Selection of clinically essential drugs for chronic constipation (with updated guidelines, evidence-based medical evidence grading)

Guide

Constipation is a (group) symptom characterized by difficulty with bowel movements and/or decreased frequency of bowel movements and dry and hard
stools.
Dysfecation includes laborious bowel movements, difficulty passing bowels, feeling incomplete, anorectal blockage, time-consuming bowel movements, and the need for assisted bowel
movements.
Reduced bowel movements are defined as fewer than 3 bowel movements per week
.
The course of chronic constipation is at least 6 months
.

Constipation seriously affects the daily life and quality of life of patients, and the treatment methods of chronic constipation mainly include: (1) general treatment: increase dietary fiber and water intake, increase exercise, establish good bowel habits, etc.
; (2) drug treatment; (3) biofeedback therapy; (4) Surgical treatment
.

Among them, drugs are commonly used treatment methods for chronic constipation, and the evidence-based medical evidence, safety, drug dependence and potency ratio
of drug application should be considered when selecting therapeutic drugs.
This article summarizes
the commonly used laxatives in clinical practice.

cathartic

Volumetric laxatives and osmotic laxatives are mainly used in patients with
mild to moderate constipation.

(1) Volumetric laxative (leavening agent)

By retaining water in the feces, increasing the water content and volume of the feces plays a laxative role, so that the dry and hard feces become soft and easy to excrete
.

Commonly used drugs: psyllium, polycarbo noncalcium, wheat bran, etc
.

(2) osmotic laxatives

After oral administration, it can form a hypertonic state in the intestine to absorb water, and at the same time prevent the intestine from absorbing water, resulting in increased intestinal content volume, promoting intestinal peristalsis, and causing bowel
movements.

Commonly used drugs: polyethylene glycol, unabsorbed sugars (such as lactulose), salt laxatives (such as magnesium sulfate), etc
.

It should be noted that excessive use of salt laxatives can cause electrolyte imbalance, and should be used
with caution in the elderly and patients with reduced renal function.

As a remedy, stimulant laxatives can be used for short-term, intermittent use
.

(3) Stimulant laxatives

Mainly by stimulating the sensory nerve endings in the colonic mucosa, enhancing colonic motility, and stimulating intestinal secretion, thereby promoting bowel movements, its effect is strong and rapid, can cause abdominal pain
.

Commonly used drugs: bisacodyl, phenolphthalein, anthraquinones, castor oil, etc
.

(4) Lubricating laxatives

It has the effect of softening feces and lubricating the intestinal wall so that feces are easy to discharge
.

Commonly used drugs: liquid paraffin, glycerin, docusate sodium and other vegetable oils
.