can experience bloating and excess |
as clinical syndromes is still a mat- |
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flatulence . Advise patients to take |
ter of debate , and discontinuation of |
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additional fluids to avoid the potential drug-induced complication of intestinal obstruction . 48 Older individuals at risk of dehydration including those |
stimulant laxatives seems to reverse these alterations . 52 , 53 Additionally , there are currently no reliable data establishing a connection between |
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with immobility , cognitive impairment |
chronic use of stimulant laxatives |
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or swallowing issues should avoid |
and colorectal cancer . While the |
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bulk-forming laxatives . Also avoid |
chronic use of these laxatives may |
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bulk-forming laxatives in the setting of |
result in a benign condition called |
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faecal impaction and opioid-induced constipation . 49 Opioids hinder the peristalsis needed to propel the increased |
melanosis coli ( see figure 10 ), characterised by darkened colonic mucosa , it holds no pathological signifi- |
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bulk , which aggravates abdominal |
cance . However , daily ingestion of |
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pain and can ultimately contribute to |
these laxatives can potentially lead |
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bowel obstruction . 49 |
to complications such as hypokal- |
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There is more evidence for the effectiveness of psyllium than bran in treating constipation in older people . 50 A small number of studies in older adults demonstrated equiva- |
aemia , protein-losing enteropathy , and salt depletion . 54 Overall , caution should be exercised when considering the chronic use of stimulant laxatives , especially in older individuals , |
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lent effectiveness of methyl cellulose |
as long-term safety evidence in this |
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and polycarbophil to psyllium . 51 |
population is still lacking . 37 |
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STIMULANTS |
STOOL SOFTENERS AND |
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These agents include diphenylmeth- |
LUBRICANTS |
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ane derivatives ( phenolphthalein |
Stool softeners ( docusate sodium ) |
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and bisacodyl ) as well as anthraqui- |
and lubricants ( mineral oils ) emul- |
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nones ( senna and cascara ). They |
sify stools and provide lubrication |
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directly act on the mucosa by stim- |
for the passage of faecal pellets . |
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ulating the myenteric plexus and |
They may be given orally or as reten- |
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altering water and electrolyte secre- |
tion enema . Although stool softeners |
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tion . The onset of action varies |
possess a more desirable side effect |
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from 10 minutes to 12 hours . There is conflicting evidence regarding the long-term safety of stimulant laxatives . Studies from the 1960s- 70s suggest the rare possibility of enteric neuropathies with chronic |
profile , they are less effective than other laxatives . 3 Aspiration of mineral oil can cause lipoid pneumonia , while long-term use can cause malabsorption of fat-soluble vitamins and foreign body reactions in |
Figure 5 . Abdominal X-ray showing faecal loading . |
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use ; however , recent studies with |
the intestinal mucosa and regional |
more advanced technology have |
lymph nodes . 55 |
enemas can lead to disturbances in |
can cause harm to the rectal mucosa , |
OTHER |
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not confirmed these findings . Long- |
fluid and electrolyte balance , as well |
while regular use of phosphate ene- |
In laxative-refractory patients with |
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term utilisation of stimulant laxatives has been linked to a condition known as ‘ cathartic colon ’, charac- |
ENEMAS AND SUPPOSITORIES Enemas and suppositories can be used for faecal impaction and as an |
as irritation of the rectal mucosa . Improper administration techniques may result in mechanical injury . It |
mas may result in hyperphosphataemia . 55 As a safer alternative , warm tap water can be used , as can glyc- |
chronic constipation , novel pro-secretary agents which promote electrolyte efflux and diffusion of water |
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terised by the presence of luminal dilation and loss of haustration as observed in barium enema examina- |
alternative in individuals who cannot tolerate oral laxatives . 47 Enemas induce defecation by causing |
is important to note that rectal perforation can occur , particularly if manual disimpaction has not been |
erin suppositories . Patients with intractable constipation may require referral for surgical treatment . The |
into gut lumen have been developed but evidence for use in older people is limited . Prucalopride is a selective |
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tions . However , the extent to which |
rectal distension and flushing out |
performed beforehand . Frequent |
usual approach is subtotal colectomy |
agonist of serotonin 5-HT4 which |
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these radiological changes manifest |
faecal matter . However , the use of |
use of phosphate and soap enemas |
with ileorectal anastomosis . 56 |
is available in Australia , however it |