Information for Patients

UNCOMFORTABLE CONSTIPATION HOW TO OVERCOME IT?

CONSTIPATION (L. Constipatio - constipation) is a slowing, delay or systematically insufficient defecation. Today, constipation is considered as a disease of the century or a disease of civilization, because 40% of people over 60 experience this problem, which significantly affects the quality of life and reduces human performance. It should be noted that the incidence of constipation is more common in women than in men. Constipation was first mentioned as a disease in the Ebers Papyrus, which dates back to the 16th century BC. In 1851, M. Strahl described constipation as "a widespread condition with bad and burdensome consequences in all circumstances".

There are many terms defining this condition as "constipation", but sometimes specialists and patients mean different symptoms under this term. So we consider it appropriate to identify 2 main views on this issue:

PATIENT'S VIEW

Different people have different characteristics of what they mean when they talk about constipation. Thus, according to the World Gastroenterological Organization:

  • 52% of people describe constipation as a bowel movement requiring excessive straining;
  • 44% describe this condition as a hard, lumpy stool;
  • 34% consider constipation as an inability to defecate when you need it;
  • 33% describe constipation as simply irregular bowel movements.

PROFESSIONALS’ VIEW

According to the latest Roman Criteria IV revision, constipation can be diagnosed if a person has at least two of the following criteria during any 12 weeks during the last 12 months.

The following criteria include:

  • frequency of bowel movements is less than 3 times per week; hard, lumpy stool in more than 25% of defecation episodes;
  • feeling of incomplete defecation in more than 25% of their total number;
  • defecation requires excessive straining in more than 25% of defecation episodes;
  • the need for manual assistance for successful defecation.

What is a cause of constipation?

There are functional and organic constipation.

Functional constipation has a number of possible causes, such as malnutrition, lack of physical activity, motor dysfunction due to intestinal myopathy or neuropathy (conditions due to impaired innervation and/or intestinal musculature pathology), and the anal sphincter spasm, which may be associated with psychological disorders.

Organic constipation is usually secondary and develops against the background of other diseases. So the most common causes of organic constipation are mechanical obstruction (tumours, diverticula, and intestinal strictures), gastrointestinal diseases (irritable bowel syndrome, haemorrhoids, anal fissures and rectal prolapse), endocrine pathology and disorders of water and electrolyte metabolism (diabetes mellitus, diabetes, hypothyroidism and chronic kidney disease), psychological and neurological disorders (depression, dementia, spinal cord pathology, Parkinson's disease).

Secondary constipation should be also noted. It can develop against the background of taking certain drugs, including antidepressants, neuroleptics, antiepileptics, antiallergics, diuretics, antacids, NSAIDs and others.

There are 3 main types of mechanisms for the development of constipation:

  1. Dyskinetic mechanism

Decreased rate of transit of intestinal contents and slow movement of fecal masses may be due to decreased motor activity or, conversely, increase and discoordination of motor function of the colon.

  1. Impaired evacuation

The rate of intestinal transit remains normal and the presence of constipation is due to impaired evacuation of feces from the rectum.

  1. Irritable bowel syndrome with constipation

Occurs due to functional disorders of the nerve plexuses of the intestine causing impaired motility and usually accompanied by abdominal pain and flatulence.

IMPORTANT!

It is necessary to distinguish between episodic and chronic constipation. Episodic or situational constipation is transient and usually does not require any medical treatment. On the contrary, the symptoms of chronic constipation persist for 3 months or more and require comprehensive therapy.

"Red flags" or when you should not waste your time

It is important to remember that constipation is primarily a symptom that can be accompanied with a number of dangerous conditions, including colorectal tumors (colon, sigmoid and rectum), and other abdomen tumors compressing the intestine as well. Dangerous symptoms are as follows:

  • defecation in the form of tapes
  • visible blood in the stool (or the detection of blood in Gregersen reaction)
  • iron deficiency anemia
  • symptoms of intestinal obstruction
  • rectal bleeding
  • rectal prolapse
  • weight loss

If you have at least one of the above symptoms, you should immediately consult a doctor for additional examination, especially colonoscopy.

Non-drug methods of constipation correction

The approach to solve such unpleasant problem as constipation should always start with a conversation. First of all, it is necessary to provide an explanation of the possible causes of constipation and recommendations for lifestyle modification. The greatest attention should be paid to proper nutrition, the need to drink enough fluids, increase physical activity, create comfortable conditions for defecation and eliminate chronic stress. In addition, it is necessary to find out whether the patient is taking drugs causing the development of constipation and, if necessary, to appoint additional consultation with specialists in order to adjust the appointments. In any case, the approach should be step-by-step and start with the simplest, non-drug methods.

Diet and food supplements

One of the leading roles in the correction of constipation plays a diet №3. In the absence of contraindications, the diet should include many foods and dishes that accelerate bowel movements. First of all, these are products that contain a large amount of plant fiber.  The plant fiber is not absorbed into the human body, but causes a feeling of satiety, improves intestinal motility, promotes the excretion of cholesterol, has a weak diuretic effect, and promotes the excretion of sodium and water. In addition to fiber, the intestine is also stimulated by organic acids and sugars contained in vegetables, fruits and berries.

Recommendations

Products containing large amounts of plant fiber are carrots, beets, zucchini, pumpkin, seaweed, rye and wheat bread from wholemeal flour, biscuits, buckwheat, pearl barley and barley porridge. It is recommended to eat fresh fruit and vegetable juices, fruit drinks, dried fruits and compote, bananas and apples. It is equally important to drink enough fluids, as fluid deficiency is one of the risk factors for constipation and it can exacerbate existing constipation. Thus, patients are advised to consume at least 2 liters of fluid, including fermented milk products: kefir, yogurt, fermented milk.

It is not recommended

On the other hand, the consumption of bread and pastries from high-grade flour, pasta and potatoes should be avoided. Fatty meat (pork, lamb, offal), canned food, smoked meat, strong coffee and tea should also be excluded from the diet. Foods causing flatulence such as legumes, cabbage, sorrel, spinach, apple and grape juices are not recommended.

Insufficient dietary fiber in the diet is the cause of constipation and hemorrhoids. Also it contributes to diverticula and serious diseases such as polyps, tumors and hernias of the intestine, and insufficiency of the biliary tract as well. Moreover, unbalanced dietary fiber is often a risk factor for diabetes and atherosclerosis with severe consequences.

PAY ATTENTION!

The World Health Organization has determined the recommended human consumption of dietary fiber – at least 30 g per day, and the Department of Nutrition and Food of the US Academy of Sciences – 25-38 g. However, in fact, no country in the world consumes so much dietary fiber!

INTERESTING FACT!

Dietary fiber changes the rate of absorption of glucose from the intestine. It normalizes blood glucose levels and, accordingly, reduces the need for insulin; reduce blood cholesterol levels; have a positive effect on the intestinal microflora and have a prebiotic effect.

Physical activity

In addition to increase the overall level of physical activity, people suffering from chronic constipation are advised to perform daily exercises aimed at strengthening the muscles of the pelvis and abdomen. Walking, slow running, swimming are especially useful for patients, because in addition to the unconditional benefits of increasing the level of physical activity, such exercises have an extremely beneficial effect on the autonomic nervous system, which is responsible for intestinal motility.

INTERESTING FACT!

Scientists from Stanford University have proved that the legs should be at an angle of 35 ° to the torso during the defecation. This position eases the defecation process significantly.

Drug correction

In cases where the above means of influence are insufficient, it is necessary to the use of laxatives, which:

  • should not cause stomach pain and pain, prolonged after a laxative effect
  • should not be addictive
  • have a convenient form for consumption, pleasant taste and smell

Recently, much attention is paid to herbal laxatives, which are used to correct various disorders, including the normalization of digestion. It is worth to pay attention to herbal remedies that contain plant fiber, sugars and trace elements. All this is necessary for normal digestion and to prevent constipation.

The World Gastroenterological Organization recommends to add FOOD FIBERS to your diet as the first line of therapy to normalize intestine functioning.

 

Classification of laxatives

 

Mechanism of action

 

Benefits

Warnings / contraindications

Remedies of natural origin that increase the volume of stool:

Ÿ Plantain seed husk (psyllium)

Ÿ Bran

Ÿ Seaweed

Ÿ Flax seeds

The fibers of these substances are practically not absorbed or digested. They retain water in the intestine, which causes the fecal mass to soften and increase in volume. As a result a mechanical expansion of the intestinal wall occurs and a soft bowel movement occurs.

Ÿ  Not absorbed, have no systemic action

Ÿ  Not addictive

Ÿ  Increase the feeling of satiety and fullness of the gastrointestinal tract

Ÿ  Low calorie

Ÿ  Promote the removal of cholesterol and toxic substances

Ÿ  A prebiotic effect

Flatulence, a feeling of fullness, the need to drink a plenty of fluids

Osmotic laxatives:

Ÿ  Lactylol

Ÿ  Lactulose

Ÿ  Polyethylene glycol (PEG)

The osmotic pressure in the intestinal lumen is increased, thereby delaying the absorption of fluid, which causes mechanical irritation of the baroreceptors of the large intestine, resulting in increased intestinal motility

Ÿ  Not absorbed, have no systemic action

Ÿ  Not addictive

Ÿ  Can be used by pregnant women, children, the elderly

Ÿ  Do not reduce the vitamins absorption

Water-electrolyte imbalance (PEG), flatulence may occur in long-term treatment

Stimulating laxatives:

·       Bisacodyl

·       Sodium picosulfate

·       Senna

Irritation of intestinal chemoreceptors causing reflex enhancement of its peristalsis

Ÿ  Low-cost group of drugs

Long-term treatment causes addiction, atony of the colon, water-electrolyte imbalance, hypokalemia, weakness, convulsions, low blood pressure, spastic pain, diarrhea, nausea, flatulence. The drug interactions with other drugs are available.

 

Given the comprehensive approach to the recommendations and prevention of constipation, it is worth to pay attention to the unique complex FIBOLEX (by Ananta Medicare). FIBOLEX is a source of natural dietary fibers for normalization of intestinal functions, the action of which is aimed at facilitating defecation, normalization of intestinal microflora, excretion of toxins, cholesterol and allergens, and enrichment of the body with necessary biologically active substances. The FIBOLEX complex contains three components:

  • Plantain seed husk (psyllium) - 5 g
  • Natural wheat fiber - 400 mg
  • Green tea extract - 400 mg

Of all the types of plant laxatives, the soluble fibers of plantain seed husk have a high ability to absorb water (40 times their own weight). Due to these properties and the fact that the husk of plantain seed is not digested in the intestine, it mixes with fecal masses and softens their density, helps to reduce the frequency of straining and increase the comfort of defecation. Dietary fiber of plantain seed husk, which is a part of FIBOLEX complex, consists of three fractions. Each of these fractions contributes to the normalization of intestinal functioning.

PSYLIUM FRACTION

MECHANISM OF ACTION

30% - non-fermentable fraction

Normalization of intestinal motility. Acts as a filler that creates volume

55% - gel forming fraction

Formation of a matrix that binds water, bile acids, cholesterol and toxins

15% - rapidly fermented faction

Promotes the growth of lacto- and bifidobacteria

Hydrophilic dietary fibers of plantain seed husk are not disintegrated by small intestine enzymes, and reach the colon unchanged. They have a prebiotic effect and cover the intestinal surface with a protective layer of mucus, which facilitates the passage of intestinal contents.

Natural wheat fiber contains polysaccharides - cellulose and lignin, which are not digested in the large intestine. Due to this, they are slowly metabolized by bacteria, help to lower the intestinal pH, and create favorable conditions for the functioning of the beneficial intestinal microflora.

Wheat fiber cellulose provides a feeling of satiety and fullness of the stomach, and improves intestinal motility as well.

CELLULOSE

LIGNIN

·       Water retention in the lumen of the colon

·        Powerfully sorbs: exo- and endotoxins, allergens, pathogenic microorganisms, bilirubin, urea cholesterol

·       Acceleration of intestinal passage

·       Contributes to the normalization of the intestinal microflora

Due to lignin, wheat fibers have a powerful sorbent activity, and promote the excretion of toxic substances, allergens and products of intestinal metabolism.

Green tea extract exhibits antitoxic and antioxidant effects. The extract has a tonic effect and improves metabolic processes in the body, strengthens blood vessels, improves mood and adds vitality as well.

INTERESTING FACT

Dietary fiber is of two types:

Soluble fibers (fruits, vegetables, oatmeal) effect on the digestion of food, in particular, normalize blood cholesterol levels. But constipation may not be affected.

Insoluble fibers (wheat, whole grain bread, cereals) increase intestinal motility, and make 1/3 of the composition of fecal masses.

Thus, FIBOLEX complex is a source of natural dietary fibers, which has a wide range of effects aimed at correcting the problem of constipation.

The laxative effect of FIBOLEX complex is realized due to dietary fibers, which retain fluid in the intestinal lumen, increase the volume of fecal masses and soften their consistency. This stretches the intestinal wall, activates intestinal motility and facilitates the passage of intestinal contents.

The prebiotic effect of FIBOLEX complex is manifested by lowering the intestinal pH and increasing the level of short-chain fatty acids, which in turn promotes the growth of beneficial microflora.

FIBOLEX complex has an antitoxic effect due to the binding of toxic substances, allergens and metabolic products.

Due to dietary fiber, FIBOLEX complex has a calming effect on the intestinal mucosa, protects it from irritation and improves the function of enterocytes.

IMPORTANT!

FIBOLEX complex:

DOES NOT have an irritating effect

DOES NOT remove electrolytes from the body

DOES NOT cause addiction

4 actions in each sachet

Laxative

Antitoxic

·       retains water and increases the volume of intestinal contents

binds toxic substances and promotes their excretion

·       stretches the intestinal wall

 

·       activates intestinal motility

 

Prebiotic

Facilitating

·       lowering the intestinal pH

·        contributes to improve the work of enterocytes

·       promotes the growth of lacto- and bifidobacteria

·        protects the intestinal mucosa from irritation

lactobacteria                                  bifidobacteria                                     FIBOLEX

 

FIBOLEX complex has two flavours - apple and orange. FIBOLEX is available in easy-to-use sachets and can be recommended for adults and children from 12 years old. Stir the content of one sachet in a sufficient amount of liquid (at least 200 ml per sachet), 2-3 times a day until normalization of defecation.

No less important is to ensure a drinking regime, at least 1.5-2 litres of liquid per day.

Due to its unique composition FIBOLEX complex easily and deliciously normalizes the physiological rhythm of the intestine!

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