Sàez L R
Dept of Medical Pathology, Covadonga Hospital and School of Medicine, Oviedo, Spain.
Ital J Gastroenterol. 1991 Nov;23(8 Suppl 1):30-5.
The objectives to be achieved by a medical therapy of constipation are: 1) to protect the patient from excessive use of dangerous drugs (laxatives), 2) to help the patient to understand what is a "normal" intestinal function, 3) to reduce or eliminate pain and 4) to avoid complications. The first step consists in general measures (reduced stress, regular meals and physical exercise) and some modifications in diet habits (greater than 1.5 1 of water a day, vegetables, fruits, whole wheat bread). The pharmacological therapy is based on drugs which act in different ways: a) some contain unabsorbable substances (i.e. cellulose, emicellulose) that increase the volume of the stools: b) unabsorbable sugars (i.e. lactulose, lactose) or salts (Mg-sulphate, citrate and Na-sulphate) that provoke an osmotic effect and stimulate the colonic motility; c) suppositories that stimulate the defecation reflex; d) drugs able to stimulate colonic secretion and propulsive motility (i.e. anthraquinones, oral bisacodyl, phenolphthalein, castor oil, prokinetics). There are many conditions in which medical therapy fails its objective: in these cases it is important to exclude other causes of constipation (i.e. drug-related constipation, endocrine disorders, metabolic diseases, systemic illnesses or lesion of the enteric plexus) in order to obtain an improvement of this symptom.
1）保护患者避免过度使用危险药物（泻药）；2）帮助患者了解什么是“正常”的肠道功能；3）减轻或消除疼痛；4）避免并发症。第一步包括一般措施（减轻压力、规律饮食和体育锻炼）以及饮食习惯的一些调整（每天饮水量超过1.5升、多吃蔬菜、水果、全麦面包）。药物治疗基于作用方式不同的药物：a）一些含有不可吸收物质（如纤维素、半纤维素），可增加粪便体积；b）不可吸收的糖（如乳果糖、乳糖）或盐（硫酸镁、柠檬酸盐和硫酸钠），可产生渗透作用并刺激结肠蠕动；c）刺激排便反射的栓剂；d）能够刺激结肠分泌和推进性蠕动的药物（如蒽醌类、口服比沙可啶、酚酞、蓖麻油、促动力药）。在许多情况下，药物治疗无法达到目标：在这些情况下，重要的是排除便秘的其他原因（如药物相关性便秘、内分泌紊乱、代谢疾病、全身性疾病或肠神经丛病变），以便改善这种症状。
