Before starting a constipation diet, contact your doctor; in fact, behind constipation we often hide more serious problems, for example also the stenosing tumor of the rectum and of the sigma. For this reason it is always necessary to carry out instrumental and laboratory investigations before starting a constipation diet. Other frequent causes of constipation are a wrong diet, a condition of diabetes or hypothyroidism, sedentary life, obesity.
Dietary sources of
dietary fibers are the cell wall of plants (non-cellulosic
polysaccharides), the non-structural polysaccharides normally found in foods (mucilage
and gums) and substances used as additives (gums, pectins).
Fruits and
vegetables have a fiber content equal to 0.5-4.5 grams for every 100 grams of
edible product, so that their consumption contributes 50% to the daily needs.
Legumes such as peas, beans and lentils are very rich in fiber, and dried ones
in particular because they have a double content compared to fresh ones. However,
bran is one of the richest in fiber: 10-50%, depending on the different
measurement techniques.
It must first of all be a diet in which refined foods such as white flour,
refined sugar and all foods containing it are reduced or excluded. An increase
in consumption of fruit, vegetables and legumes is equally desirable; a daily
intake of a portion of legumes and a consumption of fruit and vegetables of at
least 500 grams / day of each would be useful.
Cereals (pasta, bread and rice)
must therefore be unrefined; it is difficult to indicate minimum quantities, as
the packaging processes vary from region to region and from one manufacturer to
another.
A sufficient quota varies from 300 to 400 grams/day. It is also
preferable to consume unrefined cereals with greater water content (bread and
pasta) than dry ones (breadsticks and crackers). If these dietary norms have no
effect on the improvement of constipation, it is useful to associate bran with
daily diet in a recommendable amount of 25 grams / day. It is also useful to
increase water consumption and movement to favor daily peristalsis.
Diet with fibers, mass laxatives and osmotics
Diet for constipation with fibers
At breakfast: tea or coffee, or yougurth, or milk, rusks or biscuits or other
wholegrain products, raw or cooked fruit
Lunch: vegetables cooked in oil (carrots, zucchini, cabbage, artichokes, etc.),
meat, raw fruit (one fruit), wholemeal bread
Dinner: salad mixed with oil, fish or ham or cheese, raw and cooked fruit,
wholemeal bread
Drink some glasses of water possibly bicarbonate-alkaline-earthy (besides the
usual consumption), away from meals
The laxatives to be preferred are those of mass, as they stimulate the colon in
a physiological way. Osmotic laxatives can be recommended as first choice drugs
(high therapeutic index and low incidence of side effects). The use of contact
laxatives is instead not recommended as habitual therapy for the risk of induced
hypovitaminosis, for the hypotonia of the intestinal muscles and for the
progressive decrease in sensitivity by the colon to the stimulus exerted by the
fecal mass. Patients who report abuse of laxatives should be re-educated
progressively by administering preparations based on bran or glucomannans,
advising the oral intake of at least one liter of water per day; in the early
times or in resistant cases can be associated an osmotic laxative, for example
the classic lactulose (eg duphalc, laevolac, portolac etc.).
Remember that it takes at least 3-4 weeks to re-educate a "laxative-dependent" colon to contract and to get used to the stimulus of defecation. Generally, it is during this period that the patient, disappointed with what he considers to be a therapeutic failure, returns to the contact laxative or to the evacuating enemas. It is therefore necessary to inform the patient of the time necessary to regain a regular bowel and of any symptoms (meteorism, sense of abdominal swelling) associated with the intake of fibers and osmotic laxatives. When the hygiene-behavioral rules mentioned above prove ineffective, after an adequate period of compliance (sometimes it may take months to educate a long-term impaired intestinal function or altered by laxative abuse). The doctor must make a careful choice in the vast group of drugs and purgative substances (those that cause a liquid evacuation) or laxative (those that make the stool soft but not liquid).
At breakfast:
tea or coffee, or yougurth, or milk, rusks or biscuits or other
wholegrain products, raw or cooked fruit
There is no universally accepted classification of these substances. Generally,
classically, they are subdivided into:
- Borborigmi, flatulence
Sodium sulfate (Glauber's salt)
- Osmotic water retention = increase in volume
- Electrolyte imbalances (dehydration)
Diet with fibers, mass laxatives and osmotics
Lunch:
vegetables cooked in oil (carrots, zucchini, cabbage, artichokes, etc.),
meat, raw fruit (one fruit), wholemeal bread
Dinner:
salad mixed with oil, fish or ham or cheese, raw and cooked fruit,
wholemeal bread
Drink some glasses of water possibly bicarbonate-alkaline-earthy (besides the
usual consumption), away from meals
Classification of laxatives
- Mass laxatives
- Osmotic laxatives
- Lubricating laxatives
- Irritating laxatives
Mass laxatives
Psyllium
lspagula
Bran
Agar
Methylcellulose
Carboxy
glucomannan
Polycarbophil calcium
Eg. Agent
Psyllium dose used 4-30 g
Ispagula "" 2-15 g
Bran "" 15-30 g
Latency 12-72 hours
Mode of action: absorb and retain water, resulting in an increase in the volume
of faeces, stimulating peristalsis for mechanical relaxation;
- They release fatty acids with an irritant action
- Increased excretion of bile acidsSide effects
- Nausea, vomiting, diarrhea
- Abdominal distension
- Allergic reactions (psyllium: eosinophilia and bronchospasm)
- Interference with the absorption of sugars, electrolytes, bile salts, lipids
Pregnancy: safe drugs
Contraindications:
- Adhesions
- Stenosis
Osmotic laxatives
Magnesium sulfate (Epsom salt or English salt)
Sodium phosphate
Sodium and potassium tartrate
Magnesium oxide
Magnesium citrate
Mannitol
lactulose
lactitol
Sorbitol
Eg. Agent
Sodium sulfate used at dose 5-15 g
Magnesium sulphate 10-30 g
Sodium phosphate g
Sodium and potassium tartrate 8-16 g
Magnesium oxide 2-4 g
Magnesium citrate 10-20 g
Latency: 30'-180 'per os
5'-15 'by rectal route
Mode of action
- Increased secretion of water = increase in volume
- Stimulate peristalsis
- Magnesium action on CCK, which causes gallbladder contraction
reduction of sodium and water absorption in the small intestine
- stimulation of gastric secretion and pancreatic enzymes
- Variable diuretic action
Side effects
- hypermagnesaemia: hypotension of asthenia, disturbances of the heart rhythm
and of the respiratory rhythm
- Abdominal pain, nausea
Contraindications:
- hypertension
- Cardiopathies and hemodynamic decompensation, arrhythmias
- Feeding time
- Nephropathy
- Anal fissures
ES. LACTULOSE Dose: 5-30 g
Latency: 24-48 hours
Mode of action:
Split into lactic acid and acetic acid: osmotic mechanism and pH reduction with
subsequent activation of peristalsis. Also useful in Hepatic encephalopathy.
Side effects:
- Meteorism
- Abdominal pain
- Osmotic diarrhea
Contraindications:
- Galactosemia
Breastfeeding: Permitted
Gastroenterology