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First one is bulk forming laxatives such as bran, psyllium, wheat dextrin, methylcellulose. The other type is osmotic laxatives like saline agents, poorly absorbed sugars, polyethlene glycol. The third type of laxative is stimulant laxatives such as senna and cascara. Docusate and mineral oilare examples of stool softeners. Senna is a stimulant laxative (cathartic) which induces bowel movements. Its action is through direct stimulation of enteric nervous system, thus increases the motor activity. The drug is assumed to directly "irritate" the intestinal mucosa, which in response causes muscular movements (peristalsis) inside the colon, hence purging itself of waste. Other than that, senna is also involved in the alteration of electrolyte transport, as well as enhancement of water uptake into intestinal mucosa
Non-pharmacological approach to treat constipation
Increasing intake of dietary fiber and fluids along with exercise are the non pharmacological treatment for constipation. Consuming fiber-rich foods such as whole-grain bread, fresh fruits and vegetables can lessen the chances of constipation.Â Drinking plenty of liquids and getting regular exercise promotes intestinal activity. Gradually increase fiber amount in diet can avoid uncomfortable bloating or gas. High-fiber diets increase stool size, which naturally helps prevent constipation. However, without a good deal of fluids, fiber might stall and bring about constipation. Therefore, drinking sufficient plain water is vital in treating constipation together with high-fiber diet. Drink at least eight glasses of water a day can help fiber to soften and bulk-up the feaces, which promotes regularity. Exercise is believed that it could treat constipation, but the link between exercise and bowel movement is not completely understood. Exercise increases metabolic rate, burns excess calories and improves muscle tone which help digestion. A proper digestion can lead to a proper bowel movement. On the other hand, behavioral therapy in the form of biofeedback is able to treat constipation. This is because inappropriate muscle contraction is the common factor that leads to constipation. So, one would have to re-learn how to defecate. However, biofeedback is not useful to all types of constipation as it does not appear to benefit patients with slow transit constipation.
List and briefly explain five main indications for prescribing laxatives.
The indication of senna laxatives is mainly to relieve constipation. It acts by break up the bigger faecal matters into small one (loosen stool) but becomeÂ last alternative due to the bowel irritation side effect. Next, provide the body with an in depthÂ body cleansing and used to clean out the intestinesÂ before a bowel examination or surgery. Senna derivative, for example Sennosides act as stimulant laxatives to help in emptying of the bowel, incomplete or infrequent bowel movements. They work by keeping water in the intestines, which causes movement of the intestines. Lastly, used for loosen weight. With the feature of increasing bowel activity, it prevents the large intestine to absorb food where most of the food content gets absorbed in large intestine.
If a laxative is prescribed, discuss in general the following:
Most laxatives do not have side effects if used them correctly, but sometimes they can cause cramping, gas, bloating, nausea or diarrhea.There are several types of laxatives are used to treat constipation, lubricant laxatives can cause deficiencies of vitamins (prolonged use), lipid pneumonia (children and elderly), and decrease the absorption of some drugs (warfarinÂ andÂ oral contraceptives).)Emollient laxatives (stool softeners) can cause inflammation (lymph nodes and liver).Hyperosmolar laxatives can cause abdominal bloating and flatulence. Saline laxatives can cause magnesium-toxicity (individuals with impaired kidney function), diarrhea, and dehydration. Lastly, stimulant laxatives can cause severe diarrhea, dehydration, loss ofÂ electrolytes (especially with potassium), intestinal cramping, worsen the constipation.
The time gaps between taking a laxative and other drugs should be leave at least two hours. This is due to laxatives can interfere with how the body absorbs certain medications. They are able to make the substance to move more quickly in the gut. So, amount of drug absorbed by the gut will be reduced. Bisadocyl (stimulant and irritant laxative) enteric-coated tablets should not be taken within an hour of taking antacids. Enteric-coated tablets are designed to deliver drugs to the intestine. Antacids will make the enteric coating tablet to be break down when they still in the stomach. Then the drug will be released too early into our body. Besides, some laxatives can lead to potassium loss. This can increase the activity and side effects of antiarrhythmic drugs and cardiac glycosides that used in heart failure as well as potassium-sparing effect of some diuretics. Senna (stimulant and irritant laxative) inhibits prostaglandins, reducing the effect of indomethacin, which act as an anti-inflammatory drug. Laxatives should not be used in combination with each other due to the drug-drug interaction. For example, Docusate (stool softener) and mineral oil (emollient) should not be used together. This is because docusate acts as an emulsifying agent who will cause the mineral oil to be absorbed in the gut, and then lumps in the gut wall occur, rather than acting as a lubricant.
Laxative is dangerous when given simultaneously with certain drugs. It interacts with warfarin, tetracycline, ciprofloxacin and a few heart and bone medications. Besides that, patients with kidney disease, heart disease, high blood pressure, stomach pain, nausea, vomiting, or rectal bleeding should seek medical advice before using laxative. Laxative has to be used with great care if a patient develops constipation from serious condition such as appendicitis or bowel obstruction. The usage of laxative can decrease the contractility of the colon and worsen constipation. In severe cases, nerves, muscles and tissues of the large intestine can be damaged due to overuse of laxatives. Laxatives should not be given to children under age six. Strong laxatives such as purgative should not be given during pregnancy as it may harm the baby or the mother. Laxative can also pass into breast milk and results in diarrhea in nursing infants.
Administration and use of the product
Laxative can be administered by oral route and rectal administration. If patients have faecal impaction, should not take oral laxatives as overflow of diarrhea will occur. Suppositories and enemas can be used. The product is used on the initiation of opioid therapy, bowel investigations, gastrointestinal diseases such as irritable bowel syndrome, diverticular disease and colostomy, colonic constipation and straining which worsen the conditions of angina, anal fissure and haemorrhoids. Laxative should administer with a glass of full water to prevent dehydration. Laxatives acting in 6-12 hours are best taken before going to bed.
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