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Constipation, treatment and diets for constipation

  1. Gastroepato
  2. Gastroenterology
  3. Constipation, treatment
  4. Diverticulosis
  5. Laxative abuse, melanosis coli
  6. Irritable colon, variety
    with constipation
  7. Treatment of irritable
    bowel syndrom

The advice of your doctor online

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.

The diet rich in fibers

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.

Constipation, diets for constipation

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

Drugs for constipation

Laxatives

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).

Constipation, diets for constipation

Diet with fibers, mass laxatives and osmotics

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

Classification of laxatives

There is no universally accepted classification of these substances. Generally, classically, they are subdivided into:

- 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 acids

Side effects

- Borborigmi, flatulence
- 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

Sodium sulfate (Glauber's salt)
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

- Osmotic water retention = increase in volume
- 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

- Electrolyte imbalances (dehydration)
- 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

Diet with fibers, mass laxatives and osmotics
Gastroenterology