Constipation is a rather controversial condition of the body, despite the fact that from 30 to 50 percent of the adult population and from 5 to 20 percent of children face this problem. The World Health Organization considers delayed, difficult or insufficient defecation a disease, as evidenced by the “International Statistical Classifier of Diseases and Health Problems”.
At the same time, international gastroenterological organizations and associations designate constipation as a symptom of various diseases. The same position is typical for domestic medicine. The classification of problems with defecation as a symptom determines the nature of their elimination: in gastroenterology, the main step in the fight against constipation is to eliminate the causes of their occurrence. But along with this, in most cases, a quick and effective therapy is needed, aimed at normalizing the stool, which is carried out with the help of medicines belonging to a large group – laxatives.
Characteristics of laxative drugs
Laxatives are medicines that are used exclusively to combat constipation. Generally, the mechanism of their action can be divided into two directions:
- strengthening the undulating contraction of the colon (peristalsis) to accelerate the withdrawal of its contents to the outlet;
- inhibition of the process of reuptake of water in the colon.
The history of the development of laxative drugs began with herbal remedies, which included antraglycosides. Over time, salt and synthetic preparations were created, which were not always distinguished by their effectiveness and safety of use. But now pharmacology has gone far ahead, enemas, syrups and pills for constipation have become more sophisticated and we will look at them in as much detail as possible.
Classification of laxatives
According to the international drug classification system, laxatives are divided into six groups:
- emollient drugs;
- osmotic laxatives
- laxatives that increase the volume of intestinal contents;
- enemas and suppositories laxatives
- contact (irritable) laxatives
- other laxatives.
Consider each of the groups in more detail.
Laxative emollients (plasticizers)
| Essential drugs of the group |
|
| Mechanism of Action | Emollient laxatives affect the level of the small intestine. The result of their work is softening of the fecal masses, stimulation of peristalsis, reduction of fluid absorption by the intestinal walls, simplification of gliding of fecal masses to the outlet. |
| Indications for use | Appointed to people who can not be strained (women after childbirth, people after operations), patients with coprostasis (obstruction of the colon). Also, drugs of this group are recommended for various poisonings and in preparation for diagnostic procedures. |
| Contraindications | Do not use emollient laxatives for pregnant women, children under 12 years old, people with chronic constipation, hemorrhoids, kidney disease, uterine and intestinal hemorrhages. |
| Side Effects | Possible reduction of defecation reflexes, inflammation of the rectal mucosa, malignant neoplasm of the intestine |
Osmotic laxatives
| Essential drugs of the group | There are three subgroups of osmotic laxatives:
|
| Mechanism of Action | Saline laxatives act throughout the intestine, increasing osmotic pressure in its lumen. This action attracts fluid from the plasma and adipose tissue into the intestine, which leads to a softening of the feces. Prebiotics have an effect on the colon. When their bacterial fermentation in the colon increases acidity in this area, which leads to an increase in volume and softening of feces. Macrogol stimulates the hydration process, equalizing the volume of the colon and its contents. It does not affect the intestinal microflora and does not irritate it. |
| Indications for use | Osmotic laxatives are prescribed for various types of poisoning, in preparation for laboratory tests and surgery, for acute and chronic constipation. |
| Contraindications | The salt subgroup of laxatives is contraindicated in children, pregnant women and women during lactation. Also, salt laxatives can not be used for heart failure. Prebiotics and Macrogol practically have no contraindications. They are most often prescribed for constipation in children. |
| Side Effects | Salt preparations can cause an uncontrollable laxative effect, dehydration, nausea, vomiting, diarrhea. Reception of prebiotics is often accompanied by flatulence, and Macrogol can cause diarrhea and minor abdominal pain. |
Bulk laxatives
| Essential drugs of the group |
|
| Mechanism of Action | At the heart of this group are laxatives that are not digested in the intestines. In fact, they expand the volume of the rectum, while maintaining water, which leads to a reflex acceleration of bowel movements. Acceptance of the drugs themselves should be accompanied by the simultaneous use of a large amount of liquid – up to one and a half liters. |
| Indications for use | They are prescribed for chronic constipation, for people who cannot cope (postpartum and postoperative periods), for patients with irritable bowel syndrome. |
| Contraindications | The presence of allergies to the components of drugs. |
| Side Effects | Intake of bulk laxatives may be accompanied by abdominal distention, minor pain, a feeling of colon overcrowding. They are considered the safest group of laxatives. |
Enema and suppository laxatives
| Basic drugs of the group |
|
| Mechanism of Action | They have a local effect on the rectum, softening the fecal masses and increasing them in volume. |
| Indications for use | Appointed before laboratory tests, during the postpartum and postoperative periods, as well as for occasional constipation. |
| Contraindications | Remedies for constipation in the form of enemas and suppositories are contraindicated for uterine bleeding, for exacerbation of hemorrhoids, for inflammatory processes in the colon and for cracks in the anus. |
| Side Effects | With short-term use, laxatives in this group have no side effects. Prolonged use may be accompanied by pain and itching in the anus, inflammation of the rectum, diarrhea. |
Contact (irritable) laxatives
| Essential drugs of the group |
|
| Mechanism of Action | The preparations of this group irritate the mucous membrane and nerve endings in the large intestine, thereby stimulating the process of motility. Also contact laxatives prevent the absorption of fluid from the intestine, not allowing fecal masses to harden. |
| Indications for use | Appointed mainly for acute constipation. |
| Contraindications | Not assigned to children and elderly people, as well as to patients with limited mobility due to unpredictable laxative effects. In addition, most drugs in this group have individual contraindications, and their long-term use is not fundamentally recommended. |
| Side Effects | Dysbacteriosis, dehydration, addiction. |
Other laxatives
Other laxatives include mainly combination drugs. Their characteristics, indications and contraindications, as well as the list of side effects depend on the components that are part of each specific drug. The most common pills for constipation in this group:
| Drug Name | Core Components |
| Guttalaks | sorbitol and sodium picosulfate |
| Agiolax | plantain seeds, sucrose and senna fruits |
| Regulax | glycerol, plum, fig, vaseline oil, sorbitol |
Nuances of using laxative drugs
Quite often, people believe that laxative medicines for constipation are absolutely harmless and easy to use, and prescribe them to themselves without consulting a doctor. This is fundamentally wrong. Most laxatives have a significant list of contraindications, not taking into account that a person puts himself at serious risk.
In addition, the use of drugs for constipation is often addictive, so modern medical protocols involve the combination of various laxatives with a short period of use of each of them.
When choosing a remedy for constipation, you need to remember that microclysters and suppositories will bring the fastest possible effect, and chronic constipation is best dealt with using prebiotics, which are most often found in the form of tablets for constipation. In addition to the normalization of the stool, they stimulate the bowels and have a positive effect on the microflora, with virtually no contraindications.
Use laxatives before bedtime. Most of the drugs in this area begin to act after 6-12 hours, so that in the morning the expected effect will be observed. In addition, after taking laxatives, it is worth planning your time in such a way as to stay at home during the day. This will avoid many unpleasant situations.
Traditional methods of combating constipation
Considering the types of laxative drugs can be noted that many of them are based on herbal ingredients that have laxative functions. They are widely used in traditional medicine for constipation.
There are also a number of effective folk methods of preventing and combating constipation, which are very easy to use, do not require any complex components and are an important part of a healthy lifestyle. Consider them:
- after waking up, you should regularly drink at least a glass of clean water at room temperature, and postpone food intake for half an hour after that. Water will clear the stomach and prepare it for the digestive process;
- regular consumption of sufficient cabbage, prunes, beets, other vegetables and fruits in their raw form is the key to the absence of constipation and normal intestinal functioning;
- Before bed, it is helpful to drink a glass of kefir. It is very easy to pickle and allows the intestines to prepare for a new day without overloading;
- If it was not possible to avoid constipation, then castor oil will help to quickly overcome it. 30 g of oil once a day for three days will normalize the stool, and the first effect from its reception will appear in 2-8 hours. This drug is considered one of the most effective, with fast action and inexpensive, because and perhaps the most popular;
- Be sure to drink plenty of fluids when constipating. One and a half to two liters of water, drunk at a time, will make the stool softer and allow you to overcome the problem without serious therapy.
But the main thing with constipation is the elimination of the reason for which the work of the intestine was disrupted. Having correctly identified the prerequisites and getting rid of them, constipation will pass without a trace, and you will forget about this problem for a long time.
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