In people without medical problems, the main intervention is to increase the intake of fluids (preferably water) and dietary fiber. The latter may be achieved by consuming more vegetables and fruit and whole meal bread, and pulses such as baked beans and chick peas and by adding linseeds to one's diet. The routine non-medical use of laxatives is to be discouraged as this may result in bowel action becoming dependent upon their use. Enemas can be used to provide a form of mechanical stimulation. However, enemas are generally useful only for stool in the rectum, not in the intestinal tract.
Lactulose, a nonabsorbable synthetic sugar that keeps sodium and water inside the intestinal lumen, relieves constipation. It can be used for months together. Among the other safe remedies, fiber supplements, lactitiol, sorbitol, milk of magnesia, lubricants, etc., may be of value. Electrolyte imbalance, e.g., hyponatremia may occur in some cases especially in diabetics.
In alternative and traditional medicine, colonic irrigation, enemas, exercise, diet, and herbs are used to treat constipation. The mechanism of the herbal, enema, and colonic irrigation treatments often includes the breakdown of impacted and hardened fecal matter.
Laxatives
Laxatives may be necessary in people in whom dietary or other interventions are not effective or are inappropriate. Laxatives should be used with caution and only as necessary. The following sequence of laxative use is recommended: bulk forming, then stool softeners, then osmotic, then stimulants, then suppositories, and finally enemas (only as a last resort). The reason for this cautious use is because laxatives can lead to dependence, and like all medications they have side effects. Laxatives should not be used if there are signs and/or symptoms of a bowel obstruction.
Physical intervention
Constipation that resists all the above measures requires physical intervention. ''Manual dissimpaction'' (the physical removal of impacted stool) is done for those patients who have lost control of their bowels secondary to spinal injuries. Manual dissimpaction is also used by physicians and nurses to relieve rectal impactions. Finally, manual dissimpaction can occasionally be done under sedation or a general anesthetic—this avoids pain and loosens the anal sphincter.
Many of the products are widely available over-the-counter. Enemas (clysters) are a remedy occasionally used for hospitalized patients in whom the constipation has proven to be severe, dangerous in other ways, or resistant to laxatives. Sorbitol, glycerin and arachis oil suppositories can be used. Severe cases may require phosphate solutions introduced as enemas.
Paediatrics/Pediatrics
Lactulose and milk of magnesia has been compared to PEG (polyethylene glycol) in children. They had similar side effects but PEG was more effective at treating constipation. Osmotic laxatives are recommended over stimulant laxatives.
Further Reading
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