Constipation is the condition in which infrequent production of hard stools, with to pass leading to incomplete evacuation.

Constipation may be of 2 types. They are:

• Spastic
• Atonic

• Spastic constipation: this leads to irritation of bowel. The stools are hard, stone like and very difficult to pass. Laxatives are given to treat this.

• Atonic constipation: it is also referred as sluggish bowel condition. This is very common in elderly and the persons who are habituated to laxative abuse. This type of constipation does not need any kind of medication, proper intake fluids is necessary. Apart from this exercise and regular habits should be tried. Senna and bisacodyl is given to the patients at times.

Treatment for constipation:

The drugs which help to promote evacuation of bowels are called as either laxatives or purgatives. Laxatives are milder in action and they soften the stool in proper form, where purgatives are stronger in action which leads to more fluid evacuation. The drugs in low doses act as laxative and drugs with larger doses are purgatives. Depending upon types the drugs used to treat constipation are:

• Bulk forming drugs like bran, ispaghula, methylcellulose.
• Liquid paraffin is used as stool softener.
• Senna, cascara, bisacodyl, castor oil are stimulant purgatives.
• Osmotic purgatives which are used to treat constipation are lactulose, sulfate and sodium salts.

Use and choice of purgatives:

• In functional constipation senna and bisacodyl is used for the treatment

• The patients who underwent surgeries, fractures, stoke and myocardial infarction enema (soap water/glycerin) is preferred. Even bedridden patients suffering from constipation can be given enema. Other preferred agent includes senna and bisacodyl

• Strain during passing of stool causes problem to patients who suffer from hernia, eye surgery, piles, cardiovascular disease, fissure and anal surgery. In this type of patients it is necessary to keep the stools soft. Bulk forming drugs and docusates are preferred

• Before bowel surgery, abdominal x-ray and colonoscopy it is necessary to empty bowel including gas. Saline purgatives, senna or bisacodyl are commonly used

Purgative abuse:

The patients who are treated with purgative gets obsessed with it when used regularly. This is the psychological problem. It is difficult to withdraw and needs medical supervision.