Most people will experience constipation in their lives, light, heavy, long or short. Constipation is a very unpleasant experience, especially severe and stubborn constipation, which is even more painful. So how should we treat constipation?
1. Treatment principles for chronic constipation :
(I). Find the cause of constipation as much as possible, and then treat the cause accordingly;
(II) . Adjust the dietary structure, drink more water, and supplement dietary fiber;
(II). Establish good bowel movement habits: develop bowel movement habits once a day.
(IV), quit smoking and drinking;
(V), maintain a good mood ;
(V), exercise appropriately to enhance intestinal peristalsis and muscle tone and promote defecation;
(VII), choose appropriate drugs according to different conditions:
1 , Volumetric laxatives, also known as leavening agents: representative drugs are polycarboniocal and wheat cellulose granules;
2. Permeable laxatives: such as polyethylene glycol , laxatives
3. Irritating laxatives: such as rhubarb , senna leaf , aloe vera , aloe vera , as well as phenolphthalein (fruit guide), bisacodine, castor oil, etc. It is not suitable for long-term use;
4. Lubricating laxatives: such as liquid paraffin, glycerol , docusate sodium and other vegetable oils; weaker effect and poor taste;
5. Promoting agents: such as mosapride , prikapride;
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8. Intestinal probiotics: such as bifidobacterium, lactobacillus , Clostridium tsylate , Bacillus licheniformis, etc.;
9. Drugs that promote the secretion of intestinal fluid : Rubiprostone:, linaclotide , eloxibate;
10. Chinese patent medicines for treating constipation: such as Maren pills, Maren capsules, Sanhuang tablets, aloe vera capsules, Simo decoction, etc.
can also choose two drugs for combined treatment under the guidance of a doctor. A large number of studies have shown that the combined treatment of two drugs for constipation is significantly better than the effect of single-agent treatment . Common combination treatment methods used to treat stubborn constipation include:
1, polyethylene glycol (or lactulose) + intestinal probiotics
2, mosabilil + intestinal probiotics
3, polycarbofil calcium + intestinal probiotics;
4, mosabilil + polycarbofil calcium
5, mosabilil + polyethylene glycol (or lactulose)
6, bisacodine + mosabilil
7, bisacodine + Simo Tang
8, polycarbofil calcium + Maren pills;
9, polyethylene glycol (or lactulose) + Ma Ren Capsule
10, polyethylene glycol + lactulose
2. Treatment of constipation in the elderly:
At the grassroots level that increases exercise and adjusts dietary structure, the following matters should be paid attention to:
1. Under the guidance of a doctor, drugs that cause constipation should be stopped as much as possible;
2. For patients with dry and hard stools and blocked anus, they should first give enema or rectal administration with liquid paraffin, or put on sterile rubber gloves to remove blocked stools with hands.
3. When choosing drug treatment, individualized treatment principles should be followed. Severe patients can also undergo combined treatment of two drugs.
1) For patients who do not have enough dietary fiber intake and do not have strict contraindications for drinking water, oral volume laxatives such as polycarbofil calcium, wheat fiber granules, and Ochlid can be preferred to increase the volume and looseness of the stool to facilitate excretion of the stool; 2) If the effect is not obvious after oral volume laxatives such as polycarbofil calcium, you can consider switching to polyethylene glycol or lactulose; these two drugs are also safe and effective in treating constipation in the elderly;
3. If the effect is still not good after oral polycarbohydrate and lactulose, you can consider combining probiotics on the basis of the above treatment;
4. Supplementing vitamin B1 and methylcobalamin to nourish nerves, especially for patients with diabetes , loss of appetite, and malnutrition;
5. The promotor drug Prolucapriligy 2 mg/d, treats senile constipation, safe, effective and well tolerated; intestinal secretion drug: Rubiprostone can significantly improve constipation symptoms and no obvious adverse reactions. It has been approved for use in elderly patients with chronic constipation.
6. For patients with severe constipation, it is also possible to consider short-term use of irritating laxatives such as rhubarb, senna, aloe, phenolphthalein (fruit guide), bisacodine, castor oil, etc. to relieve symptoms; remember: It is not suitable for long-term use;
7. For elderly patients with renal failure, volumetric laxatives, salt permeable laxatives and irritating laxatives should be avoided;
8. For patients with cardiac insufficiency, salt permeable laxatives should be avoided;
3. Treatment of constipation during pregnancy
The safest drug for treating constipation during pregnancy is: volumetric laxatives. This type of drug generally takes a slower effect and is mainly suitable for long-term treatment of patients with no complications. It is not suitable for the relief of acute symptoms, and is also prohibited for patients with fecal impaction. Studies have shown that wheat cellulose granules can significantly improve the stool traits and reduce dysfunction of bowel movements, and no obvious adverse reactions were found during the medication.
animal experiments have proved that lactulose and polyethylene glycol have no teratogenic effects and are safe and effective for pregnant women. Lactulose is not absorbed in the intestine, so it will not affect the growth and development of the fetus and will not enter the milk. Therefore, can still be used during lactation. The American Gastroenterology Association (AGA) recommends: Polyethylene glycol is the first choice for constipation in pregnant women; for patients with severe constipation, polyethylene glycol and lactulose can also be treated in combination.
If volumetric laxatives (such as wheat cellulose) and permeable laxatives (such as polyethylene glycol and lactulose) are ineffective, you can consider using bisacodine in irritating laxatives. Although bisacodine has not been reported for teratogenicity, it will cause spasms and .
Drugs that are not suitable for use during pregnancy:
1, salt-based laxatives, because this type of drug can cause sodium retention in the mother, and should be avoided;
2, mineral oil can affect the mother's absorption of fat-soluble vitamin , It is not suitable to use;
3, rhubarb, senna leaves, aloe and other plant laxatives containing anthraquinones, which should be avoided during pregnancy because the dananthraquinone is related to congenital malformations;
4, senna leaves, which can enter milk, should also be avoided during breastfeeding;
5, castor oil can cause uterine contraction, which should be avoided during pregnancy;
6, dokuester sodium: There are reports that long-term use of this drug during pregnancy caused hypomagnesemia in mothers and neonates; the US Drug and Food Administration (FDA) has classified the pregnancy safety of dokuester sodium as C, that is, animal studies have proved harmful to the fetus (teratogenic or embryonic death, etc.), but there is no clinical research evidence. It is not clear whether sodium dokuster is secreted into milk, so breastfeeding women should also use it with caution.
When using any drug for pregnant women, you must keep in mind the principle of "harmlessness" in mind, understand the teratogenicity and safety of the drug in detail, and achieve safe and effective treatment.
4. Treatment of constipation in children
The prevalence of constipation in children is about 7% to 30%”; Treatment of constipation in children:
1. First, emphasize basic nursing and treatment
1), family education : Let parents learn more about constipation and learn more about parenting knowledge;
2), train children's bowel habits: For children over 3 years old, children should be encouraged to go to the toilet for 5~10 after breakfast 5~10 after breakfast Min;
3), Lifestyle adjustment: Diet reasonably and exercise, including: drinking enough water, increasing plant food intake, and increasing outdoor activities; I recently encountered a 4-year-old child with constipation, who had been constipated for nearly a year, but after going to his hometown in rural areas for a few days during the National Day holiday, the bowel movement was normal without using any medicine; but once I returned to the city, the bowel movement was abnormal again;
4), Psychological behavior treatment Treatment: Children's tension and anxiety will cause dry and hard stools to be difficult to relieve, and the painful experience of relieved stools will lead to children's fear of relieved stools; therefore, it is also very important to relieve children's tension and anxiety and create a relaxed and comfortable defecation environment.
2. For children with hard stools and blocked anus, they must first remove dry and hard stools and relieve anal blockage. You can choose to use open-stools or warm saline enema; then you can use safe and effective drugs such as probiotics, polyethylene glycol, lactulose, etc. to maintain daily defecation. To prevent the stool from clogging the anus again.
Due to the lack of sufficient clinical information, it is not suitable for children to use prodynamic drugs and secretory drugs for constipation.
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