Assessment and treatment options for patients with constipation.

Constipation is a common complaint for people of all ages, with prevalence increasing with age and during pregnancy. Women are more likely to be affected than men. Severity of constipation varies from person to person; most people experience short periods of constipation during their lives, including possibly after surgery, while others have constipation as a chronic long-term condition that can significantly affect their quality of life. There are a number of factors that can contribute to developing constipation including diets low in fibre, changes in lifestyle, side effects of certain medications and low fluid intake. People can successfully treat constipation by making changes to their diet and lifestyle. However, medication may be required to manage constipation for some.

Can increased dietary fibre reduce laxative requirement in peritoneal dialysis patients?

Constipation is an important cause of technique failure and poor dialysis efficiency in Peritoneal Dialysis (PD) patients. A review of patient notes on our unit revealed 43% reported difficulties associated with constipation. A stool and laxative recording diary was sent to 126 PD patients. 46 patients reported using laxatives. All respondents using laxatives were invited to use a soluble dietary fibre supplement for 4 weeks, followed by dietary advice to see if they could achieve the same effect using high fibre foods. 23 patients entered the intervention stage of the study. 17 succeeded in replacing prescribed laxatives with the fibre supplement. 16 tried to increase their intake of high fibre foods, with 8 of these succeeding in improving their dietary intake of fibre; however only 2 were able to reduce their intake of fibre supplement. The results of the study suggest that a fibre supplement can be as effective as current laxative treatment in preventing constipation, as well as being the preferred choice of patients as many felt it improved bowel habits while not having the side effects of stimulant laxatives.

Assessment of the genotoxic risk from laxative senna products.

Laxative senna products and several of their specific components have been submitted to a large number of genetic tests. While most studies gave negative responses, results from some of the studies suggest that components of senna products, particularly emodin and aloe-emodin, have genotoxic activity. Assessment of the genotoxicity profile of these substances, in light of other data from animal and human metabolism or kinetic studies, human clinical trials and rodent carcinogenicity studies do not support concerns that senna laxatives pose a genotoxic risk to humans when consumed under prescribed use conditions.

Chronic constipation in long stay elderly patients: a comparison of lactulose and a senna-fibre combination.

OBJECTIVES: To compare the efficacy and cost effectiveness of a senna-fibre combination and lactulose in treating constipation in long stay elderly patients. DESIGN: Randomised, double blind, cross over study. SETTING: Four hospitals in Northern Ireland, one hospital in England, and two nursing homes in England. SUBJECTS: 77 elderly patients with a history of chronic constipation in long term hospital or nursing home care. INTERVENTION: A senna-fibre combination (10 ml daily) or lactulose (15 ml twice daily) with matching placebo for two 14 day periods, with 3-5 days before and between treatments. MAIN OUTCOME MEASURES: Stool frequency, stool consistency, and ease of evacuation; deviation from recommended dose; daily dose and cost per stool; adverse effects. RESULTS: Mean daily bowel frequency was greater with the senna-fibre combination (0.8, 95% confidence interval 0.7 to 0.9) than lactulose (0.6, 0.5 to 0.7; t = 3.51 p < or = 0.001). Scores for stool consistency and ease of evacuation were significantly higher for the senna-fibre combination than for lactulose. The recommended dose was exceeded more frequently with lactulose than the senna-fibre combination (chi 2 = 8.38, p or = 0.01). As an index of the standard daily dose, the dose per stool was 1.52 for lactulose and 0.97 for the senna-fibre combination, at a cost per stool of 39.7p for lactulose and 10.3p for senna-fibre. Adverse effects were no different for the two treatments. CONCLUSIONS: Both treatments were effective and well tolerated for chronic constipation in long stay elderly patients. The senna-fibre combination was significantly more effective than lactulose at a lower cost.

A new technique for measuring the consistency of faeces: a report on its application to the assessment of Senokotot therapy in the elderly.

The use of a penetrometer provided a reliable and simple method of measuring stool hardness which enabled the stool softening effect of Senokot medication to be quantified.