Medicines

MEDICINES IN CONSTIPATION

Enema

  • In enema, a locally active agent is introduced through anus into rectum and colon that helps in evaluation of the stool, either by drawing water into the rectum (saline enema, glycerine enema) and/or by lubricating the stool (glycerin enema, oil enema).
  • Enema basically by causing rectal distension (by the volume effect) and stimulate large intestine and rectum in action and thus, helps in relieving distal bowel.
  • Enemas make backbone in bowel training programme in the children who suffer intractable constipation following anorectal surgery or due to weak nerve supply to rectum.
  • Commercially packaged enema bags are easily available in the market. The enema bags available in the market have a tip that releases the liquid inside the rectum once tip is placed just inside the rectum and the bag is squeezed.
  • Simple saline enema suffices most of the times. Oil enema, glycerine enema are required in few cases. In stubborn cases, peroxide enema can be used (1% hydrogen peroxide with olive oil can act as a slow action enema for hardened rectal plug). Soap water enema is usually not preferred as it can irritate the gut.  
  • Administration of enema, however, requires a number of precautions. Hence, it is advisable that a patient first learns the technique of enema administration or he might have to face undesirable consequences.

while administration of enema

One should be beware of loading too much of water inside a patient with heart or kidney disease, as it can be dangerous. Pushing in the fluid under great pressure can cause colonic rupture.

Pushing too much enema fluid, especially plain water enema, in presence of inflamed colon can cause water intoxication (fluid overload on heart, kidney, and other organs).

Too frequent administration of enema can cause soreness of anus.

In younger children, suppositories are preferred over enema. They are bullet shaped pills that can be pushed up the rectum and can induce defecation by their local actions (glycerin suppository, dulcolax suppository).

Laxatives

  • Laxatives are the agents taken by mouth either in liquid, tablet gum, powder and granular form and facilitate passage of stools in various ways.
  • They can be
    • Bulk forming laxatives : They are the safest fiber supplements. They swell up after absorbing water from the intestine and make stool softer e.g. fleased husk.
    • Stimulants : They cause rhythmic muscle contractions in the intestines e.g. Bisacodyl
    • Lubricants : Grease enables stools to move easily inside the intestine e.g. mineral oil taken at bed time. They should never be taken with meals as oil can present absorption of vitamins from food.
    • Saline laxative : They draw water inside the colon and facilitates easy passage of the stool.  e.g. milk of magnesia.
  • Laxatives are indicated when a person fails to pass stools for 4 days or more and has no stomach pain. For temporary relief of constipation enema is a favoured option as it is unfair to trouble the whole gut when the problem lies in the lower part of the gut (intestine).