What is constipation and How ispaghula works in constipation?

What is constipation & its definition?

Constipation is a symptom. It means the delayed passage of feces through the intestine with the defecation process remains normal.

• It usually refers to persistent, difficult, infrequent, or incomplete defecation.
• Most persons have less than three bowel movements per week.
• Many constipated patients have a normal frequency of defecation but complain of excessive straining, hard stool, lower abdominal fullness, or a sense of incomplete evacuation.

What is the common cause of constipation:-

• Lack of fiber in the diet.
• Physical inactivity.
• Pregnancy:- the uterus may compress the intestine, slowing down the passage of food.
• Aging:- As a person gets older, the metabolism slows down, resulting in less intestinal activity.
• Changes in routine:- Meals are eaten at different times, or a person might go to bed, get up, and go to the toilet at different times.

LAXATIVES (APERIENTS, PURGATIVES, CATHARTICS)

Drugs that promote evacuation of bowels and are used for the treatment of constipation are called laxatives (mild action) or purgative (strong action).

Ispaghula works in constipation?

• It is a bulk-forming agent.
• It Consists of dried seeds of Plantago. The seeds contain a large amount of natural which forms a gelatinous mass by absorbing water.
• It is largely fermented in the colon: increases bacterial mass and softens the faces.
• Dose-5-15 gms/day taken with plenty of water.
• It acts in 1-3 days.

Bulk-forming laxatives are especially useful in patients with:-

• Irritable bowel syndrome.
• Hemorrhoids and anal fissures.
• Colostomy or ileostomy.
• Higher consumption of fiber-rich food may decrease the duration of contact of locally (in the colon) formed carcinogens with the colonic wall and may be helpful in preventing colonic cancer.
• Dietary fibers are also known as ‘roughage’ or ‘residue Chemically, this consists mainly of cellulose, hemicelluloses, pectins, and lignin.

Some Preparations are AGAR, BRAN Side effects:

Contraindications:-

They should not be used in patients with gut ulcerations, adhesions, stenosis, and when fecal impaction is a possibility.

Alternative Medication Stool softeners:-

1. LIQUID PARAFFIN:- It is a mild lubricant and by itself does not initiate peristalsis Because of its lubricant action, straining during defaecation can be avoided.

2. DIOCTYL SODIUM SULFOSUCCINATE(DOSS)

Stimulant Purgative:-

1. BISACODYL:- It is supplied as 5 mg enteric-coated tablets for oral use and as 10 mg rectal suppositories.
   • Suppositories: These are bullet-shaped tablet that remains solid at room temp. but become slippery & melts at body temp. They are inserted into the rectum. vagina or urethra. The suppository is used to deliver both systemically and locally acting medications.

2. SODIUM PICOSULFATE

3. CASTOR OIL: It is a fixed oil obtained from the seeds of Ricinus communis. The active compound is ricinoleic acid which acts on the small intestine.lt produces copious, liquid stools, with associated fluid loss.

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Osmotic purgatives:-

Certain salts, non-absorbable disaccharides, and higher alcohols, given orally, are not absorbed and are retained in the Gil tract. Such preparations exert an osmotic effect and hold considerable amounts of water, thus acting as purgatives.

Seidlitz powder:- It is a mixture, in which 2.5 g of sodium bicarbonate and 75g of Rochelle salt are dispensed together in a blue paper while 2.5 g of tartaric acid is dispensed in a white paper.

It is an example of a saline purgative.

Saline purgative:- All inorganic salts which are used as osmotic purgative are called saline purgative.

They are generally used for food poisoning or drug poisoning.

LACTULOSE:-

This is a synthetic non-absorbable disaccharide that acts by its osmotic effect. So, it is used in hepatic encephalopathy(coma).

Dose-30-50 ml

Polyethylene glycol (PEG):-

• It is supplied as a powder or as a ready-to-use electrolyte solution.
• The dose to treat constipation is 250-500 ml orally once a day.

ENEMA:-

Administration of a drug in a liquid form into the rectum is called an enema. In constipation evacuant enema is given like soap water enema or glycerin enema. Fluid distension of the bowel wall causes reflex evacuation. They act locally and may be preferred to laxatives in some situations like fecal impaction or bowel cleansing before bowel surgery, colonoscopy, or radiological examination.

CONTRAINDICATION:-

All laxatives are contraindicated in: abdominal pain, colic, or vomiting.