Pay attention to the causes

Chronic constipation is often idiopathic, that is without any explicable cause. It can also be caused by some diseases or medications. The former includes Parkinson’s disease, as well as the condition shortly after a stroke. Diseases in the anal region such as fissures, haemorrhoids or anal stenosis can cause the patients to keep back their stool which will then harden. As a result, acute constipation develops.

It helps if PTA checks the medication schedule whenever constipation occurs in connection with newly prescribed medicines. Opioids are classic constipation-promoting drugs. Constipation is one of the most common side effects of opioids. Opioid-induced constipation occurs at the beginning of an opioid therapy and usually persists throughout the treatment period. Psychotropic drugs such as tricyclic antidepressants or neuroleptics are also known to affect the bowel activity. Anticholinergics or some antihypertensives can slow down bowel movements as well and cause problems with the stool.

In the case of Parkinson’s disease patients, but also people taking opioids, those affected benefit if PTA proactively addresses the topics of bowel emptying and constipation and offers appropriate advice.

To find a suitable laxative, the individual needs of the patient must be taken into account. The aim is to ensure a reliable effect with a defined effectiveness as well as a physiological stool consistency; in addition, the remedy should be well tolerated and easy to dose.

According to the step-by-step plan concept of the S2k-guideline Chronic Constipation, therapy in the case of mild symptoms should be started with dietary fibres such as linseed or psyllium husks (e.g. Mucofalk®, Agiocur®, Linusit® Gold Linseed). They increase the stool volume and thus provide a stretching stimulus in the rectum. During the application, it is important to drink sufficiently. However, the effect often does not suffice for patients with a delayed intestinal passage. Dietary fibres can also trigger unpleasant side effects such as flatulence or abdominal cramps.

The remedy of choice for a long-term therapy are therefore osmotically active preparations. Macrogols (e.g. Movicol®, Dulcolax Balance®) bind fluid in the intestinal lumen via osmotic effects and reduce reabsorption. The stool volume increases and a defecation stimulus is triggered. The powders are to be dissolved in water and taken one to three times a day, independent of any meals. They are available unflavoured as well as in different flavours. The effect is felt after one to two days. Sugar alcohols such as lactulose (e.g. Bifiteral®) have a similar effect. However, since intestinal bacteria break down the sugar alcohols, their use is usually accompanied by disturbing gas formation, flatulence and meteorism.