects of these medications is the compaction of stool and the weakening of intestinal motility.

This can also be supplemented by decreased physical activity, stress and severe toxicosis.

Sedentary lifestyle

Despite the fact that skeletal muscles are of the striated type, and the intestinal muscles are of the smooth type, there is a close relationship between their activity. In other words, the less a person moves, the greater the risk of constipation.Sedentary work and low physical activity are almost guaranteed to lead to stool retention.

Lack of fluid

People who do not drink enough water decrease the production of digestive juices. In addition, the stool becomes too dry and hard, which makes it difficult for them to move through the intestines.

Unbalanced diet

Constipation can be provoked not only by a lack of fruits and vegetables in the diet, but also by eating muffins, large amounts of meat, rice, smoked and fatty foods.In addition, the absence of the habit of eating at the same time, evenly distributing the amount of food for each meal, also contributes to the violation of intestinal motility.

Treatment of constipation

Choosing methods of treating constipation, the doctor primarily focuses on eliminating the causes that caused this condition. Treatment should be comprehensive, however, regardless of its main course, all patients should increase their physical activity, adjust their diet and consume at least one and a half to two liters of water per day.Treatment methods can be grouped, which we will discuss below.

Physiotherapy

Physiotherapeutic methods are used to relieve constipation as part of ancillary therapy. It should be noted that the appropriateness of the application of some of them is the subject of controversy and discussion in science. Not all modern medical guidelines contain such information.

  • Belly massage. It is assumed that this method helps to improve intestinal motility and relieve spasms.Mainly gentle pressing and stroking movements are used, which are performed strictly clockwise.
  • Electro-impulse therapy. Due to the use of electrical impulses, the contractile function of intestinal smooth muscles improves, which is especially important for atonic constipation.
  • Inductothermy. It is usually used for neurogenic constipation of a spastic nature, as well as for inflammatory processes in the intestine that provoke stool retention.The essence of the method is in the application of a high-frequency electromagnetic field.
  • Electrophoresis with novocaine. A gauze cloth moistened with a solution of novocaine is placed on the patient’s lumbar region. Due to the influence of a constant or pulsed electric current, the drug flows through the skin to the lumbar plexus. The procedure is relatively painless – the patient only feels a slight tingling sensation.

Special mention should be made of methods such as acupressure (shiatsu), acupuncture (acupuncture), aromatherapy and other branches of the Far Eastern traditional medicine.At the end of the last century, these methods were widely advertised by all sorts of charlatans from medicine as a universal remedy for almost any disease. Currently, their popularity is gradually dwindling, and so far there has been no evidence of the effectiveness of such techniques.

It is important to understand that from the point of view of modern medicine, stimulation and piercing of various points on the body, supposedly responsible for improving bowel function, have no proven clinical effectiveness.At best, the patient can count on a placebo effect.

Phytotherapy

As an alternative to pharmacological preparations, herbal remedies with a laxative effect can be used. However, it is not recommended to choose them yourself, since if used incorrectly or unjustifiably, they will do more harm than good.

Some herbs have an antispasmodic effect, others irritate the nerve endings of the intestine. The use of such effects should be related to the cause of the constipation, and only the attending physician can understand it.Some of the most common herbal remedies for constipation include licorice root, senna, buckthorn and oregano, which are used to prepare decoctions. In addition, ready-made laxative preparations are sold in pharmacies. It should also be remembered that any laxative drugs with prolonged use (2 weeks or more) are addictive.

Medicines

If you disassemble laxatives aimed directly at relieving constipation, then they can be divided into several groups.

Prebiotics

This group of drugs does not give a quick laxative effect, since it is aimed at normalizing the composition of the intestinal microflora – this takes a certain amount of time. In essence, prebiotics are a breeding ground for lacto- and bifidobacteria, without which the intestines cannot function normally. The main active ingredients of prebiotics are inulin and lactulose. They are poorly digested, and therefore reach the intestines practically unchanged, contributing to the growth of beneficial microflora.

Osmotic laxatives

These remedies allow you to quickly get rid of constipation, but they are recommended to be taken in case of acute stool retention. Osmotic laxatives may also be prescribed to a patient to cleanse the bowel before diagnostic procedures. Drugs in this group promote the accumulation of fluid in the intestine, which creates the osmotic pressure necessary for normal bowel movements. Osmotic laxatives are made with macrogol, lactitol, and magnesium sulfate.

Prokinetics

Preparations of this group improve peristalsis by improving the excitability of intestinal receptors. As a result, the propulsive activity and motility of the gastrointestinal tract are improved. It is not recommended to take such drugs on your own, as they can disrupt the heart rhythm. The active components of prokinetics are itopride hydrochloride, domperidone and metoclopramide.

Lubricants

The laxative effect of the drugs in this group is achieved due to the lubricating effect: the feces soften and their movement through the intestines improves.Lubricants are available both for oral administration (flaxseed oil and mineral oil) and for rectal administration in the form of suppositories (with glycerin or sodium docusate).

Stimulant laxatives

Preparations based on bisacodyl and sodium picosulfate improve peristalsis due to irritating effect. They are considered second-line drugs because they are highly addictive, contributing to the development of the so-called lazy bowel syndrome. In addition, irritation is associated with side effects such as cramping abdominal pain or diarrhea.

Antispasmodics

Appointed only for spastic constipation. Most often, drugs based on drotaverine and bendazole are used, which relieve spasm of intestinal smooth muscles and contribute to its relaxation. For other forms of constipation, these remedies can have the opposite effect.

Diet and lifestyle correction

It is necessary to learn to eat not only correctly, but also in a timely manner. The intervals between meals should be approximately equal. The same applies to the distribution of its volume throughout the day.How does it look in practice?

Since the middle of the last century, many people in Russia have been accustomed to having breakfast in a hurry, and during the lunch break to kill their appetite with a dry-boiled sandwich. At the same time, during dinner, “compensate” for malnutrition during the day with an abundance of food, using the first, second and dessert at one time. Unfortunately, this is not the healthiest eating style.

Another assumption implies a ban on eating after a certain time of day. However, the secret to maintaining a healthy weight lies not in the evening fasting at all, but in the correct distribution of the balance of nutrients throughout the day, as well as in physical activity.

Overeating at night is really harmful, especially when it comes to foods rich in complex carbohydrates. However, you do not need to torture yourself with hunger: lean meat combined with whole grain bread and vegetables or cottage cheese with kefir not only stimulate normal digestion, but also help maintain normal weight.

To ensure normal intestinal motility, you should eat at least three times a day, and preferably at the same time. If possible, it is better to eat fractionally, in small portions, about 4-5 times a day.To do this, you can either take a lunch box with you to work or study, or dine in the dining room.

It is important to ensure at least minimal physical activity. Work for a large number of modern people is associated with a long stay in a sitting position. This negatively affects intestinal motility. But you can find a little time for physical activity. For example, you can replace taking the elevator by walking up the stairs, and public transportation by walking. Perhaps this will slightly increase the travel time, but the result is worth it – in addition to intestinal motility, walking improves sleep and overall well-being.

It is very beneficial to do physical exercises, working out the legs, shoulder girdle and abdominal muscles. This is best done at the gym, but there are many exercises that are easy to do at home. It is more effective to spend an extra hour on exercise or walking than to spend the same time every day in the toilet torture.

You should also develop the habit of emptying your bowels at the same time of day and not create the need to regularly suppress the urge to defecate at the wrong time.

Regular suppression of the urge to empty the bowel reduces the reflexes of the rectum, which ensure normal bowel movements.

Strongly do not recommend eating “dry water”, it is better to always have the opportunity to drink food. You can also add more liquid foods, such as soups, to your diet.

Folk remedies

Most of the folk methods aimed at treating constipation are somehow associated with the intake of any products or decoctions. Below we have described a number of foods that can help relieve symptoms of constipation and support prevention.

What to eat with constipation

Source: freepik.com/natali-ploskaya

If you experience constipation, do not rush to buy a laxative. First, you should reconsider your diet. Is there enough fiber in the diet? Fiber is the part of plant foods that the body cannot break down. When eating fiber-rich foods, the extra fiber helps keep stools soft and speeds up digestion.

All plant foods, including fruits, vegetables, whole grains, and beans, contain fiber.The nutritionist recommends consuming 25 grams of fiber per day for women and up to 38 grams for men. After 50 years, the amount can be reduced to 21 grams for women and 30 grams for men. The percentage of fiber content is indicated in table No. 1.

Table No. 1. The percentage of fiber in various products.
Wheat bran 43.5 Oatmeal 6.0
Flax seeds 27.2 Carrot 3.2
Sprouted wheat 17.0 Broccoli 3.0
Almonds 15.0 Cabbage 2.9
Green peas 12.0 Apples 2.0
Prunes 9.5 White potatoes 1.8
Hazelnuts 9.0 White rice 0.8
Beans 7.0 Grapefruit 0.5

If during the day you cannot get the required amount of fiber from fruits and vegetables, you can compensate for its lack by using granulated bran: 40-50 grams per day will be enough. At the same time, it is important to drink them with a sufficient amount of water, since otherwise they will enter the intestines in the form of dry food lumps.Julia Anders, the author of the book “Charming Intestines,” recommends drinking at least 2.5 liters of water a day, but you need to focus primarily on your own thirst. For some people, one and a half liters of purified water a day is quite enough (which, by the way, is also not so little), while others are able to drink all three. In doing so, of course, it must be remembered that diet is only part of the treatment program prescribed by the doctor. What foods should you eat?

Prunes

We all heard from childhood that prunes help with constipation.The laxative effect is carried out due to the fact that the prune has a moderate choleretic effect, and also suppresses the activity of opportunistic intestinal microflora, thereby normalizing the intestinal biocenosis. It is used both in the form of dried fruits and for the preparation of decoctions.

Plums and plum juice

As in the case of prunes, the laxative effect of plums and plum juice is due to their choleretic and antibacterial properties. When they enter the intestines, they retain moisture and increase osmotic pressure, which stimulates peristalsis.

Kefir

Kefir improves the balance of intestinal microflora due to the high content of lacto- and bifidobacteria. However, it should be borne in mind that if you are prone to constipation, you should drink only fresh kefir – it is he who has a laxative effect. Two or three days of kefir gives the opposite effect.

Olive oil

The mechanism of action of olive oil for constipation is simple: it envelops the intestinal walls and softens the stool, thereby improving peristalsis.As we already know, such products are classified as lubricants. Usually, one spoonful on an empty stomach is enough to eliminate stool retention.

Baked apples

Apples contain ingredients useful for digestion such as pectin, sorbitol, lactulose and cellulose. In case of constipation, it is advisable to use apples both raw and baked, but it should be remembered that more does not mean better. Eating more than 3 apples a day can cause bloating, which will backfire and worsen constipation.Baked apples cause less gas formation, so this type of use is considered more gentle.

Red beet

Beets contain a large amount of hemicellulose, which is poorly digested, but completely eliminated from the body. Due to the slight irritating effect of undigested fibers, intestinal motility is improved. In addition, polysaccharides in dietary fiber play the role of a prebiotic, being a nutrient medium for beneficial intestinal microflora.

Lemon juice and warm water

In some sources, you can find recommendations to use lemon juice diluted in warm water for constipation. However, no one has yet provided a convincing justification for its effectiveness in stool retention: supporters of the use of this recipe operate with general phrases from the series “effectively stimulates digestion” or “quickly eliminates congestion in the intestine.”

Lemon juice really has a number of beneficial properties, however, in the educational and periodical literature on nutritional therapy, the benefits of lemon for constipation are not mentioned.In addition, it should be remembered that in a number of inflammatory diseases of the gastrointestinal tract, lemon is contraindicated. Of course, you can try to agree on the advisability of using this prescription with your doctor, but the gastroenterologist will almost certainly not approve of this idea.

Flax seeds

Since flax seeds contain a large amount of dietary fiber, and they themselves, with sufficient water intake, increase in volume and stimulate intestinal motility, their use for constipation is quite common.In this case, it is important to know the nature of stool retention, since such a recipe is contraindicated in case of mechanical constipation.

Figs

Figs contain a large amount of dietary fiber that stimulates peristalsis. Pectin softens fecal matter, due to which a mild laxative effect is achieved.

Water

Constipation really often occurs due to insufficient water intake – with a lack of water in the body, the feces become excessively hard and dense, and this significantly complicates their movement through the intestines.Reception of one and a half to three liters of water per day (the exact amount should be agreed with the doctor) improves intestinal motility and the production of gastric juice.

Save yourself a memo with foods that help with constipation.

Source: MedPortal

Prevention

For the prevention of constipation, the following recommendations should be adhered to:

  • Timely consult a doctor in case of digestive disorders – constipation is often the result of various diseases of the gastrointestinal tract.
  • Do not eat dry food and chew food thoroughly.
  • Provide sufficient physical activity – at least half an hour of walking a day, exercise, work out the abdominal muscles. All this improves intestinal motility.
  • Drink plenty of water and eat fiber-rich foods.
  • Minimize the consumption of alcohol, as well as fried, flour and fatty foods.
  • Avoid nervous stress.
  • Train yourself to eat and go to the toilet at about the same time.

You can also watch a video that looks at reliable, home remedies for constipation.

Conclusion

Thus, constipation occurs either as a consequence of an underlying gastrointestinal disease, or as a result of errors in diet, stress and improper lifestyle. Taking laxatives on your own can cause a number of unpleasant addictive side effects. Constipation treatment should always be comprehensive.

Sources

  1. V.T. Ivashkin, I. V. Maev, A. A. Sheptulin // Clinical guidelines of the Russian Gastroenterological Association for the diagnosis and treatment of adult patients with chronic constipation
  2. Enders J. // Charming intestines
  3. Fulghum D. // Chronic Constipation: Facts vs. Myths

Salofalk suppositories (Salofalk) – BY front page (RUS lang)

INSTRUCTION
(information for specialists)
on the medical use of the drug
SALOFALK®

INN: Mesalazine

General characteristics
White to grayish torpedo-shaped suppositories, uniform consistency and intact smooth surface.

Composition of the medicinal product
Each suppository contains
active substance: mesalazine (5-aminosalicylic acid)
excipients: solid fat, cetyl alcohol, sodium docusate.

Dosage form
Rectal suppositories

Pharmacotherapeutic group: anti-inflammatory intestinal agents, aminosalicylic acid and similar active substances
ATC code: A07EC02

Pharmacological properties
Pharmacodynamics
The mechanism of anti-inflammatory action is unknown.In vitro studies have demonstrated that inhibition of the enzyme lipoxygenase may play a role.
An effect on intestinal mucosal prostaglandin concentrations has also been demonstrated. Mesalazine (5-aminosalicylic acid / 5-ASA) can also act as a radical scavenger for reactive oxygen compounds.
When it enters the intestinal lumen, rectally administered mesalazine has a significant local effect on the intestinal mucosa and on the submucosa.
Pharmacokinetics
General properties of mesalazine:
Absorption
Mesalazine is absorbed most efficiently in the proximal regions and least effectively in the distal intestines.
Biotransformation
Mesalazine undergoes first-pass metabolism with the formation of inactive N-acetyl-5-aminosalicylic acid (N-Ac-5-ASA) both in the intestinal mucosa and in the liver. Apparently, acetylation does not depend on the phenotype of the patient’s acetylation. Part of mesalazine is also acetylated by bacteria in the large intestine.Plasma protein binding is 43% for mesalazine and 78% for N-Ac-5-ASA.
Excretion / excretion
Mesalazine and its metabolite N-Ac-5-ASA are excreted in excrement (most of it), kidneys (the amount varies from 20 to 50% depending on the route of administration, dosage form and mechanism of release of the active substance) and together with bile (smaller part). It is excreted by the kidneys mainly in the form of N-Ac-5-ASA. Approximately 1% of an oral dose of mesalazine is excreted in breast milk, mainly as N-Ac-5-ASA.
Specific features of Salofalk® rectal suppositories 500 mg:
Distribution
Scintigraphic studies carried out with the use of Salofalk® rectal suppositories labeled with technetium has shown that the peak of drug distribution occurs 2–3 hours after drug administration due to decomposition under the influence of temperature body. First of all, the drug penetrates into the rectum and rectosigmoid colon. Salofalk® rectal suppositories 500 mg are especially suitable for the treatment of proctitis (ulcerative colitis of the rectum) due to the presented data on the distribution of the drug.
Absorption
The maximum concentration of 5-aminosalicylic acid in blood plasma after a single dose, as well as after multiple doses (within several weeks of taking the drug Salofalk® rectal suppositories 500 mg 3 times a day) is in the range of 0.1-1, 0 μg / ml, and the concentration of the main metabolite N-Ac-5-ASA is 0.3–1.6 μg / ml. The period of reaching the maximum concentration of 5-ASA is partially realized within the first hour after the application of the drug.
Excretion
After using a single dose of Salofalk® rectal suppositories 500 mg, approximately 11% of the drug (within 72 hours) is excreted in the urine, and after repeated use (within several weeks of using Salofalk® rectal suppositories 500 mg 3 times a day) – 13% of the 5-ASA dose is excreted in the urine. Approximately 10% of the drug is excreted in the bile.
Data from nonclinical safety studies
Preclinical data from standard studies of pharmacological safety, genotoxicity, carcinogenicity (in rats) in reproductive toxicity did not reveal any particular hazard to humans.
Nephrotoxicity (medullary necrosis of the kidney and damage to the epithelium of the proximal convoluted renal tubule or the entire nephron) was observed in toxicity studies with repeated administration of high oral doses of mesalazine. The clinical significance of the findings is unclear.

Indications for use
Treatment of acute attacks of ulcerative colitis limited to the rectum.

Route of administration and dosage
Adults and the elderly:
1 suppository of Salofalk® rectal suppositories 500 mg three times a day (which corresponds to 1500 mg of mesalazine daily) is administered rectally.

As soon as remission has occurred, the use for prophylaxis should be reduced to 1 suppository of Salofalk® rectal suppositories 250 mg three times a day (for example, Salofalk® rectal suppositories 250 mg).

Children and adolescents:
There is little experience with the use of Salofalk® rectal suppositories 500 mg in children and limited literature on the effectiveness of the drug in children.
General instructions for dosing the drug:
When using the drug Salofalk® rectal suppositories three times a day, they should be administered rectally in the morning, in the middle of the day and before bedtime.
Treatment with Salofalk® rectal suppositories should be carried out regularly and according to the instructions, since the effect is achieved when these conditions are met.
The duration of treatment is determined by the attending physician.

Side effects
The following side effects have been reported with mesalazine:
Organ system / organ / category Frequency according to the Medical Regulatory Dictionary
Rare (≥1 / 10,000, <1/1.000) Very rarely (<1/10 000)
Disorders from the circulatory and lymphatic systems Changes in the blood count (aplastic anemia, agranulocytosis, pancytopenia, neutropenia, leukopenia, thrombocytopenia)
Disorders from the nervous system Headaches, dizziness Peripheral neuropathies
Disorders on the part of the cardiovascular system Myocarditis, pericarditis
Disorders of the respiratory tract and mediastinum Allergic or fibrous pulmonary reactions (including shortness of breath, cough, bronchospasm, alveolitis, pulmonary eosinophilia, pulmonary infiltration, pneumonitis)
Disorders from the gastrointestinal tract abdominal area, diarrhea, bloating, nausea and vomiting Acute pancreatitis
Renal disorders Renal dysfunction, including acute and chronic interstitial nephritis and renal failure
Skin and subcutaneous tissue disorders Photosensitivity (increased sensitivity of the skin to light) Alopecia hair)
Musculoskeletal and connective tissue disorders Myalgia, arthralgia
Immune system disorders Hypersensitivity reactions such as allergic exanthema, drug fever, drug-induced lupus erythematosus syndrome, pancolitis
Liver and biliary tract disorders liver (increased levels of transaminases and cholestasis parameters), hepatitis, cholestatic hepatitis
Reproductive system disorders Oligospermia (reversible)

Photosensitivity (increased sensitivity of the skin to light)
More severe reactions have been reported in patients with underlying skin conditions such as atopic dermatitis and atopic eczema.

Contraindications
– known hypersensitivity to salicylic acid and its derivatives or to any of the excipients included in the composition of the medicinal product;
– severe liver and / or kidney dysfunction.

Overdose
There is very limited information about mesalazine overdose (for example, when ingested high doses for suicidal purposes), which do not indicate nephro- or hepatotoxicity of the drug. No specific antidote is known.Treatment is symptomatic and supportive.

Precautions
At the discretion of the physician, before starting treatment and during treatment, a blood test (blood test with differential leukocyte count), determination of liver function parameters (ALT or AST enzyme levels, plasma creatinine content) and urinalysis (test stripes). It is recommended to carry out these studies 14 days after the start of treatment and then 2-3 times with an interval of 4 weeks.
If the results obtained are normal, then it is sufficient to carry out these analyzes every three months. If additional manifestations of the disease appear, additional research should be carried out immediately.
Use with caution when treating patients with impaired liver function.
Do not use Salofalk® rectal suppositories when treating patients with reduced renal function. If there is a decrease in renal function during treatment, the presence of nephrotoxicity associated with mesalazine should be assumed.
Careful observation of patients with respiratory system disorders, especially asthma, is necessary when prescribing Salofalk® rectal suppositories.
Treatment of patients with known hypersensitivity to drugs containing sulfasalazine should only be initiated under close medical supervision. If symptoms of acute intolerance appear, such as cramps, acute abdominal pain, fever, severe headaches and skin rashes, treatment with Salofalk® rectal suppositories should be discontinued immediately.
Cetyl alcohol contained in Salofalk® rectal suppositories may cause local skin irritation (eg contact dermatitis).

Period of pregnancy and lactation
At the moment there is insufficient data on the appointment of the drug Salofalk® rectal suppositories for pregnant women. However, no negative effects of mesalazine on pregnancy or fetal and newborn health have been observed. At the moment, no other epidemiological information is available.There is one case of renal failure in a newborn who was born to a woman who received high doses of mesalazine for a long time during pregnancy (2–4 g per day orally).
Animal studies of the oral route of mesalazine have not demonstrated any direct or indirect adverse effects on gestation, embryo / fetal development, labor and postnatal development.
Salofalk® rectal suppositories should be prescribed during pregnancy only if the expected benefit outweighs the potential risk.
N-acetyl-5-aminosalicylic acid and small amounts of mesalazine are secreted in breast milk. To date, there is very limited experience with the use of mesalazine during breastfeeding. The development of hypersensitivity reactions in infants, such as diarrhea, cannot be ruled out. Thus, the drug Salofalk® rectal suppositories should be prescribed during breastfeeding only if the expected benefit outweighs the potential risk. If the baby develops diarrhea, breastfeeding should be stopped.

Impact on the ability to drive and control complex equipment
No effect on the ability to drive or operate complex equipment was observed. The use of Salofalk® rectal suppositories either has no effect, or has a slight effect on the ability to drive a car and operate complex equipment.

Interaction with other medicinal products
No specific interaction studies have been conducted.
The likelihood of an increase in the suppressive effect of azathioprine, 6-mercaptopurine or thioguanine on the bone marrow should be taken into account when treating with the simultaneous use of Salofalk® rectal suppositories.
There is weak evidence that mesalazine may reduce the anticoagulant effect of warfarin.

Storage conditions and shelf life
Store in a dark place at a temperature not exceeding 25 ° C.
Keep out of reach of children.
Shelf life 3 years.Do not use after the expiration date.

Terms of dispensing
By prescription

Packing
Rectal suppositories, 500 mg, 250 mg: 5 suppositories in a blister, laminated with PVC / low density polyethylene; 2 blisters each with instructions for use in a cardboard box.

Applicant / manufacturer
Dr. Falk Pharma GmbH
Leinenweberstr. 5
79108 Freiburg
Germany

Representative in the Republic of Belarus
Representative office of JSC “Alpen Pharma AG” in the Republic of Belarus
220053, St.Minsk, st. Parkhomenko 3, office 1-B
Tel / fax: (+375 17) 3350644

90,000 What is Sodium Docusate?

Sodium Docusate is a stool softener. It is available in several types of oral preparations as well as suppositories and enemas and is probably the most widely used stool softener. There are many forms available over the counter, but prescription drugs are also available.

Sodium docusate oral forms are tablets, liquid suspension and drops.All oral forms must be taken with a full glass of water or as directed by your healthcare provider. Adequate water intake is important while taking this medication. If use is advisable during pregnancy or lactation, a doctor should be consulted.

Stool softeners are a form of laxative and are mildest on the intestines. They work by increasing the amount of water in the stool and do not irritate the intestinal lining. While they are commonly used to prevent constipation, they are sometimes used to treat occasional constipation.

When taken orally, docusate sodium is effective for one to three days. Taken rectally, it is effective within five to twenty minutes. If bowel movements are not produced within the time indicated on the package, you should consult your doctor.

Side effects are usually mild and include diarrhea, cramps, gas and throat irritation if the liquid form is used. Overdose symptoms include severe diarrhea and abdominal pain. If an overdose is suspected, contact a healthcare professional or Poison Control immediately.

There are several cases when docusate sodium should not be taken. Patients with nausea, rectal bleeding, vomiting, intestinal obstruction, unexplained abdominal pain, or allergies to any of the ingredients should not use it. In addition, patients with hemorrhoids and patients under the age of twelve should not use the enema option.

Sodium Docusate should not be taken with mineral oil. Some mineral oil can be absorbed by the body when taken with sodium docusate.This can lead to mineral oil toxicity or overdose. Overdose symptoms include diarrhea, vomiting, abdominal pain, and dehydration.

Especially when used in combination with a roll-on syringe, docusate sodium has been shown to be an effective agent for earwax accumulation. Excessive amounts of earwax can cause hearing problems and even dizziness. Other complications of earwax buildup include tinnitus, pain, and infections. Earwax removal should only be performed by a healthcare provider.Patients should never inject sodium docusate into their own ear canals.

OTHER LANGUAGES

90,000 Constipation: Treatment

Constipation: treatment

It is necessary to take into account the causes, duration and severity of constipation, age
the patient and his attitude towards treatment. Symptomatic treatment wears
empirical in nature, many recommendations do not have a strict scientific
justification.

They usually start with diet therapy – recommend
include more fiber in the diet.It has not been proven that patients with constipation
consume less fiber than non-constipated people; but
an increase in fiber in the diet up to 20-30 g / day really has
Effect. High content diet
fiber leads to an increase in the volume of feces, the frequency of bowel movements,
as well as accelerating the passage of intestinal contents. This diet should not be prescribed
with obstruction of the gastrointestinal tract, as well as with megacolon and
megarectum.

Unique
laxatives that can be taken continuously are those that act
which is due to an increase in the volume of intestinal contents.Others
laxatives cause a number of complications – for example, aspiration of petroleum jelly droplets can lead to lipoid pneumonia, and damage to the intermuscular
plexus when taking laxatives,
containing anthraglycosides, – to atony of the colon. Laxatives that increase intestinal volume
contents, consist of natural polysaccharides and fiber (plantain seed) or synthetic
polysaccharides that resemble fiber in action. When consumed
laxatives of this group should be drunk more.

Softening laxatives include liquid paraffin, calcium docusate and docusate.
sodium. Vaseline oil is prescribed by mouth or as an enema. It
penetrates into the thickness of the feces and liquefies them. Dokuzat calcium and docusate
sodium – surfactants for better mixing
water-soluble and fat-soluble components of feces.

Osmotic laxatives include polyethylene glycol / electrolytes,
lactulose and sorbitol. They are
create a high osmotic pressure in the intestine that retains water.They are usually used to cleanse the bowel before colonoscopy, but
lactulose is sometimes prescribed for a long time.

In the elderly, saline laxatives can cause water retention.

Stimulant laxatives include castor oil, diphenylmethanes (eg phenolphthalein and bisacodyl), and laxatives containing anthraglycosides.
Castor oil is converted to ricinoleic
acid that stimulates secretion and intestinal motility. Laxatives
containing anthraglycosides, promote the accumulation of fluids and electrolytes
in the distal ileum and in the colon.Phenolphthalein and
bisacodyl stimulates colon motility and inhibits glucose absorption
and sodium.

It was found that cisapride
accelerates the passage of feces in the proximal colon; but
data on its effectiveness for constipation are not yet available.

There is a hypothesis
that in the occurrence of disorders of intestinal motility and constipation can play
the role of endogenous opioids. there is
data on efficacy for constipation
opiate receptor blockers, but additional
clinical trials.

For constipation associated with discoordination
contractions of the muscles of the pelvic floor and external sphincter of the anus, can
prove to be an effective biofeedback method.

Surgical
treatment for severe constipation is controversial. The exception is Hirschsprung’s disease, in which it is shown
removal of a section of the intestine with the absence of intermuscular plexus neurons.

With atony of the colon, sometimes
produce subtotal colectomy with the imposition of an ileorectal anastomosis.This operation can only be performed if violations are excluded
motility of the upper gastrointestinal tract and impaired coordination of the pelvic floor muscles.

Elimination of rectocele,
intussusception and prolapse of the rectum is not
always leads to the disappearance of constipation.

References:

Dokuzat Sodium instruction, price in pharmacies for Dokuzat Sodium

There are no products on the site with the trade name “Dokuzat Sodium”

Dokuzat Sodium – laxative.

Readings

Symptomatic treatment of constipation, preparation for endoscopic examination of the lower colon.

Contraindications

Violation of intestinal patency, abdominal pain of unclear etiology, hemorrhoids in the acute phase, anal fissure, hemorrhagic proctitis and colitis.

Side effects

  • Ingestion: rarely – diarrhea, nausea, abdominal cramps, skin rash, abdominal pain, throat irritation.
  • For rectal administration: burning sensation in the rectum; with long-term treatment rarely – congestion in the rectum.

Application features

Use during pregnancy or lactation

Use during pregnancy or lactation is possible as directed by a doctor, in cases where the expected benefit of therapy to the mother outweighs the potential risk to the fetus.

Children

In children, use with caution – according to indications, in doses and dosage forms recommended according to age.

The ability to influence the reaction rate when driving motor transport or other mechanisms

Not affected.

Overdose

Possible increased side effects. Therapy is symptomatic.

Storage conditions

Store at a temperature not exceeding 25 ° C, out of reach of children.

Pay attention!

Description of the drug Dokuzat Sodium on this page is a simplified author’s version of the apteka911 website, created on the basis of the instructions for use.Before purchasing or using the drug, you should consult your doctor and familiarize yourself with the original manufacturer’s instructions (attached to each package of the drug).

Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide on the appointment of the drug, as well as determine the doses and methods of its use.

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