The article was prepared by a specialist for informational purposes only. We urge you not to self-medicate. When the first symptoms appear, consult a doctor.
A person with constipation faces difficult choices. The range of pharmaceutical products that help get rid of the problem is simply huge. However, you cannot rely on chance. All medications have different mechanisms of action and have certain indications and contraindications for use.
The main disadvantage of all medications for constipation without exception is their symptomatic effect. They help cope with stool retention, but do not eliminate the cause that provoked it. Therefore, constipation will return after a while.
You need to be very careful when using anti-constipation medications. First, it is recommended to find out the cause of stool retention. Most often, chronic constipation is a consequence of diseases of the digestive system. Such disorders need to be treated by a gastroenterologist. The doctor will find out their cause and prescribe specific medications.
If you don’t have time to visit a doctor, then you need to try to cope with constipation without medications, following simple recommendations:
- Every morning, immediately after waking up, you need to drink 1 or 2 glasses of water at room temperature. This should be done half an hour before the first meal. You can drink regular or mineral water, but it is important that it is without gases. This procedure allows you to cleanse the intestines and give a start to metabolic processes in the body.
- To normalize stool, you need to massage the abdomen. Coffee and honey improves stool excretion.
- You need to eat right and lead an active lifestyle. The menu should include cabbage, beets, prunes, and apricots. In general, eating vegetables and fruits raw allows the intestines to contract more actively. This is an excellent prevention of constipation.
- Before going to bed, it is useful to drink a glass of kefir, but it must be fresh.
- Castor oil helps to quickly cope with constipation.
Constipation medications can have an osmotic or irritant effect, others are prebiotics. There are also filler drugs. When choosing a specific drug, you need to decide not only on its mechanism of action, but also take into account all possible indications and contraindications.
You need to ask the pharmacist how the drug works and what active ingredient it is based on. Before taking the chosen product for the first time, you should read the instructions.
It is not recommended to use laxatives for a long time. If constipation does not go away, you need to consult a doctor and eliminate the reasons that led to bowel dysfunction.
When a person suffers from chronic constipation, it is recommended to take probiotics. They force the intestines to work correctly, while simultaneously restoring the disturbed microflora.
If you need an immediate effect, you need to do an enema. As an option, use an oil microenema.
Irritant anti-constipation medications
People with stool disorders use irritating laxatives more often than others. Their selection is huge. These drugs are taken if intestinal motility is impaired or if there is atony. Medicines from this group include: drops, suppositories, syrups, tablets. An example of such drugs is Sodium picosulfate, Bisacodyl, etc. [1].
Many plants have a laxative effect, for example, senna leaves, rhubarb root, buckthorn bark, castor oil. The effect after taking laxatives comes quickly. If you take the drug at night, stool will occur in the morning.
How do irritant laxatives work? The components that make up laxatives irritate the receptors of the colon. This causes the organ to contract. Therefore, after a few hours a person has a bowel movement.
Side effects. Doctors strongly recommend refraining from regularly taking laxatives. Otherwise, the receptors of the colon will be depleted and its tone will decrease. If laxatives are used for more than 10 days, a person may develop intestinal atony, nervous tissue undergoes degeneration, and electrolyte balance is disturbed.
Laxatives promote rapid development of addiction. The dose that helped relieve constipation when initially taken will no longer produce the desired effect. Therefore it will have to be increased.
Taking irritating drugs leads to intense abdominal pain. It is difficult to withstand, so many patients refuse such treatment.
Contraindications and indications for use. You can take an irritating laxative, but only if constipation is a one-time occurrence. Chronic stool retention is a contraindication to such treatment.
It is prohibited for infants and women to take drugs from this group during pregnancy and lactation.
Other contraindications include:
- Peritonitis.
- Cystitis.
- Perforation of the digestive organs.
- Inguinal hernia.
- Intestinal obstruction.
- Bleeding (uterine, intestinal, gastric).
- Diseases of the peritoneal organs in the acute phase.
- Anal fissures and hemorrhoids.
- Acute proctitis.
- Abdominal pain, the cause of which is unknown.
Before using any laxative for the first time, you should consult a doctor.
Bisacodyl (Laxatin, Laxacodil, Dulcolax, Bisacodyl, Pirilax, Laxbene, Stadalax)
These drugs are recommended to be taken when it is necessary to prepare the intestines for examination. They can be used against constipation caused by surgery, as well as errors in diet and idiopathic stool retention.
Take the drug 1 tablet before bedtime. If the desired effect does not occur, then the dose is increased to 2 or 3 pieces [2].
Side effects include:
- Flatulence and abdominal pain.
- Intestinal colic.
- Heaviness in the stomach.
- The appearance of blood and mucus in the stool.
If the drug is taken uncontrolled and for a long time, dehydration, leaching of electrolytes from the body, and intestinal atony may develop.
pros
The advantage of the drug is that the intestines are cleansed efficiently. After taking the medicine, you can undergo organ diagnostics, for example, a colonoscopy. The effect comes quickly, after 6 hours. Depending on the individual characteristics of the body, stool may occur even after half an hour or an hour. It brings relief. In general, the drug acts gently and fully copes with the task. It can be used to treat young children.
Minuses
If you take Bisacodyl for a long time, a person will develop an addiction to it, which manifests itself in the form of intestinal atony. As a result, the natural urge to defecate may disappear altogether. You won’t be able to go to the toilet without the next dose. Also, taking the drug threatens the removal of useful substances from the body. If Bisacodyl is used uncontrollably, the likelihood of developing acute intestinal inflammation increases. In addition, it has many side effects that have been described above.
Sennosides A and B (Senade, Regulax, Herbion Laxana, Antrasennin, Tisasen, Ex-Lax, Senna chewable lozenges, Senna holly leaves, Senalex)
All of the listed drugs contain anthraglycosides, which are present in the leaves of the senna plant. Its laxative properties have been known for a long time. Taking senna-based medications promotes rapid excretion of feces. A person does not develop addiction. The effect occurs within 6-12 hours.
They take medications to normalize stool against the background of hemorrhoids, with weak intestinal motility, with atony of the organ and with spastic constipation. The dose depends on the drug chosen. It is best to take it before bed.
Side effects and contraindications are the same as for Bisacodyl.
pros
Preparations based on senna are of plant origin, that is, the basis of laxatives is a natural component. Their use allows you to quickly cope with constipation. The effect occurs within a few hours. Addiction to the drug does not develop. Senna is a plant whose properties have been well studied. Therefore, such a laxative has been tested by time, and doctors are well aware of its strengths and weaknesses.
Minuses
Many patients complain of abdominal pain that precedes bowel movements. In addition, the drug has many side effects. In case of overdose, a person develops severe diarrhea.
Sodium picosulfate (Guttalax, Guttasil, Laxigal, Regulax Picosulfate, Slabicap, Slabilen)
These drugs help to increase intestinal motility, resulting in bowel movement. Their use reduces the absorption of water and electrolytes.
They take drugs based on sodium picosulfate for the same purposes as Bisacodyl. The effect occurs within 10-12 hours [3].
Side effects:
- Abdominal pain.
- Dehydration.
- Cramps.
- Weakness.
- Diarrhea.
- Fall in blood pressure.
- Electrolyte imbalance.
pros
Preparations based on sodium picosulfate do not have a systemic effect on the body; they work exclusively in the intestines. The organ is cleaned efficiently. Most patients tolerate drugs in this group well. The dose can be selected depending on the real need, that is, it can be reduced.
Minuses
With prolonged use or if the dosage is not observed, dehydration develops, as well as electrolyte imbalance. Compared to other irritating laxatives, the effect will take longer. The intestines will be cleansed only after 10 hours, not earlier. In addition, these products should not be taken by children under 4 years of age. Side effects can be quite serious.
Glycerol (suppositories Glycerin, Glycelax)
Glycerol is used in the form of suppositories. Their use allows you to lubricate the intestines, soften stool and facilitate its elimination. In addition, the drug stimulates peristalsis of the organ and irritates its mucous membrane.
Glycerol is prescribed to patients who are unable to strain the peritoneum to have a bowel movement. It is used by people after a heart attack, for hemorrhoids, and anal fissures. Glycerol is often prescribed to pregnant and lactating women [4].
Contraindications to the use of candles:
- Neoplasms in the intestines.
- Hypersensitivity to the components of the drug.
- Acute phase of hemorrhoids or proctitis.
If a person has kidney failure, then suppositories should be used with caution.
To cope with constipation, you need to insert 1 suppository into the rectum. The procedure is carried out 20 minutes after the morning meal.
Glycerol causes side effects such as itching and burning in the injection area, allergic reactions. If you use suppositories for a long time, independent bowel movement becomes difficult.
pros
The drug acts gently, its use does not cause abdominal pain. The candles are small in size, so they are convenient to insert. Glycerol has few contraindications and side effects. This is one of the few remedies that can be used by people who are unable to strain their abdominal cavity to empty their bowels. Suppositories are used in pediatric practice. The effect occurs almost instantly, feces leave the intestines within 5-10 minutes.
Minuses
With prolonged use of suppositories, intestinal contractility decreases, and addiction develops. The use of suppositories may cause irritation of the organ.
Composition and release form
The main component of the drug is bicasodil. Excipients have different compositions depending on the dosage form. These are cellulose, lactose, powdered sugar, talc, wax, magnesium stearate, medical polyvinylporrolidone, corn starch.
The laxative is dispensed in the form of:
- Tablets - have a soluble intestinal coating, for oral administration. Light brown, biconvex, round in shape. The package contains several blisters of 10 pieces.
- Suppositories are administered rectally. Contains 10 mg of active substance. Packaged in cardboard packaging of 10 suppositories.
Laxatives with a delayed effect - prebiotics
Prebiotics are safe drugs that can be used to relieve constipation in women during lactation and after childbirth. They are carbohydrates that the digestive organs are unable to digest. Therefore, they enter the colon in their original form. There, prebiotics activate the growth processes of beneficial bacteria.
Prebiotics are represented by inulin, lactulose and fructooligosaccharides. They do not provide immediate relief from constipation, but do not pose a health hazard. The effect of their use lasts longer than that of saline or irritating laxatives.
How do prebiotics work? Taking prebiotics stimulates the growth of beneficial bacteria in the intestines. The laxative effect is achieved due to the osmotic effect and slight irritation of the intestinal wall. Fermentation of prebiotics causes them to produce organic acids, which cause the muscles of the organ to contract. Lactulose is a prebiotic that is used more often than others. Taking it in a large dosage (45 ml) ensures that stool occurs within 2 hours.
Side effects. The drugs have virtually no side effects. Taking them is associated with flatulence, but after three days the bloating goes away on its own. Constipation can be dealt with with standard doses in about 2 days. The effect is delayed in time, since lactulose must pass through the entire digestive system.
Indications, contraindications, advantages. Prebiotics are used to treat acute and chronic constipation, intestinal dysbiosis, accompanied by a lack of stool. The undoubted advantage of such drugs is their detoxification effect. They are prescribed for hepatic encephalopathy, as they remove nitrogen-containing substances from the body. Thanks to prebiotics, phosphorus and calcium are absorbed better. These substances are destructive to pathogenic flora.
Lactulose (Normaze, Portalac syrup, Duphalac, Goodluck, Lactulose Poly, Livolyuk-PB, Lactulose Stada, Romphalac)
Preparations based on lactulose act mildly; they are prescribed to patients with constipation, encephalopathy, and also to prepare the digestive system for diagnosis.
Lactulose removes ammonium ions from the body, allows for better absorption of calcium and phosphorus, and stimulates the intestines to work actively. The stool becomes softer, the feces swell, and more bile is produced. All this has a positive effect on the functioning of the digestive system [5].
Contraindications to the use of Lactulose are:
- Intestinal obstruction.
- Hypersensitivity to the components of the drug (lactulose and fructose).
- Diabetes. This contraindication is not absolute, but diabetics should take lactulose-based medications with caution.
The dose is determined individually. Prescriptions must be made by a doctor. Lactulose is recommended for use for constipation in children as a safe and effective drug.
pros
Lactulose acts gently and does not cause irritation to the intestinal walls. After taking it, a person does not develop diarrhea. The time-delayed effect can also be considered an advantage, not a disadvantage. The body does not experience stress, feces come out easily. Lactulose is not addictive. It regulates the functioning of the intestines; after its withdrawal, atony of the organ does not develop, and its peristalsis does not suffer. Constipation goes away, and the physiological rhythm of the intestines is restored. Beneficial microflora is activated and copes better with harmful microbes. The drug can be used to treat children and pregnant women.
Minuses
The drug can cause bloating, which is accompanied by characteristic pain. The taste of Lactulose is not always pleasant, so children may refuse to take it. The drug has no other disadvantages.
Lactitol (Exportal, Importal N - powder for solution)
Lactitol can be found in products for diabetics. It acts as a sugar substitute. Doctors prescribe Lactitol to patients prone to constipation. Taking the drug allows you to make stool softer, they swell and leave the intestines more easily. Stool occurs a day after taking Lactitol. When a lasting effect can be achieved, the dose of Lactitol is gradually reduced.
Side effects after taking the drug are limited to bloating and the appearance of a certain discomfort against this background [6].
pros
The drug not only helps to cope with constipation, but also has an antitoxic effect, removing nitrogen-containing compounds from the body. Its intake has a positive effect on the intestinal microflora. Harmful microbes die, and beneficial flora, on the contrary, multiply.
The drug acts exclusively at the intestinal level and does not have a systemic effect on the body. Taking Lactitol is convenient because it can be mixed with almost any liquid, for example, juice, coffee or tea.
Lactitol can be used to treat constipation in children and people with diabetes.
Minuses
The effect does not come as quickly as we would like. A person's stool occurs only after a day. After the first dose of Lactitol, bowel movement will occur only after 2-3 days. The drug can cause increased gas formation, which leads to abdominal discomfort. In case of overdose, vomiting may occur. During treatment you need to drink a lot of water, which causes some difficulties for some patients.
How does the laxative Bisacodyl work?
Bicasodil is a strong drug. The main pharmacological effect is laxative. It has a direct effect on the nerve receptors of the large intestine, helping to restore peristalsis and its natural release. The drug stimulates the synthesis of mucus, so emptying the body occurs easily.
Along with the normalization of intestinal motor function, Bicasodil accumulates fluid in it. Due to this, the feces soften and are excreted without problems.
After oral administration, the therapeutic effect of the laxative is observed after 6 hours. When using a suppository, the effect occurs after 30-60 minutes.
Osmotic laxatives
If a person has diseases of the digestive system and is plagued by chronic constipation, one should not try to cope with the problem with the help of osmotic laxatives. They are recommended to be taken only once, when stool retention is acute, or a person has poisoning (food or drug). Also, osmotic laxatives are prescribed for high-quality preparation of the intestines for diagnostic measures.
Drugs in this group do not cause intestinal atony, so some of them, for example, Kolokit, Forlax, can be taken for up to 3 months. However, it must be borne in mind that they do not affect the cause of constipation, but simply eliminate it. Patients do not develop addiction to the drug [7].
How do osmotic laxatives work? After taking an osmotic laxative, fluid begins to accumulate in the intestines, water is removed from fat cells and blood plasma. This allows you to soften the stool and make it larger in volume. Emptying of the organ occurs against the background of increased osmotic pressure.
Side effects. Drugs in this group, when taken for a long time, promote the removal of salts from the body and disrupt its water-electrolyte balance. Therefore, they should be prescribed with extreme caution to children and people with heart disease.
After taking osmotic laxatives, abdominal pain occurs, which can be quite intense.
Indications and contraindications. Osmotic laxatives are prescribed for nutritional poisoning or intoxication with medications. They are also used to relieve acute constipation. Polyethylene glycol is approved for the treatment of nursing and pregnant women.
Carlsbad artificial salt
This drug is a substitute for geyser Karlovo salt and is classified as a saline laxative. Its intake promotes increased secretion of bile. The drug is prescribed for nutritional poisoning, constipation and chronic cholecystitis. It is forbidden to take salt to patients with intestinal obstruction, as well as at high body temperature.
Side effects from taking Carl's salt:
- Atony of the large intestine.
- Water and electrolyte imbalances.
- Diarrhea.
Take salt on an empty stomach. Give a teaspoon to children over 2 years old, dilute the specified amount of the drug in half a glass of water. Adults are advised to take a tablespoon of salt, which is diluted in a glass of water. Start eating after 40 minutes.
pros
The drug helps not only cope with constipation, but also improves the functioning of the gallbladder. Charles salt makes it easier to cope with poisoning caused by ingesting expired foods, alcoholic beverages, medications, etc.
The drug has virtually no side effects. It does not cause allergies. It can be used to treat children, but salt is contraindicated for pregnant and lactating women.
Minuses
Carl's salt cannot be combined with other medications, as it will reduce their effectiveness. It is prohibited to drink diuretics during treatment, as the likelihood of dehydration increases many times over. Violation of storage conditions leads to changes in the properties of salt, as a result of which it may lose its qualities. Therefore, the drug must be kept at a temperature of +22-27 °C.
Macrogol (Lavacol, Osmogel, Fortrans, Relaxan, Tranzipeg, Forlax, Forteza Rompharm)
Macrogol is often used as a laxative. It can be taken for a long time (up to 3 months). This will normalize intestinal function. To ensure that after completing the course there is no malfunction in the digestive system, a person will need to follow a diet and also exercise.
The drug is not absorbed into the blood; it works only at the intestinal level. After taking it, patients do not experience abdominal discomfort and gas formation does not increase. Macrogol softens stool and facilitates bowel movements.
The drug does not lead to dehydration and does not interfere with metabolic processes. The effect develops 1-2 days after the first dose. It is recommended to drink Macrogol during breakfast. The dosage is determined by the doctor [8].
pros
The drug allows you to thoroughly cleanse the intestines and completely remove all contents from it. This is especially true for people who are undergoing an organ examination. You can take Macrogol for a long time. The drug acts only in the intestines and is not absorbed into the systemic circulation.
Minuses
Many patients note the unpleasant taste of the drug. To feel the laxative effect, you need to take a large amount of the drug. Most Macrogol-based drugs are prohibited for use by children, nursing and pregnant women.
Magnesium hydrate sulfate (bitters salt, Epsom salt, magnesium, epsom salt)
The drug is prescribed for biliary dyskinesia, to relieve constipation, for inflammation of the gallbladder, to prepare for a diagnostic examination of the intestines, and for intoxication with heavy metal salts.
In addition to the laxative effect, magnesium sulfate has a choleretic effect on the body. For your appointment, take one packet of the drug, which is diluted in 100 ml of water [9].
pros
Magnesium sulfate is an effective and fast-acting remedy for relieving constipation. It is widely used in medical practice. It liquefies even the hardest stones and does not cause inflammation of the intestines and gastrointestinal tract as a whole.
Minuses
The drug is not prescribed to children under 15 years of age, patients with heart disease and disorders of the central nervous system. It relieves constipation but does not address its cause. With uncontrolled use of the drug, a person develops dehydration. If you take magnesium sulfate for more than 3 months, it will negatively affect the functioning of your kidneys and heart.
Contraindications
Absolute contraindications for the use of laxatives are:
- Children under 2 years of age.
- Allergic reaction to active or auxiliary components.
- Violation of the integrity of the anus.
- Severe gastrointestinal diseases.
- Inflammation of the anterior abdominal wall.
- Hernia.
- Spastic constipation.
- Intestinal neoplasms.
- Pain in the epigastric region of unknown etiology.
- Inflammatory lesion of the caecum.
- Gynecological bleeding.
- Cystitis.
- Dehydration of the body.
- Violation of water balance.
- Blood loss from the gastrointestinal tract.
It is also not recommended to use the drug during pregnancy, lactation, liver and kidney diseases.
Fast acting laxative
Microlax is a microenema that is used for rectal administration. The effect develops within 15 minutes after its application. Feces become soft and easily leave the intestines. One tube is enough to provide a laxative effect. Sodium citrate, which is part of the drug, acts as a peptizer. Sodium lauryl sulfoacetate has a thinning effect, and sorbitol attracts water into the intestines. Together, these substances contribute to the rapid cleansing of the organ from feces.
Microlax is prescribed to patients with constipation, as well as to cleanse the intestines before an upcoming study. For children over 3 years old, 1 microenema is recommended, which is administered into the rectum [10].
pros
The drug acts very quickly, so it can be used to quickly relieve constipation. Enemas are allowed for children. There are no side effects from the treatment.
Minuses
Not all patients are comfortable with an enema to relieve constipation. Sometimes certain circumstances do not allow this. Some people experience discomfort from the procedure, indicate a burning sensation and other unpleasant sensations. In addition, Microlax does not affect the cause of constipation itself; an enema simply eliminates this symptom. No other shortcomings of the drug were identified.
Side effects
A laxative can cause negative reactions such as:
- Gas formation.
- Pain in the epigastrium.
- Feeling nauseous.
- Possible vomiting.
- Diarrhea, including the profuse type, which leads to dehydration.
- Lack of intestinal motility.
- Allergic manifestations in the form of swelling, itching, development of urticaria symptoms.
- Local irritation in the anus when taking suppositories.
Enteric fillers
Intestinal fillers are substances that the gastrointestinal tract is unable to digest. They are not absorbed into the systemic circulation. The laxative effect is achieved by increasing the volume of feces. Fillers can be represented by both modified saccharides and herbal agents.
Some patients suffering from chronic stool retention refuse to take these laxatives, since their effect does not always develop. There is also a high probability of flatulence, rumbling in the stomach, and pain along the intestines.
Intestinal fillers: agar-agar, flax and flaxseed, wheat bran, sterculia, methylcellulose, psyllium husk (oval or ovoid) [11].
How do enteric fillers work? Fillers, regardless of their type, absorb water. The intestinal walls stretch, so the organ tries to get rid of excess fluid. Feces come out along with the water. However, with atony of the organ, these remedies are ineffective. To develop a laxative effect, you need to drink as much water as possible (at least 2 liters per day).
Fillers are classified as mild agents that do not immediately relieve constipation. Depending on the chosen drug, the effect develops after 12 hours (when taking agar-agar) or after 24 hours (when taking flyavort seeds). Methylcellulose will help you cope with constipation in only 1-3 days.
- Side effects. When taking fillers, the intestinal walls stretch, the organ fills with gases, and strong rumbling may occur. In order for the full effect to develop, a person must drink a lot of water, which is not always possible. An obstacle to this can be various diseases of the urinary system and not only.
- Contraindications. Pregnant women should not take medications for constipation, as this increases the likelihood of spontaneous abortion. Fillers are prohibited for people with IBS, as well as bedridden patients, people with intestinal obstruction and diseases of the nervous system.
Etiology of constipation
In the development of physical diseases, social factors play a significant role, including stress, unhealthy lifestyle and nutrition (physical inactivity, lack of ballast substances in the diet, irregular meals, small amount of food, insufficient daily fluid volume, laxative abuse) [9, 10]. Normalizing nutrition and increasing physical activity, as a rule, lead to normalization of intestinal functions. This group includes nutritional, or, as M. Kamm puts it, simple constipation, caused by a deficiency of dietary fiber. In such patients, with the onset of the fruit and vegetable season, the stool usually returns to normal without additional treatment.
Hormonal imbalance during pregnancy, menopause, hypothyroidism, diabetes mellitus, hyperparathyroidism and other diseases also leads to physical dysfunction [11].
Constipation develops when taking certain medications (anticholinergics, opiates, tricyclic antidepressants, neuroleptics, antispasmodics, calcium channel blockers, laxatives, antacids containing aluminum and calcium, iron ions, diuretics, etc.), with cerebral and spinal disorders, depression, multiple sclerosis , dysregulation of the peripheral and enteric nervous systems [1, 11, 12]. Neurogenic constipation develops under the influence of stress (for example, with irritable bowel syndrome), a sudden change in the usual lifestyle or diet (long trips, flights).
