A, cassia seeds caused by the “tragedy”
In recent years, probably because of the age, the stool is not as smooth as before, but through dietary adjustments, it is not bad. Six months ago, I suffered from “dry eyes”, and one day a famous herbalist came from a big city to the hospital near my home, so I went to see him and got back a prescription and started to take the medicine. But eating and eating eyes seem to be some improvement, but the stool can not, often not out.
This check does not matter, the original pink intestine is now black, some places like the pattern of leopard skin, there are also a few polyps.
The good intestine now has so many problems, stubborn constipation, precancerous disease intestinal polyps, black lesions of the colon, all from a medicine: cassia.
There are many other examples like Auntie Liu, and the problem of intestinal damage caused by laxatives has become more and more serious in recent years. In China, the incidence of constipation is about 15%, and up to 50% in elderly people over 60 years old. According to incomplete statistics, among these patients, about 1/5 of them are aggravated by constipation and other adverse reactions caused by taking laxatives, so the reasonable use of laxatives is urgent.
Second, the types of laxatives and clinical characteristics
According to the mechanism of action, laxatives can be generally divided into five categories, namely volumetric, stimulant, osmotic and lubricating laxatives and intestinal motility drugs. Among them, stimulant laxatives and high-dose osmotic laxatives are considered as “steep laxatives” because of their fast and strong laxative effect. Volumetric, lubricating, small doses of osmotic laxatives and enterokinetic drugs are called “slow laxatives” because of their relatively slow action. The adverse effects of laxatives have been widely recognized, and clinical use is also very cautious, while laxatives are currently the most important drugs for laxatives, and people have not paid enough attention to their harmful effects.
1.Expansive laxatives
It is mainly a laxative containing cellulose. Soluble cellulose has very good hydrophilicity and helps to keep the stool water, such as Ou Che Qian cellulose preparation (Kangjier), Kaiser, Golden Valley Fiber King, methyl cellulose, pectin, oat bran, etc. Insoluble cellulose is not absorbed and can absorb water and swell, increasing stool volume, such as plant cellulose, lignin, etc. The increase in water and volume of stool can make the stool loose and soft, accelerate colon peristalsis and easy to expel. It is suitable for the treatment of mild to moderate constipation, and the onset of action is about 24 hours after taking the drug. The drug is slow to take effect, the side effects are relatively small.
2.Lubricating laxatives
Most of them are inorganic mineral oil, which is not absorbed in the intestine and can hinder the absorption of water in the intestine, which can lubricate the intestinal wall and soften the stool, so that the stool can be easily discharged. Such as glycerin, liquid paraffin, castor oil, hemp nut laxative pills, edible oil, etc. Lubricants can also be used for enema or anal, softening stool, so that embedded in the rectum, anal canal stool can be removed.
3, osmotic laxatives
Mainly salt, sugar and alcohol three categories. Salts osmotic laxatives can form a hypertonic environment in the intestine, absorb a large amount of water and prevent intestinal water absorption, so that the intestinal volume increases, strengthen the intestinal mucosa stimulation, enhance intestinal peristalsis, promote defecation. Such as magnesium sulfate, sodium sulfate, etc. Sugar osmotic laxatives are fermented into monosaccharides by bacteria in the intestinal lumen to increase osmotic pressure, such as lactulose and sorbitol. Alcohol osmotic laxative is not fermented or bacterial decomposition, its relative molecular weight increased to more than 3000 intestinal absorption is almost zero, between its hydrogen bond can carry water, increase the volume, softening stool, polyethylene glycol (Fosone).
4.Intestinal power agent
Act on intestinal nerve endings, release motor neurotransmitters, antagonize inhibitory neurotransmitters or act directly on smooth muscle to increase intestinal dynamics. There are more drugs in this category, such as parasympathomimetic tranylcypromine, neostigmine, 5-HT4 agonist cisapride, mosapride, tegaserod, prilucapride succinate tablets, gastrin agonist erythromycin, CCK receptor blocker cloglumide, power pro-secretory agent misoprostol, colchicine), neurotrophic factor, i.e. neurotrophic factor-3 and some Chinese medicine preparations of Si Mo Tang, Liu Wei An Xiao Capsules, etc.
What are the possible side effects of long-term use of these laxatives?
Even laxatives can have certain side effects if used for a long time. In addition to the disadvantages of drug dependence, there are also the following side effects.
Swelling laxatives can reduce the sensitivity of the intestinal nerves, thus creating drug dependence. Taking large doses can easily lead to gastrointestinal distention and can affect the absorption of nutrients.
Lubricating laxatives can interfere with the absorption of vitamins A, D, E and K as well as calcium and phosphorus causing malnutrition. Secondly, it can cause anal itching and osteochondrosis. There can also be oil stains that contaminate underwear.
Salt laxatives in osmotic laxatives, if used in excess or repeatedly, can easily cause water and salt electrolyte disorders, hypomagnesemia, hypernatremia and hyperphosphatemia. Therefore, patients with fecal impaction, intestinal obstruction, congenital megacolon and electrolyte disorders should be used with caution. Patients with constipation combined with congestive heart disease should prohibit osmotic laxatives containing magnesium or phosphorus salts because such laxatives can increase blood volume and increase the burden on the heart, which can easily lead to heart failure.
Enterodynamic agents common side effects are gastrointestinal reactions, such as abdominal cramps, abdominal pain, diarrhea, intestinal tinnitus, a small number of patients appear dizziness and nausea and skin allergic reactions, in recent years, long-term use and cardiotoxicity.
Fourth, the use of laxatives precautions
There is no uniform standard on how to use laxatives to be considered reasonable. In order to maximize the clinical effect and reduce the occurrence of side effects, combined with clinical practice, the following recommendations are made.
1.Understand the characteristics and master the usage
Swelling laxatives are irritating to the gastrointestinal tract, so it is best to choose to take them half an hour after meals and drink more water. Lubricating laxatives should be taken with care to prevent inadvertent inhalation of them into the trachea, causing respiratory tract infection. Osmotic laxatives should be taken with plenty of water. Intestinal motility agents should not be used simultaneously with anticholinergics atropine, belladonna and scopolamine butylbromide, otherwise the efficacy will be reduced.
2.For the cause of the disease, identify the use of evidence
No matter what kind of laxative, must be used under the guidance of a doctor. First diagnose clearly what type of constipation they belong to, what degree, and then choose the right symptoms. For constipation of colon weakness should be filled with expansion agent. Lubricants are mainly used for senile constipation. Salt laxatives are mainly used for intestinal preparation before colonoscopy. Sugar and alcohols are currently more clinically used laxatives, both of which are less likely to cause bloating and abdominal pain than alcohols polyethylene glycol than lactulose and sorbitol. Enterokinetic agents are mainly used for slow transmission type constipation, especially for functional constipation caused by diabetes, gastrointestinal disease, etc.
3, not for a long time, flexible dosage
The laxative should not be used for a long time, but in the end how long is considered long, there is no uniform time, in principle, when the role of maintenance 1 to 2 months, and then slowly reduce the dosage, until the drug is completely stopped. There is no standard for how much each person should take, and the dosage should be increased or decreased flexibly according to the reaction after taking the drug within the safe dosage. If transient intestinal cramping abdominal pain, abdominal rumbling or diarrhea occurs during the intestinal motility agent Moxaburi, the dosage can be immediately reduced.
4, the combination of drugs, medicine and food combination
For most constipation, rarely a single cause, so the clinical often choose several types of drugs used in combination at the same time, can improve the efficacy. For example, the combination of penetrating agents and power agents, lubricants and power agents, but also with probiotics, forming a triad of drugs. It is also possible to combine medicine and food, choosing foods with similar effects with medicine to reduce adverse effects. Foods that have a similar effect of swelling laxatives include wheat bran, buckwheat, oats, apples, mushrooms, bamboo shoots, etc., which can be used in conjunction with intestinal dynamics drugs.
5.Chinese medicine laxatives, screening use
Generally think that Chinese medicine is safer and can be used for a long time, in fact, this is very wrong. Chinese medicine covers the above types of laxatives, both tonics and proprietary Chinese medicines should be readily available and screened for use. For example, rhubarb, senna and cassia are stimulant laxatives, fire hemp and cypress are lubricating laxatives, mannitol is an osmotic laxative, and betel nut, thick park, citrus aurantium and large abdominal bark are intestinal motility drugs.