Fight constipation: key tips

Constipation in adults is one of the most frequent consultations in the pharmacy, standing out in both its acute and occasional forms, and its chronic form, especially in older patients. In this group, it affects more than 50% of people over 65 years of age due to decreased intestinal motility and polypharmacy. It is essential to understand what is considered constipation, when it is considered chronic, and what medications can cause it. In addition, factors such as low fiber and water consumption, along with a sedentary lifestyle, are associated with constipation.

In the pharmacy, it is crucial to provide appropriate recommendations on nutrition and measures that facilitate evacuation. An imbalance in the intestinal microbiota is also associated with constipation, and probiotics may be a complementary treatment option to improve intestinal transit.

Laxative misuse, in terms of self-medication and abuse, is a significant concern, especially in older people and those with eating disorders. Pharmaceutical advice is essential for the correct use of laxatives and to adapt recommendations to the circumstances of each patient.

Definition and Classification of Constipation

Definition: Constipation is a change in bowel habit characterized by a decrease in the frequency of bowel movements, difficulty passing stools with hard stools, and/or a feeling of incomplete evacuation. The normal frequency varies between three bowel movements a day and one every three days. The diagnosis is based on the Rome IV criteria (2016).

Types of Constipation:

• Acute: Caused by specific factors such as changes in diet, stress or pregnancy, and disappears spontaneously in less than three months.
• Chronic: Related to alterations in intestinal motility (functional constipation) or due to pathologies or chronic use of certain medications (secondary constipation), lasting more than three months.

Drugs That Can Cause Constipation

Some medications are known for their ability to induce constipation, including:

• Opioid analgesics.
• Iron and calcium supplements.
• Antacids with aluminum.
• Antipsychotics.
• Tricyclic antidepressants (such as amitriptyline and clomipramine).
• Antiparkinsonians.

Excessive use of laxatives, especially stimulants, can cause a paradoxical reaction increasing constipation due to decreased intestinal function (colonic atony).

Non-Pharmacological Treatment

Non-pharmacological treatment is the first step in the management of constipation, although it may be insufficient in cases of defecatory dyssynergia and constipation due to slow transit.

High Fiber Diet and Water Intake:

• The WHO recommends a daily intake of 25-40g of fiber, with a preference for soluble fiber.
• The consumption of fruits, vegetables, legumes and whole grains is essential.
• Studies indicate that consuming two golden kiwis a day improves stool consistency and reduces defecatory effort.
• It is essential to accompany fiber consumption with adequate fluid intake (1.5-2L daily).

Other measures:

• Regular moderate physical activity.
• Try to go to the bathroom at the same time.
• Avoid repressing the desire to defecate.
• Use an appropriate posture to facilitate defecation (rest your feet on a stool to elevate your knees).

Probiotic Supplementation:

• Multispecies probiotics can improve constipation symptoms by increasing the abundance of Bifidobacteria and Lactobacilli.
• Examples include Bifidobacterium lactis, which increases bowel movement frequency, and Bacillus subtilis, which improves intestinal motility.

Pharmacological Treatment: Laxatives

Drug treatment is the second step in the management of constipation.

Oral and Rectal Laxatives:

• Dough formers (plantago) are first-line and useful in pregnancy and lactation.
• Osmotic laxatives (lactulose, macrogol 3350) are preferred in the elderly.
• Stimulant laxatives (bisacodyl, sodium picosulfate) should be used with caution due to the risk of dependence and tolerance.
• Lubricant laxatives (liquid paraffin) can reduce the absorption of fat-soluble vitamins.

Conclusion

Constipation is a prevalent condition that requires a comprehensive approach. Pharmaceutical recommendations should focus on dietary measures, physical activity and the appropriate use of laxatives, adapted to the specific needs of each patient. Education on the correct use of laxatives and the importance of a diet rich in fiber and adequate hydration is essential for the effective management of constipation in adults.