Pharmacoterapy of

Constipation
Andi Alfia MT
Pharmacology Department, Medical Faculty
Universitas Tadulako
2020

1
 Epidemiology
Prevalence

• North America 3.2–45% (median 16%), Europe 0.7–79% (median 19.2%), Asia 1.4–32.9% (median 10.8%), Oceania
4.4–30.7% (median 19.7%), South America 26.8–28% and the study from South Africa showed a prevalence rate of
29.2%
• Indonesia  general population 16,2%

Distribution

• Age  more prevalent after the age of 60 years & laxative use increases with age
• Sex  females >>
Epidemiology
 Definition
• Functional constipation is a disorder
characterized by persistent difficult or seemingly
incomplete defecation and/or infrequent bowel
movements (once every 3–4 days or less) in the
absence of alarm symptoms or secondary causes.

• Symptom, not a disease

• Can be caused by a variety of diseases or drugs

 Associated Factors
• socioeconomic status
• educational level
• excessiveweight or obesity
• immobility or less self-reported physical activity
• consumption of fibre, fruit and vegetables
• positive family history of constipation
• experiencing anxiety, stressful life events and
depression
Pathophysiology
Possible causes and constipation-associated
conditions
Medications associated with constipation
Diagnostic Criteria
Diagnostic Criteria
Diagnostic Criteria
Diagnostic Criteria
Treatment
Guideline
 Laxatives: Bulk forming
• High fiber
• Absorbs water to increase bulk
• Distends bowel to initiate reflex bowel activity
• AEs
– Impaction
– Fluid overload
• Examples:
– psyllium (Metamucil)
– methylcellulose (Citrucel)
– Polycarbophil (FiberCon)
 Laxatives: Emollient
• Stool softeners and lubricants
• Promote more water and fat in the stools
• Lubricate the fecal material and intestinal walls
• AEs
– Skin rashes
– Decreased absorption of vitamins
• Examples:
– Stool softeners: docusate salts (Colace, Surfak)
– Lubricants: mineral oil
 Laxatives: Hyperosmotic
• Increase fecal water content
• Result: bowel distention, increased peristalsis, and
evacuation
• AEs
– Abdominal bloating
– Rectal irritation
• Examples:
– polyethylene glycol (GoLYTELY)
– sorbitol (increases fluid movement into intestine)
– glycerin
– lactulose (Chronulac)
 Laxatives: Saline
• Increase osmotic pressure within the intestinal tract, causing more water
to enter the intestines
• Result: bowel distention, increased peristalsis, and evacuation
• AEs
– Magnesium toxicity (with renal insufficiency)
– Cramping
– Diarrhea
– Increased thirst
• Saline laxative examples:
– magnesium sulfate (Epsom salts)
– magnesium hydroxide (MOM)
– magnesium citrate
– sodium phosphate (Fleet Phospho-Soda, Fleet enema)
 Laxatives: Stimulant
• Increases peristalsis via intestinal nerve stimulation
• AEs
– Nutrient malabsorption
– Skin rashes
– Gastric irritation
– Rectal irritation
• Examples:
– castor oil (Granulex)
– senna (Senokot)
– cascara
 Laxatives: Indications
Laxative Group Use
Bulk forming Acute and chronic
constipation
Irritable bowel syndrome
Diverticulosis
Acute and chronic
Emollient constipation
Softening of fecal impaction;
facilitation of BMs in
anorectal conditions
 Laxatives: Indications (cont'd)
Laxative Group Use
Hyperosmotic Chronic constipation
Diagnostic and surgical
preps
Constipation
Saline Diagnostic and surgical
preps
Removal of helminths
and parasites
 Laxatives: Indications (cont'd)
Laxative Group Use
Stimulant Acute constipation
Diagnostic and
surgical bowel preps
 Laxatives: Cautions
• Assess fluid and electrolytes before initiating therapy
• Patients should not take a laxative or cathartic if they are
experiencing nausea, vomiting, and/or abdominal pain
• A healthy, high-fiber diet and increased
fluid intake should be encouraged as an alternative to laxative
use
• Long-term use of laxatives often results in decreased bowel tone
and may lead to dependency
• All laxative tablets should be swallowed whole, not crushed or
chewed, especially if enteric coated
• Bisacodyl and cascara sagrada should be given with water
due to interactions with milk, antacids, and H2 blockers
Thank You