Constipation - a common problem

Constipation is a group of symptoms affecting up to 20% of the population. When caused by a specific disease (tumour, diverticula,

narrowing of the bowel or hypothyroidism), it is referred to as secondary and treated with respect to the causative agent. Primary

constipation is either caused by poor motility of the large bowel (so-called lazy bowel syndrome or inactive colon) or by difficult evacuation

due to an impaired defecation reflex or an anatomical obstruction in the rectal region (= terminal constipation). A patient with

chronic constipation should be examined thoroughly by his general practitioner or by a specialist – gastroenterologist. It is the cause of

constipation that determines the treatment. For instance, secondary constipation caused by a tumour cannot be treated with laxatives,

but with surgery. Terminal constipation can be managed with physiotherapy or surgically and the patients often may not need to take

laxatives. By contrast, lazy bowel syndrome frequently cannot be treated satisfactorily otherwise than with long-term use of laxatives.

The role of the pharmacist consists in informing patients of when a medical examination can be recommended and in recommending

the best treatment available that will bring relief to the patient. Treatment often has to be individualized with one patient responding

well to a certain preparation and another to a different one. Laxatives include bulk forming, stimulant, osmotic and other agents. Laxatives

are not only used in patients with constipation but also to cleanse the bowel before surgical or diagnostic procedures involving the

large bowel. As for stimulant laxatives (e.g. Guttalax), the myth persists both among the lay and expert public that these laxatives are

deleterious, lead to addiction, and worsen the existing constipation. None of the above has been confirmed scientifically. These laxatives

are fully effective and safe, even when used for more than 15 years. The increase in dose during this long period of time is only small.

Therefore, discouraging patients who benefit from stimulant laxatives from their long-term use is not warranted. Bulk laxatives include

a wide range of over-the-counter preparations and their main constituent is fibre. Hyperosmolar solutions (Fortrans) or lactulose can

also be used as laxatives. The article summarizes the recent knowledge on the causes and treatment of constipation with an emphasis

on the possible role of the pharmacist.

Keywords: constipation, lazy bowel, anismus, laxatives, biofeedback