This article relays pertinent information regarding how constipation is addressed through a variety of pharmacologic and non-pharmacologic interventions.
Constipation is basically a change in the normal bowel habits of a person. This is characterized by a decrease in the usual frequency of bowel movement and/or the passage of dry stool. How can you address this problem? This article relays pertinent information regarding how constipation is addressed through a variety of pharmacologic and non-pharmacologic interventions.
Pharmacological activities are using laxatives as appropriate and administering enema or irrigation, as appropriate. There is very limited research on these activities and specific pharmacologic agents. The few laxative trials that are available vary widely in the definition of constipation used, population studied, and outcomes measured. Laxatives may be classified as bulk-forming, emollient r softener, saline, hyperosmotic, stimulant, suppositories, and enemas. The actions, precautions, and research support for each of these drug categories are discussed in turn. Selection of specific pharmacologic agents should be made after considering the following:
- The factors contributing to the individualís constipation, including concurrent illnesses
- Side effects of the agents, including drug interactions
- The individualís home bowel management pattern and plan (pharmacological and non-pharmacological measures)
- Opportunities to enhance nonpharmacological measures
- Research evidence on the effectiveness of the drug
- Invasiveness of the agent
- User preference
Nonpharmacologic Intervention: Fiber Supplementation
Fiber supplementation is another dietary activity frequently recommended to prevent constipation. The fiber in bran can decrease intestinal transit time by adding nonnutritive bulk to the stool. Fiber also binds with water to form a gelatinous substance that acts to inhibit resorption of water by the intestinal wall. Studies examining the effectiveness of high fiber have been conducted in the community, acute-care and long-term settings.
Positive findings about fiber supplementation have not been universal, and a number of parameters remain unclear, hampering the practical application of this recommendation to practice.
- People often find fiber supplements unpalatable and consume less than the prescribed amount.
- There is no consensus on the amount f fiber that is desirable, feasible, and effective.
- There is no consensus on the best form of dietary fiber as evidenced by the great variety of supplements that have been evaluated. The various forms of fiber have different effects on the gastrointestinal tract influenced by characteristics such as solubility and particle size. Furthermore, questions have arisen about the safety of such commonly used fiber supplement ingredients as prune juice, which is purported to distort the colon and cause atonia with long-term use.
- Fiber may not be effective with certain conditions, including right colonic stasis, outlet obstruction, and spinal cord injury.
Nonpharmacologic Intervention: Exercise
Exercise is another activity commonly recommended for constipation. The proposed mechanisms for a relationship between inactivity and constipation include lack of stimulus to cause mass propulsion, loss of normal reflexes when response to rectal distention is delayed, dilation of the rectum, increased transit time, reduced visceral blood flow, an loss of assistance from gravity. Research on the relationship between exercise and constipation has focused on community populations and, with one exception, has found that inactivity is associated with self-reported constipation. Encourage independently mobile individuals to walk three times a day to a distance as tolerated. As for those weak with ambulation, you can assist them daily (preferably to toilet after breakfast).
Nonpharmacologic Intervention: Toileting
Toileting is proposed for inclusion in the nonpharmacologic interventions because the availability of adequate toilet facilities, privacy, and the time necessary to defecate are as important to normal bowel function as an intact gastrointestinal tract. Others note that prolonged inhibition can result in progressive ineffectiveness of the defecation reflex.