Complete Guide On Constipation

CONSTIPATION


Definition:
It is a condition characterized by a difficulty in emptying the bowels. It is associated with hardened faeces. Usually the bowel movements will be less than 3 a week in constipation.

Constipation in men:

Older men are particularly prone to chronic constipation.

The symptoms shown by most men are one or more of the following:
•Having bowel movements less than 3 times a week
•Hard, small lumpy stools
•Difficulty in passing the hard stools
•Straining
•Painful bowel movements
•The incomplete feeling after defecation

The causes of constipation in men are usually the following:

•Lifestyle factors, including lack of dietary fibre, consuming too few calories, lack of exercise, and dehydration
•Some medications like aluminium-containing antacids, antihistamines, tricyclic antidepressants, narcotics, non-steroidal anti-inflammatory drugs, anti-Parkinson’s disease agents etc.
•Supplements, including iron and calcium
•Endocrine gland disorders like diabetes and a hypothyroidism
•Metabolic imbalances like low potassium levels and high calcium levels
•Neurologic disorders like multiple sclerosis, Parkinson’s disease, and spinal cord disorders
•Psychological problems like depression and anxiety
•Bowel diseases like tumours, irritable bowel syndrome, inflammatory bowel disease and rectal disorders

Constipation in women:


Constipation frequently occurs in women.

Causes of constipation in women can be the following:
a.Slower movement of food through the digestive tract
b.Effect of female hormones on the digestive tract
c.Pregnancy

Apart from the above, the causes leading to constipation in men can contribute to constipation in women as well.

Symptoms of constipation in women can be the following:
i.Having bowel movements less than 3 times a week
ii.Hard, small lumpy stools
iii.Difficulty in passing the hard stools
iv.Straining
v.Painful bowel movements
vi.The incomplete feeling after defecation

Constipation and pregnancy:


Nearly 50%of the women suffer from constipation during pregnancy.
Constipation in pregnant women is believed to occur due to the hormonal effects, which result in intestinal relaxation and the pressure of the enlarged uterus on the intestines. Iron supplements can also cause constipation in pregnant women. Therefore, pregnant women must drink plenty of water if they are taking iron supplements or they should discuss with their doctor to use another iron supplement.
Constipation during pregnancy can be relieved by the following measures:
1.Eating a high fibre diet.
2.Drinking plenty of water or fluids
3.Routine exercises
4.Reduce the use of Iron supplements( after consulting with the doctor)

Pregnant women should NOT use laxatives or mineral oils to relieve constipation.

Constipation in babies:

Symptoms of constipation in babies:

  • Less frequent bowel movements than usual, like the baby has not passed stools for 3 or more days.
  • Uncomfortable defaecation
  • Hard, dry stools which is difficult to pass even if it is passed frequently.

Causes of constipation in babies:

a.Solid food like rice
b.Weaning of baby from breast milk can lead to constipation due to dehydration.
c.Formula – babies fed with breast milk rarely get constipated.
d.Medical conditions such as hypothyroidism, botulism, certain food allergies and metabolic disorders. Constipation can rarely be caused by Hirschsprung’s disease( it is a birth defect that prevents a baby’s gut from functioning properly.)

Treatment of constipation in babies:

•Help the baby to get some exercise. If the baby is a crawler, encourage him/her to do a few laps. If the baby lies on the back, gently move his/her legs in a forward, circular motion as if pedaling a bicycle.
•Massage the baby’s belly. Apply gentle firm pressure with fingertips on the point which is three finger-widths below the baby’s navel on the lower left side and.. Maintain gentle but constant pressure for about three minutes.
•If the baby is fed formula, discuss with the doctor to switch to another brand, which helps to relieve constipation. Studies have revealed that adding dark corn syrup to the formula helps to relieve constipation. The amount of dark corn syrup should not exceed 1 teaspoon per 4 ounces.
•If the baby is at least 4 weeks old, add a little prune juice/ apple juice/ pear juice to formula or breast milk. If the baby is one – month old, he or she can have 1 ounce of juice per day and the amount of juice can be increased per month like 2 ounces for 2 months etc.
• If the baby has started eating solid foods, avoid constipating foods like raw Indian bananas/ rice. The Indian banana can be boiled and given to the baby to avoid constipation. Brown rice can be used instead to avoid constipation. For the best result, give your baby a belly massage first, then some high fibre food.
•Raisins soaked in water and squeezed with fingers and drain- this juice can be used like a constipation reliever.
•A smaller amount of bath soap soaked in fingers and applied to baby’s anus externally can stimulate bowel movements. But this is fine occasionally and should not be done on a regular basis. Because the baby’s body can entirely rely upon this to evacuate bowels, if the technique is used regularly.
•The doctor may suggest a glycerin suppository if the baby is severely constipated. The suppository stimulates the baby’s rectum and helps her pass a stool. But this is fine occasionally and should not be done on a regular basis. Because the baby’s body can entirely rely upon this to evacuate bowels if the technique is used regularly.
•If the anal skin of the baby shows slight tears due to the passing of hard stools, apply some aloe vera lotion to the area to help it heal. Keep the area as clean and dry as possible, and mention the fissures to the baby’s doctor.

Constipation in toddlers:

Constipation in toddlers is not usually a sign of any serious disease. Usually, it’s caused by a problem that’s easy to solve, like diet or ignoring the urge to go.

Causes of constipation in toddlers:

•A diet which is rich in processed foods like sweets
•A diet low in fibers
•Holding the urge to defecate
•A child who has a previous history of constipation associated with painful defecation would be afraid to go to the toilet.
•Change in routine like using a toilet which the child is not used to.
•Lack of exercise
•Some diseases
•Some medicines like high-dose Iron supplements, narcotic medicines, etc.
•Very rarely an anatomical problem with the intestine, rectum or anus can lead to constipation.
•Certain nervous diseases like cerebral palsy can lead to constipation.

Symptoms of constipation in toddlers:

• The child has a bowel movement fewer than three times a week (or less often than he typically does)
• Child passes stools that are large, hard, dry, and accompanied by painful bowel movements
• Soiling between bowel movements
• Bloody on stool
Other symptoms exhibited in toddlers along with constipation are as follows:
• Stomachache
• Bloating
• Nausea
• Loss of appetite
• General crankiness
• Crying or screaming during bowel movements
• Avoiding the toilet
• Clenching the buttocks, crossing the legs, turning red, sweating, or crying during defecation
• Smears of liquid stool in the diaper or underwear (soiling)
Constipation treatment in toddlers: Treatment in toddlers;
• Diet. Include fiber-rich foods in the diet. High-fiber foods include fruits and fruit juices that contain sorbitol (prune, mango, pear), vegetables (broccoli, peas), beans, and whole-grain bread and cereals. Limit foods that can increase constipation, such as fatty foods, cheese, curd, processed food and meat that are low in fiber. Limit milk to 16 ounces per day.
• Exercise. Make sure that the toddler gets plays physically for at least 30 to 60 minutes a day. Moving the body keeps the bowels moving, too.
• Improve bowel habits. Encourage the child to use the bathroom at regular times during the day, especially after meals and whenever he or she feels the urge to go. Let the toddler sit for at least 10 minutes at a time on the toilet. Put a small stool under the child’s feet so that the leverage will help him push. Encourage the toddler to do so, by giving him a sticker or an allowing him to something that he likes, as positive behavior enforcement.
• Medicine. The child’s doctor can prescribe medicate=ions for constipation. If the constipation is caused by some medicate=ions that he or she takes, please mention it to the child’s doctor so that he can switch to another medication.

Constipation in old age:

Experts estimate that two-thirds of people over the age of 65 experience constipation.

Causes of constipation in old age:

Block in the intestine or rectum
Issues with the nerves which lead to the contraction of muscles of the colon and rectum. This might be due to stroke, spinal cord injury, Parkinson’s disease, autonomic neuropathy, and multiple sclerosis.
Problems with muscles involved in defaecation
Conditions that affect hormones like diabetes, hyperthyroidism, etc.

Symptoms of constipation in old age:

• Infrequent defecation( less than 3 bowel movements a week
• Hard and lumpy too
• Straining
• The sense of incomplete evacuation
• Sometimes, they have to pull the stool out with their hand

Other associated signs and symptoms can include:

• Bloating
• Pain in the abdomen
• Feeling of fullness
• Lack of appetite
• Irritability

Risk Factors of constipation in old age:

• Being older than 65
• Being female
• Dehydration
• Not getting enough dietary fiber
• Physical inactivity
• Having mental health issues like depression or an eating disorder
• Taking medications that cause constipation in the elderly, which include certain sedatives, antihistamines, muscle relaxants, anti-nausea medications, narcotics, antidepressants, diuretics, and calcium and iron supplements.

Constipation in Keto diet:


Following a keto diet is excellent for losing weight, increasing energy and improving health. However, focusing more on the consumption of cheese or fats and avoiding vegetables rich in fibers can lead to severe constipation.
Including more vegetables like broccoli, cucumber, etc. in the keto diet can cure constipation resulting from following the keto diet.

Now we can enter into some commonly believed co-symptoms of constipation. The symptoms are shown in some individuals if they have constipation, but it is not necessary that the symptoms are shown in all individual with constipation. These symptoms are described below:
• Chest pain:
Studies have revealed that chest pain is not a common symptom in patients with even chronic severe constipation. But very rarely, constipation, as it affects the movement of intestines and the nerve supply in the intestine and chest region, is almost the same, can result in chest pain. This pain can mostly be relieved by having some quick remedies for constipation or acidity or taking antacids.
Sometimes gas gets trapped in the bowels, along with stools in individuals with severe and chronic constipation and it may lead to chest pain in the left side. This chest pain is usually associated with other symptoms like burping, indigestion, nausea and loss of appetite.
But sometimes, the victims and the bystanders worry as they cannot distinguish the pain in the chest from a heart attack. The gas that gathers in the stomach or left part of the colon can feel like heart-related pain.
The following symptoms associated with that chest pain indicates a heart attack:
• Pain like a strong pressure applied to the chest
• pain or discomfort in neck, back, shoulders, arms, or jaw
• pain in the jaw is (common in women)
• shortness of breath
A person experiencing the above listed symptoms should seek emergency medical attention.
Anyone who experiences persistent and severe symptoms of gas pain in the chest, or symptoms that last for more than 2 hours should also seek medical attention.

• Shortness of breath:
Studies have proved that constipation can lead to shortness of breath. Shortness of breath is the difficulty in breathing and the affected individual has the feeling that he or she is not taking in enough air while breathing. If this shortness of breath continues for long periods, the individual may faint.
If the shortness of breath continues for a long period and the victim seems to be highly stressed and uncomfortable or if he or she faints immediate medical attention should be sought.

Complications of Constipation:

Constipation is not a serious medical condition that requires immediate medical attention.
• Haemorrhoids (swollen rectal veins): Long term straining during defecation can lead to hemorrhoids which in turn can cause rectal bleeding or if they become clotted (thrombosed), severe rectal pain.)
• Anal fissures( tears in the skin of anus): The combination of training and hard stools can tear rectal tissue, producing anal fissures that are so painful.
• Fecal Impaction ( stool that cannot be passed out normally): In older men (and women), hard, dry stools can become impacted (trapped) in the rectum, preventing normal bowel movements. Eventually, the stools get stuck in the bowels and can be evacuated only with medical intervention.
• Rectal prolapse: Straining can also push rectal tissue out through the anus; these rectal prolapses may require surgical repair.
• Diverticulosis and Diverticulitis: In addition, the low-fiber diets typically associated with chronic constipation are associated with diverticulosis and diverticulitis, common colon disorders that can cause bleeding or inflammation with pain and fever.
Even without any complications, the discomfort associated with chronic constipation provides good reason to seek treatment.

Constipation treatment:


The goal of treatment for constipation is to help the patient to have regular bowel movements, but to ease the process of defecation.
Simple lifestyle changes can prevent or treat many cases of chronic constipation. Four things are important:

  1. Dietary fiber: Constipation is varied rare in people following a traditional diet but is more common in people consuming fast foods. This is due to the lack of dietary fibers in fast foods. The Institute of Medicine recommends 38 grams of fiber a day for men before age 50 and 30 grams a day for older men. For women, the recommended amount is 30 grams a day before age 50 and 21 grams a day thereafter. The daily intake of fiber can be increased slowly until the target is achieved. This can be started with the consumption of high fiber diet.
  • Fiber-rich foods:
  • Shredded wheat( 1 cup has nearly 6 gm fiber)
  • Oatmeals( 1 cup cooked oatmeal has almost 4 gm fiber)
  • Barley( 1 cup cooked has nearly 9 gm fiber)
  • Brown rice( 1 cup cooked has nearly 4 gm fiber)
  • Whole wheat bread ( 1slice has nearly 3 gm fiber)
  • Spinach (1 cup cooked has 4 gm fiber)
  • Broccoli (½ cup has nearly 3 gm fiber)
  • Carrot (1 medium has nearly 2 gm fiber)
  • String beans (½ cup has nearly 2gmfiber)
  • Baked beans (1 cup canned has nearly 10 gm fiber)
  • Kidney beans (½ cup cooked has nearly 6gm fibre)
  • Pear (with skin, 1 medium has nearly 6 gm fiber)
  • Apple (with skin) (1 medium has nearly 4gm fibre)
  • Banana (1 medium has nearly 3 gm fibre)
  • Prunes (6contain nearly 12 gm fibre)
  • Raisins (¼ cup contain nearly 2gm fibre)
  • Peanuts (10 nuts contain nearly 1 gm fibre)
  • Popcorn (1 cup contain nearly 1gm fibre)
  • Wheat bran (crude) (1 ounce contains 12 gm fibre)
  • Wheat germ (1 ounce contains 4gm fibre)

It is better to limit foods that are high in fat and low in fibre, like curd and cheese, processed foods and meat.

  1. Exercise. Exercise speeds the transportation of wastes through the intestinal tract and thereby helps to cure constipation or prevent it. I simpler words, moving the body helps in moving the intestines and thereby promotes movement of stools out.
  2. Fluids. Everyone with severe constipation should consume 6 to 8 glasses of water per day/
  3. A good routine. Never withhold the urge to empty the bowels as withholding the urge can give the intestines a wrong message.
    The above-listed lifestyle changes can relieve constipation largely. If it is not relieved by adapting the above listed improved lifestyle, mild laxatives can be tried.

CONSTIPATION – AYURVEDA PERSPECTIVE

The Ayurveda perspective of constipation begins with the Concept of Agni and Koshtam, as described by different Ayurveda scholars. The importance of these 2 concepts is that all Ayurveda scholars have the same views and classifications for Agni and Koshtam, unlike many other vast topics regarding routines or disease symptoms or treatments where they rived different opinions and suggestions.

Agni:
The major Ayurveda textbooks ( Samhithas) explain Agni as a very important factor which plays a vital role in digestion and metabolism. According to Ayurveda scholars, a person with Sama Agni is considered to be healthy; which means Agni should not be too intense or too mild in order for digestion and metabolism to take place appropriately. Sama Agni leads to proper digestion which results in proper metabolism and serves the vital functions of the body, which sustains life. The fact that an optimal metabolism is essential for the healthy maintenance of the body can be compared to the aspect of Sama Agni.
Agni has been classified into 13 types by Charak Acharya :
Jatharagni. Based in the stomach and it is only one and the most important among the 13 Agni.
Jathara Agni is responsible for the digestion of the food ingested and its separation into essence (Saara) and waste (kitta). (This description makes the concept of Agni similar to the metabolism detailed in modern medicine).
Bhoothagni: 5 types Based on the 5 basic elements (Vaayu(air), Agni( fire), Jala( water),Prithwi( earth ) and Aakasha( space))
Dhatuagni: 7 based on Sapt dhatus( 7 vital components of the body)

• Charak Acharya has classified Jatharaagni into 4 types based on its ability to digest- Vishamaagni, Theekshnaagnii, Mandaagni and Samaagni.
1.Vishamamagni is indicated with inconsistent digestion- sometimes the food gets digested faster and sometimes too slow . it is associated with Vata dosha predominance.

  1. The quick digestion of food ingested, where the individual gets hungry at frequent intervals, indicates Theekshnaagni. It is associated with Pitta dosha predominance.
  2. Manadaagni indicates very slow digestion or lower metabolism. For the same reason, the individual can consume only a small quantity of food and it takes a longer time duration to digest it. It is associated with kapha dosha predominance.
  3. Sama Agni indicates a stable state of metabolism where digestion takes place normally and where all the 3 doshas are maintained in proper balance.

Koshtam:
There are three types of digestive tracts (Koshta):

  1. Kroora Koshta – wherein the person will take a long time for digestion. Bowel evacuation will be irregular. It is influenced by Vata.
  2. Mrudu Koshta – Sensitive stomach, influenced by Kapha Even Administration of milk will cause bowel evacuation. The bowel evacuation will be at shorter intervals.
  3. Madhya Koshta – The healthy and balanced Koshtam, characterized by normal bowel movements. It is influenced by Tridosha balance.

As evident from the above description, Constipation can be a consequence of an individual with Krura koshtam . According to Ayurveda, Vata ( one among Tridoshas) controls the evacuation of faeces and it also states that when Vata dosha increase beyond the normal level it can result in Shakrut Graha
(Constipation). As explained in Ayurveda textbooks, while there is a decrease of faeces, Vata moves in an upward direction in the intestine causing discomfort and pain in the region of the heart and flanks. (This clearly can be related to the shortness of breath and chest pain occurring in a constipated individual).

The individual with Kroora koshta usually experiences constipation and expels hard stools and Kroora koshta is usually associated with Vishama Agni.

Usually Kroora koshta is seen in an individual having Vata predominance or Vata Kapha ( dual) predominance in their body constitution. When Kapha is dominant, it hampers the normal functioning of Vata. This in turns leads to irregular bowel movement s and eventually in constipation.

Ayurveda describes constipation using different terms like Shakrut graham, Vibandham, Badha pureesham etc. It is mainly described among with symptoms of some major diseases affecting intestines and the digestive tract.But it is not considered as a separate disease in Ayurvedic textbooks. This is mainly because constipation is mainly a lifestyle disorder and during the era when Ayurveda formed the mainstream of medicine, there were fewer chances for a lifestyle disorder.
The pathology of constipation can be explained as the causative factors aggravating Apana vata( which controls lower bowel movements) and hampers its normal functioning resulting in constipation.

Constipation treatment in Ayurveda:


Though Ayurveda does not consider or emphasize on Constipation as a major disease, there are many treatment modalities, which can be used for the temporary and permanent cure for constipation.
• Mrudu snehana( mild intake of oils or Ghee) can be used for treating constipation. Dadimadi Ghrutha, Sukumara Grutham, Castor oil etc. can be used like this.
• Ayurveda suppositories like Guda varthi or Phala varthi can be used for facilitating bowel movement.
• External oil massage pertaining to the abdomen helps in leading Apana Vatha to its normal state and facilitation =g bowel movement. Any oil can be used for this purpose. It will be great if the oil is massaged to the navel and the lower abdominal region.
• The following medicines also help in relieving constipation:

  • Abhayarishtam
  • Amalakarishtam
  • Aragwatharishtam
  • Dantyarishtam
  • Drakshaarishta
  • Duralabharishtam
  • Padoladyarishtam
  • Pippalyasavam
  • Pootheekaranjasavam
  • Pootheekasavam
  • Useerasavam
  • Abhayadi Choornam
  • Ashta Choornam
  • Avipathi choornam
  • Bruhath Triphala Choornam
  • Dadimashtaka Choornam
  • Hinguvachadi Choornam
  • Thakrarishta Choornam
  • Thripahala choornam
  • Vaiswanaram Choornam
  • Pulimkuzhampu Gulika
  • Virechana Gulika
  • Vayu Gulika
  • Chithrakagranthikadi Kashayam
  • Dusparsakadi Kashayam
  • Drakshadi Kashayam
  • Gandharvahasthadi Kashayam
  • Kalasaakadi Kashayam
  • Pachanamrutham Kashayam
  • Patolakadurohinyadi Kashayam
  • Agasthya Rasayanam
  • Drakasha Leham
  • Hrudyavirechanam Leham
  • Maanibhadram Gulam
  • Nayopayam Leham
  • Sooranamodakam
  • Trivrit lehyam
  • Padoladi Gana kashyam
  • Home remedies for constipation:
  • Raisins soaked in water
  • Increase the use of fruits and smoothies
  • Consumption of lukewarm water with ghee
  • Aloe vera gel intake regularly

Single drugs used in the treatment of constipation


Gooseberry powder
Vibheethaki powder
Castor oil


Yoga poses to relieve constipation:


Regular exercise or any type of physical activity plays a vital role in boosting metabolism. And thereby helps to relieve constipation.
Yoga comprises of several poses, breathe control, and do not make use of any external media to work out. It helps to promote circulation and digestion and thereby serves to increase the metabolic rate.

Regarding metabolic boosting and constipation relieving, all Yoga poses could do a considerable impact- but below mentioned are a few major yoga poses, which can produce a severe impact on metabolism.

  1. Ardha Pavanamuktasana:

Lay down at your back on the floor or Yoga mat. Keep your hands close to your body on sides. Breathe in slowly and lift your right leg. Keep the toes of the right leg relaxed while lifting it. Meanwhile, keep the left leg stretched. Breath out slowly and bend the right leg at the knees. Then grab the leg below the knee with both hands (as shown in the picture) and try to bring the leg closer to your stomach. The head can rest on the floor. Breathe in and out and hold the position for 30 seconds. Repeat with the left leg. Minimum of 3 repetitions for both legs will be good. Shavasana should follow this.

2.Pavana Muktasana:

Lay down at your back on the floor or Yoga mat. Keep your hands close to your body on sides. Breathe in slowly and lift both your legs up and straight. Then bend both legs at the knees inwards towards your stomach while breathing out. At the same time, lift your head off the floor or mat and bend, try to touch your knees with your chin-grasp the legs below the knees with your palms, and try to grab the legs closer to your stomach as possible. Hold the position for 30 seconds. Then breathe in and relax and get back to the starting position. Repeat it for 3 times minimum followed by Shavasana.

  1. Bhujangasana:

Lay down on the floor or yoga mat. The hand should be kept near the side of the body palm on the floor. Extend the legs as we normally lay on stomach, but make sure that the legs are kept closer to each other. Breathe in and slowly lifts your head up. While lifting the head, arms should stretch up as shown in the figure resting the palms on the floor. The weight of the body will be on palms.
Tile the head backwards as possible. The body also should stretch backwards. The legs should be very relaxing. Hold this position for several breaths seconds and then return to the starting position. This pose can have a minimum of 3 repetitions followed by Shavasana.

  1. Trikonasana

Stand straight on the yoga mat or floor. Extend your arms horizontally with the palm facing downwards. The legs should be kept at a 3 feet distance. Turn your right foot outwards and the left should be kept slightly inwards. Then lift the left arm up while slightly twisting and bending the body in such a way as to touch the right arm on the ground on the left side of the left foot. Hold the pose for several breaths, return, and repeat with the other side. This pose can have a minimum of 3 repetitions and you can relax on Shavasana.

  1. Dhanurasana:

Lie down on your stomach. Keep your legs away from each other as possible. Keep hands on the side parallel to your body. Inhale and raise the upper portion of the body slowly while holding the ankle with your stretched hands. Hold the position as long as you can and then, slowly exhale and get back to the laying position.

  1. Surya Namaskara:

Surya Namaskar or Sun Salutation is the best pose to increase sweat, circulation, digestion and metabolism.

Position 1: Stand with the legs closer on the mat or floor. Fold your palms in front of the chest. Breathe normally.
Position 2: Raise the arms over the head, so that palms touch each other on sides and the arms touch the ears. Slowly bends the body backwards. Inhale and stretch as much as you can. Then hold the position for a few seconds and then exhale.
Position 3: Inhale and bend the body downwards. Try to place the palms on the side of the feet. Try to touch your knee with the forehead. Hold on for few seconds and then exhale.
Position 4: Take the right leg back and keep the left leg in the front while keeping the palms firm on the ground. Head should be-be kept normally but straight. Inhale.
Position 5: Now bring the left leg back with the right leg. Raise the hip off the floor. And should be placed firmly on the floor to support the body. Exhale.
Position 6: Lower the body slowly so that knees, chest touches the ground. Palms should be on the floor, while elbows bend outwards. The neck should be stretched and the head should be kept a bit bent upwards. Hold your breath.
Position 7: Keep the waist down on the ground and raise the upper body. Look up. Arms should be straight. Inhale slowly.
Position 8: Lift your hips. The palms should be placed firmly on the floor. The heels should also be kept on the floor. Look down. Exhale slowly.
Position 9: Repetition of position 4.Inhale
Position 10: Repetition of position 3. Exhale
Position 11: Repeat position 2. Inhale.
Position 12: Repeat position 1. Breathe normally.

Modern Medicines used in the treatment of constipation:

Laxatives:

Laxatives are substances that loosen stool or stimulate a bowel movement.

The main classes of laxatives are :

  1. Bulk-forming laxatives: They are not digested. They move through the body undigested, absorb water and swell to form a stool.
  2. Stool softeners: They increase the amount of water absorbed by the stool to make it softer and easier to pass.
  3. Lubricant laxatives: They coat the surface of the stool and intestinal lining to keep the moisture locked and thus help to form softer stools and thereby easier passage.
  4. Osmotic-type laxatives: These help the colon to retain more water and thus increase the frequency of bowel movements.
  5. Saline laxatives: These draw water into the small intestine to encourage a bowel movement.
  6. Stimulant laxatives: They speed up the movement of the digestive system to induce a bowel movement.

Laxatives- side effects:
Though over-the-counter laxatives can be very helpful in alleviating constipation, using them frequently and regularly can cause electrolyte disturbances and changes in acid-base balance, eventually leading to heart and kidney damage in the long term
Electrolytes — which include calcium, chloride, potassium, magnesium and sodium — regulate a number of body functions. An electrolyte imbalance can cause abnormal heart rate, weakness, and convulsions.

Medical intervention will be required if the following symptoms are observed in a person who has been on the laxative for a prolonged period:

• Nausea
• Dizziness
• Abdominal cramps
• Bloody stools
• Severe cramps or pain
• Weakness or unusual tiredness
• Dizziness
• Rectal bleeding
• Unexplained changes in bowel patterns
• Constipation that lasts longer than seven days irespective of laxative use

mayoclinic.org has sited the following table, which describes the types, and side side effects of laxatives. They have cited examples with certain brands of laxatives.

Risks of laxative use:
• Interaction with medications- Laxatives can effect the action of some antibiotics, and certain heart and bone medications. Therefore, it is always better to ask the pharmacist or the medical practitioner on using some laxatives.
• Complicating conditions – Laxative use can be dangerous if constipation is caused by a serious condition, such as appendicitis or bowel obstruction.
• Precautions for pregnant women and children – Children under 6 year of age should not be given laxatives.. Pregnant women should seek advice from the medical practitioner before using laxatives.


ARTICLES ON CONSTIPATION.

  1. Chronic Constipation
    ncbi.nlm.nih.gov/pubmed/
    Abstract:
    “Chronic constipation is a prevalent condition that severely impacts the quality of life of those affected. Several types of primary chronic constipation, which show substantial overlap, have been described, including normal-transit constipation, rectal evacuation disorders and slow-transit constipation. Diagnosis of primary chronic constipation is achieved through several steps including the exclusion of ‘alarm’ features (for example, unintentional weight loss or rectal bleeding) that might indicate organic diseases (such as polyps or tumours) and a therapeutic trial with first-line treatments such as dietary changes, lifestyle modifications and over-the-counter laxatives. If symptoms do not improve, investigations to diagnose rectal evacuation disorders and slow-transit constipation are performed, such as digital rectal examination, anorectal structure and function testing (including the balloon expulsion test, anorectal manometry or defecography) or colonic transit tests (such as the radiopaque marker test, wireless motility capsule test, scintigraphy or colonic manometry). The mainstays of treatment are diet and lifestyle interventions, pharmacological therapy and, rarely, surgery. This Primer provides an introduction to the epidemiology, pathophysiological mechanisms, diagnosis, management and quality of life associated with the commonly encountered clinical problem of chronic constipation in adults unrelated to opioid abuse.”
  2. Chronic constipation
    A review of the literature
    ncbi.nlm.nih.gov/pmc/articles

Abstract
Background:
Chronic constipation is described as a common complication determined by the difficult and/or rare passage of stool or both. The difference in the definition of constipation has led to a wide range of reported prevalence (i.e., between 1% and 80%). Various factors are involved in the pathogenesis of the disease, including the type of diet, genetic predisposition, colonic motility, absorption, social economic status, daily behaviours, and biological and pharmaceutical factors. Diagnostic and therapeutic options play a key role in the treatment of chronic constipation. There are still debates about the timing of these diagnostic and therapeutic algorithms.

Methods:
A systematic and comprehensive search will be performed using MEDLINE, PubMed, EMBASE, AMED, the Cochrane Library and Google Scholar. A better understanding of the pathophysiology of chronic constipation and efficacy of pharmacological agent can help physicians for treating and managing symptoms.

In this study, some of the old and new therapies in the treatment of chronic constipation have been studied based on controlled studies and strong evidence. We are trying to address some of the controversial issues to manage the disease and to provide appropriate diagnostic options in an efficient and cost-effective way.

Results:
The results of this systematic review will be published in a peer-reviewed journal.

Conclusion:
To our knowledge, our study will provide an overall estimate of chronic constipation to assess controversial issues, available diagnostic and therapeutic strategies of chronic constipation.

References:


•Ashtanga Hridayam
•health.harward.edu
•Babycentre.com
•Webmed
•Naturalforce.com
•Healthline.com
•Americanpregnancy.org
•Medalerthelp.org
•Mayoclinic.org

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