Constipation drug classification.
1.Volumetric laxatives.
Representative drugs: cellulose, plantain
Clinical role: fermentation by bacteria in the intestine, increase intestinal osmotic pressure and prevent the absorption of water in the intestine, enhance laxative. Drinking more water after taking the drug can improve the efficacy. However, the effect of such drugs is slow, and large doses are likely to cause abdominal distension, abdominal pain, and should be used with caution for patients with colonic weakness.
2, stimulating laxatives.
Representative drugs: anthraquinone-containing plant laxatives (senna, rhubarb, hemp pills), castor oil, etc.
Clinical role: can directly stimulate the colonic mucosa and promote peristalsis. Long-term application of such drugs can produce dependence and even damage the patient’s enteric nervous system, making the colon less dynamic and further aggravating constipation. In addition, anthraquinones can cause colonic melanosis, should be alert.
3, osmotic laxatives.
Representative drugs: lactulose, mannitol, sorbitol, polyethylene glycol, salt laxatives
Clinical role: produce a hyperosmotic environment in the intestine, increase the osmotic pressure in the intestinal cavity, so that water and electrolytes are retained in the intestinal cavity, softening stools, used to treat mild and moderate constipation with good results.
Lactose and sorbitol can be decomposed in the intestinal lumen to produce lactic acid and acetic acid, etc., which lower the colonic pH, stimulate the colonic mucosa and promote intestinal peristalsis, and the main adverse effect is intestinal flatulence.
Polyethylene glycol increases the water content of stool by fixing water molecules in the intestinal cavity through hydrogen bonding in the molecule, softening the stool. It is not absorbed by the intestinal tract and does not affect the absorption of fat-soluble vitamins and electrolyte metabolism. It is indicated for patients with constipation combined with hypertension, heart disease and renal insufficiency.
Salt preparations (magnesium sulfate, sodium citrate) in the intestinal tract is not completely absorbed, laxative effect is more rapid, should be noted that excessive application can cause electrolyte disorders, the elderly and renal decompensation is used with caution.
4.Lubricating laxatives.
Commonly used drugs are paraffin oil, which can lubricate the intestinal cavity, prevent the absorption of water in the colon, so that the stool can be easily excreted, mainly for patients with hard stools.
Long-term application can interfere with the absorption of fat-soluble vitamins, with gastroesophageal reflux, the elderly and frail, long-term bedridden people should be cautious with such drugs, in order to avoid causing lipid aspiration pneumonia.
5.Pro-intestinal dynamics drugs
Act on the intestinal nerve endings, regulate the release of neurotransmitters or directly on the smooth muscle of the intestinal wall to promote intestinal dynamics.
Mosapride is currently used in clinical prokinetic drugs, with Mosapride as the basic power drug, with other types of laxatives is an effective program for the treatment of slow transmission type constipation.
Tegaserod : It is a 5-hydroxytryptamine 4 receptor partial agonist that promotes colonic transit of contents in healthy volunteers and in patients with irritable bowel syndrome with prominent constipation. It is now discontinued due to its cardiovascular and cerebrovascular events.
Procapride: A highly selective, high-affinity 5-hydroxytryptamine 4 receptor agonist that minimally activates 5-hydroxytryptamine 3 receptors and cardiovascular potassium channel receptors, which promotes fecal transit and elimination. Side effects are headache, nausea and diarrhea.
Others: Renzapride
6.Microecological agents
Probiotics can metabolize and produce organic acids, which can make the intestinal pH value drop and regulate normal intestinal peristalsis, and at the same time can promote the excretion of food residues and facilitate the passage of feces from the rectum to the anus.
7.Other drugs.
Opioid antagonists: suitable for the treatment of opioid-induced colonic dysfunction and postoperative intestinal obstruction, such as Avemopan and methylnaltrexone.
Chloride channel activators: Lubiprostone is a prostaglandin E1-derived agent that facilitates the elimination of intestinal fluids by activating chloride channels.
Neurotrophic factor: Neurotrophic factor 3 stimulates the development and functional refinement of the nervous system and significantly increased the number of bowel openings in patients in an experimental study.
Conclusion.
Biofeedback therapy is the transformation of imperceptible biological activity information into visible and understandable signals for the patient, which in turn guides the patient in self-training and functional coordination to establish correct bowel behavior.
Constipation seriously affects the quality of life of modern people, and the research on it has been intensifying in recent years, but the current treatment effect of constipation is still unsatisfactory. In the future, we need to further standardize the treatment procedure of constipation, reasonably select drugs, and further research and develop non-pharmacological treatment measures.