How Can Chronic Constipation Be Treated Long-term?
Aug 11, 2023
With the changes in people's diet structure, the accelerated pace of life, and the influence of social and psychological factors, the prevalence of chronic constipation is on the rise. At present, the prevalence of chronic constipation in China is as high as 10%. But many people don't pay much attention to constipation, the rate of seeing a doctor is low, and they often abuse laxatives, which often leads to some serious consequences. In the past two months, two news related to constipation have been hotly searched on Weibo: one is that Aunt Wang took enzymes for 3 years and caused melanosis of the colon, and the other was that Ms. Huang took intestinal tea for 2 years and caused melanosis of the colon. These two patients had melanosis of the colon due to long-term improper use of laxatives. Therefore, the long-term management of chronic constipation needs to be paid attention to clinically. We should guide patients to treat constipation correctly, use drugs rationally, and help them improve their quality of life and reduce medical burden.
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1. Why does melanosis of the colon occur in the treatment of chronic constipation?
Melanosis coli is a non-inflammatory, benign, reversible intestinal disease that can involve the esophagus, gastroduodenal, pericolic lymph nodes, and appendix. Pigmentation of the mucosa is caused by pigment-like substances. Melanosis of the colon is on the rise year by year in China, and melanosis of the colon can be associated with intestinal diseases such as colonic polyps, colon cancer, and colitis.
The onset of colonic melanosis is mainly caused by anthraquinone laxatives, which are stimulant laxatives. These compounds are found in rhubarb, senna, aloe, and other drugs. Long-term use of such laxatives can induce the destruction of the intestinal mucosal barrier and promote the release of tumor necrosis factor, leading to the apoptosis of colonic epithelial cells, which are phagocytized by macrophages and form brown pigment in the lamina propria of the colon, leading to the occurrence of colonic melanosis.
2. Precautions for long-term treatment of chronic constipation
1. Adhere to lifestyle adjustments, which are the basic treatment for chronic constipation, including increasing dietary fiber and water intake, increasing exercise, etc. In addition, special attention should be paid to establishing good bowel habits. Colonic activity is most active in the morning and after meals. It is recommended that patients try to defecate within 2 hours of waking up or after meals, concentrate on defecation, reduce the interference of external factors, and develop good defecation habits.
2. Avoid the drugs that cause constipation. If you cannot avoid them, you can use laxatives in combination.
Clinically constipating drugs include opioid analgesics, tricyclic antidepressants, anticholinergics, antihistamines, antiparkinsonians, antacids containing calcium carbonate or aluminum hydroxide, bismuth Drugs, iron, diuretics, etc.
3. Organic constipation needs to be treated according to the disease.
4. Reasonable drug treatment needs to pay attention to both efficacy and safety.
3. Drug selection for long-term treatment of chronic constipation
(1) Laxatives suitable for long-term use
Drugs commonly used in the clinical treatment of constipation include volumetric laxatives, osmotic laxatives, stimulant laxatives, prokinetic drugs, and secretagogues.
1. Bulk laxatives (stool-bulking agents)
Representative drugs: polycarbophil calcium, psyllium, etc.
The recommended amount of dietary fiber intake is 20~35g/d, but modern people often eat too fine a diet, resulting in insufficient intake of dietary fiber, that is to say, there is no "raw material" of feces. At this time, volumetric laxatives become the "preferred drug", their function is to increase the water and volume of the stool, help the stool to form, and promote intestinal peristalsis, thereby promoting defecation.
The "2019 Chinese Chronic Constipation Expert Consensus" recommends that polycarbophil calcium forms a hydrophilic gel in the intestinal tract and participates in the formation of feces, making the feces bulky and soft, and easy to excrete. The drug is not absorbed in the digestive tract and is safe for long-term use. Help patients establish good bowel habits.
2. Osmotic laxatives
Representative drugs: lactulose, polyethylene glycol, etc.
Osmotic laxatives create a hypertonic state in the intestine, absorb water and stimulate intestinal peristalsis. Generally relatively safe, some patients need to adjust the drug dose due to adverse reactions such as diarrhea and flatulence.
The "2019 Chinese Expert Consensus on Chronic Constipation" recommends that osmotic laxatives are suitable for patients with mild to moderate constipation, and can be used for long-term treatment of patients with chronic constipation.
3. Stimulant laxatives
Representative drugs: anthraquinones, bisacodyl, etc.
Stimulant laxatives act on the enteric nervous system to increase intestinal motility and stimulate intestinal secretions. Long-term use of stimulant laxatives is prone to drug dependence, malabsorption, and electrolyte disturbance. It can also damage the patient's enteric nervous system, resulting in weakened colon motility, and even melanosis of the colon.
The "2019 Chinese Expert Consensus on Chronic Constipation" recommends that stimulant laxatives are used as a remedial measure, short-term and intermittent use is recommended, and long-term use is not recommended.
4. Prokinetic Drugs
Representative drugs: prucalopride, mosapride, etc.
Prokinetic drugs shorten colonic transit time, accelerate gastric emptying, small intestinal transit, and colonic transit in constipated patients without anorectal dysfunction, and increase the frequency of defecation in patients. Recommended for patients whose constipation symptoms do not improve with conventional laxatives.
The "2019 Chinese Expert Consensus on Chronic Constipation" recommends that if there is still no effect after 4 weeks of medication, it is necessary to re-evaluate the patient's condition and whether to continue taking this type of drug.
5. Secretagogues
Representative drug: Linaclotide
Linaclotide stimulates intestinal fluid secretion and facilitates defecation and may be considered a second-line treatment in patients who have failed fibrous and osmotic laxatives. Compared with a placebo, linaclotide has been shown to improve the symptoms of IBS-C such as constipation and abdominal pain, and is relatively safe. The common side effect is diarrhea.
(2) Drug therapy for foot therapy
Chronic constipation requires long-term management. However, in practical application, there is often no clear concept of the course of treatment, and most of them are taken on demand. At the same time, it is combined with basic treatment, emphasizing cause treatment and anti-anxiety, depression, etc. Domestic and foreign guidelines have given suggestions on the course of medication according to clinical needs.
Domestic guidelines recommend that the treatment of constipation should last for 2 to 4 weeks, and foreign guidelines recommend an even longer time, even if the constipation is relieved, you should continue to take it for a few more weeks. Withdrawal should not be sudden and may take several months to withdraw slowly. Patients with constipation have individual differences in the duration of medication, and those with insufficient intestinal motility and nerve damage may need to take medication for life, and it is necessary to choose safe and effective drugs.
In summary, the treatment needs for long-term management of chronic constipation patients in China have not been met, seriously affecting the quality of life of patients. Generally speaking, patients need to adjust their diet and lifestyle first. Bulk laxatives, such as polycarbophil calcium, can improve the frequency of defecation and have good efficacy and safety. Long-term use can help patients establish good defecation habits. Osmotic laxatives are also a recommended option, but the use of stimulant laxatives requires special attention.
Natural Herbal Medicine For Relieving Constipation-Cistanche
Cistanche is a genus of parasitic plants that belongs to the family Orobanchaceae. These plants are known for their medicinal properties and have been used in Traditional Chinese Medicine (TCM) for centuries. Cistanche species are predominantly found in arid and desert regions of China, Mongolia, and other parts of Central Asia. Cistanche plants are characterized by their fleshy, yellowish stems and are highly valued for their potential health benefits. In TCM, Cistanche is believed to have tonic properties and is commonly used to nourish the kidney, enhance vitality, and support sexual function. It is also used to address issues related to aging, fatigue, and overall well-being. While Cistanche has a long history of use in traditional medicine, scientific research on its efficacy and safety is ongoing and limited. However, it is known to contain various bioactive compounds such as phenylethanoid glycosides, iridoids, lignans, and polysaccharides, which may contribute to its medicinal effects.
Wecistanche's cistanche powder, cistanche tablets, cistanche capsules, and other products are developed using desert cistanche as raw materials, all of which have a good effect on relieving constipation. The specific mechanism is as follows: Cistanche is believed to have potential benefits for relieving constipation based on its traditional use and certain compounds it contains. While scientific research specifically on Cistanche's effect on constipation is limited, it is thought to have multiple mechanisms that may contribute to its potential to relieve constipation. Laxative Effect: Cistanche has long been used in Traditional Chinese Medicine as a remedy for constipation. It is believed to have a mild laxative effect, which can help promote bowel movements and induce constipation. This effect may be attributed to various compounds found in Cistanche, such as phenylethanoid glycosides and polysaccharides. Moistening the Intestines: Based on traditional use, Cistanche is considered to have moisturizing properties, specifically targeting the Intestines. By promoting hydration and lubrication of the Intestines, it may help soften tools and facilitate easier passage, thereby relieving constipation. Anti-inflammatory Effect: Constipation can sometimes be associated with inflammation in the digestive tract. Cistanche contains certain compounds, including phenylethanoid glycosides and lignans, that are believed to have anti-inflammatory properties. By reducing inflammation in the intestines, it may help improve bowel movement regularity and relieve constipation.
references:
[1] Gastrointestinal Kinetics Group, Functional Gastrointestinal Diseases Collaborative Group, Gastroenterology Branch, Chinese Medical Association. Expert consensus opinion on chronic constipation in China (2019, Guangzhou) [J]. Chinese Journal of Digestion, 2019, 39(9): 577-598.
[2] Gastrointestinal Dynamics Group, Digestive Disease Branch, Chinese Medical Association, Colorectal and Anal Surgery Group, Surgery Branch, Chinese Medical Association. Guidelines for Diagnosis and Treatment of Chronic Constipation in China (2013, Wuhan) [J]. Chinese Journal of Digestion, 2013, 33 (5): 291-297.
[3] Geriatrics Branch of Chinese Medical Association, Editorial Committee of Chinese Journal of Geriatrics. Expert Consensus on Evaluation and Treatment of Chronic Constipation in the Elderly [J]. Chinese Journal of Geriatrics. 2017, 36(4): 371-381.
[4] American Gastroenterological Association Technical Review on Constipation [J]. J Neurogastroenterol Motil, 2013, 19(2): 149-160.
[5] Clinical Practice Guideline: Irritable bowel syndrome with constipation and functional constipation in the adult [J]. Rev Esp Enferm Dig, 2016, 108(6): 332-363.
[6] Fang Xiucai. The specificity and optimal diagnosis and treatment of chronic constipation in the elderly [J]. Chinese Journal of Clinical Health Care, 2019, 22(1): 4-6.
