1. Classification of laxatives
At present, the commonly used laxatives in clinical practice can be divided into the following categories, which take effect through different mechanisms.
1. a lubricating laxative
Lubricate the intestinal wall, soften the stool, and make the stool easier to pass, such as liquid paraffin, glycerin (10-30 ml each time orally), peanut oil, soybean oil or sesame oil: 15-30 ml each time orally, etc. The main disadvantages of this type of medicine are poor taste and weak effect, and long-term use can cause malabsorption of fat-soluble vitamins.
2. Stool softener
Softens the stool and makes it easier to pass. It is better for patients with constipation due to taking certain prescription drugs or sitting for a long time. The most commonly used in this class of drugs is docusate sodium.
Natural dietary supplements can absorb water and help patients maintain regular bowel habits. It is suitable for people with insufficient dietary fiber intake.
4. Volumetric laxatives
For example, plantain, magnesium sulfate, etc., because they are not absorbed by the intestinal wall but are soluble in water, they can absorb a large amount of water in the intestine, which increases the capacity of stool and plays a cathartic effect. But because it cannot increase colonic tension, it is not suitable for patients with slow bowel movements.
5. Stimulant laxatives
Fast action and strong potency. Drugs or their metabolites can stimulate the intestinal wall and increase intestinal peristalsis, such as bisacodyl and senna. Such drugs sometimes cause adverse reactions such as abdominal cramps. In addition, because the drugs stimulate the intestinal mucosa and nerve plexus of the intestinal wall, they may cause permanent damage to the intestinal wall, so it is not suitable for long-term use.
6. Osmotic laxatives
Keep the intestinal tract moist and make the stool easy to pass. Commonly used are polyethylene glycol, sorbitol, lactulose, salt laxatives, etc. Osmotic laxatives are effective, but excessive use can cause water and electrolyte imbalance in the body.
Lactulose, which is not absorbed by the body, is decomposed by bacteria and releases organic acids to act in the colon. Especially suitable for the elderly, pregnant women, children and postoperative constipation. Use with caution in diabetic patients. The main disadvantage of this type of medicine is the fermentation of bacteria to produce gas, causing discomfort such as abdominal distension.
Second, the use of laxatives
The selection of laxatives should be determined according to the instructions for use of the medicine and the specific conditions of the patient. Excessive use can cause serious side effects, and laxatives should not be used for weight loss. In January 2014, the FDA issued a safety warning about the over-the-counter laxative sodium dihydrogen hydrochloride, stating that there are rare case reports that multiple use of this type of drug within 24 hours can cause severe kidney and heart damage and even death. Especially for special people with constipation medication, you should be more cautious.
1. Elderly constipation medication
On the one hand, constipation in the elderly can induce the onset of cardiovascular and cerebrovascular diseases, and on the other hand, many treatment drugs for the combined diseases of the elderly can induce constipation. In terms of choice of therapeutic drugs, it is easy to choose osmotic laxatives for long-term treatment, and probiotics can also be considered for patients who often use antibiotics.
When constipation occurs in the elderly, organic intestinal diseases should be ruled out first, and then laxatives should be used to relieve symptoms. First of all, probiotics should be selected. Commonly used are containing Bifidobacterium, Lactobacillus and so on. This type of preparation can remove "garbage" from the body, adjust the balance of intestinal flora, restore normal intestinal function, and keep stool smooth.
Secondly, the elderly can choose oral laxatives according to their system and condition. Patients with simple constipation should choose Maren pills, Tongtai capsules and lactulose. Maren pills are intestinal moisturizing drugs, 1-2 times a day, 6 grams each time. Tongtai capsules are natural fiber plant polysaccharides. The first dose is doubled, and the maintenance dose is 3 times a day, 1-2 capsules each time. Drink plenty of water when taking it. The effect is best when taken on an empty stomach. Lactulose is a mild laxative. Take 2-3 times a day for the first two days of constipation, 10-20 grams each time, and once a day, 7-10 grams each time.
Constipation occurs in elderly patients with high blood pressure and heart failure. In addition to Maren pills and lactulose, liquid paraffin can also be used to relieve diarrhea. Because liquid paraffin can lubricate the intestines and soften stools, it has a laxative effect. The usual amount is 10-20 ml, and it will be effective 6-8 hours after the medication. It is best to take it before going to bed, but not for a long time. Such as long-term oral administration of the drug will affect the absorption of fat-soluble vitamins and stimulate the proliferation of gastrointestinal granulation tissue.
People with diabetes and constipation should choose cisapride. Cisapride can accelerate gastric and intestinal motility. Use 3-4 times a day, 5-10 ml each time. It should be taken before meals, but pay special attention to the fact that the drug cannot be used with Take erythromycin, ketoconazole, and itraconazole together.
2. Pregnancy medication for constipation
Pregnant women have reduced bowel movements, weakened intestinal tension, reduced exercise volume, and pressure from the uterus and fetal head, causing difficulty in defecation, constipation and even hemorrhoids. The best way to correct is to pay attention to the diet, exercise more, have regular bowel movements, and not use laxatives, nor should you use Kaisailu.
Clinical studies on lactulose in pregnant women in China have confirmed its safety and effectiveness. Lactulose is a synthetic disaccharide. After entering the intestine, it will not be absorbed into the blood by the small intestine, which can lead to the formation of an osmotic gradient in the intestine, which can retain water as much as possible and does not enter the milk. Therefore, it can be used during pregnancy and lactation.
3. Constipation medication for mental patients
It is mainly related to the anticholinergic effect of certain antipsychotic drugs. If fundamental treatment is required, it is necessary to consider changing the drug, changing to a drug with weak anticholinergic effect, or choosing drugs with different mechanisms of action, such as 5-HT reuptake inhibitors , There are side effects of diarrhea. In addition, reduce the combination of drugs to reduce side effects. Such as symptomatic treatment, you should start with the patient's diet and living habits.
For patients who need long-term treatment such as antipsychotic constipation, it is not recommended to use stimulant laxatives to prevent damage to the intestinal wall.