Most people are extremely particular about two rituals every morning: defecation and a bath. One of the most important concerns relating to cleansing of the bowels daily is the belief, that all ailments from ague to plague are caused by constipation and if the bowel is not cleansed at least once a day, purgatives are necessary. Curiously enough, many infants are routinely inflicted with purgatives, usually given in the form of home remedies, with the belief that the cleaner the bowels, the better the health.



What Really Constitutes Constipation? Constipation is a condition in which the bowels are evacuated after a longer interval or with difficulty and the person is not satisfied. What the right interval should be, is difficult to generalise since it varies from person to person. Some evacuate their bowels once, others twice a day, while there are still others who do so only once in 2 or 3 days and yet have sound health.

Causes: Some may have constipation on account of a change of environment or emotional tension, but the normal rhythm returns after a few days, and should not be a source of worry. The most important causes of constipation are a disregard of the call of nature to pass a motion and an improper diet. When the rectum is full, it sends signals to the central nervous system for their movement and if this is repeatedly ignored, it gradually leads to failure of the rectum to signal the urge. Other causes of constipation may be a disease or abnormality of the gastro-intestinal tract, adverse effects of drugs, drying of the stools (faecal impaction), obstruction of the intestines, and severe illness in which the food and intake is too little. In case of prolonged constipation in infants or intermittent constipation with diarrhoea, the physician should be consulted to rule out surgical problems. If there is a painful disorder of rectum and anus, the person tends to avoid defecation due to pain. This must be investigated and treated properly.

Prokinetic Drugs

A new class of drugs are now available which increase the bowel movements primarily by increasing activity of bowel-musculature. They are devoid of osmotic effects. These drugs are slow acting and are therefore useful in chronic functional constipation due to reduced bowel activity seen in diabetes, irritable bowel syndrome and atonic constipation. Drugs available are

Cisapride (Ciza, Prokine, Syspride, Unipride)

It is useful in reflux esophagitis (heart burn), gastritis, non ulcer dyspepsia and chronic constipation. It is given in a dose of 10 mg thrice a day. Full effects take about 7 days.

Adverse Effects: Abdominal cramps, diarrhoea, headache and abnormal movement, irregular heart-beat (some times serious) have been reported when Erythromycin, ketoconzole or anti depressants were taken with cisapride. In many countries cisapride is banned.

Mosapride (Mosid, Normagut)

It acts like cisapride but no adverse interactions have been reported. Its usual dose is 5 mg thrice a day.

Other prokinetic drugs are metoclopramide, domperidone, and itopride. All of these are useful in prevention and treatment of constipation. These drugs are useful in vomiting and heartburn also.

Tegaserod (Tegibs, Tibs)

It is used to treat constipation in irritable bowel syndrome in a dose of 2 mg to 6 mg twice a day before meals. Adverse effects are pain in abdomen, diarrhoea, headache and dizziness.