Chronic constipation is defined as the emission of stool less than three times per week, hard, and with a total daily weight of less than 35 g. It can be primary or secondary to numerous digestive and extradigestive diseases. This paper will briefly review primary or idiopathic chronic constipation, which is mainly influenced by psychological, hormonal and dietary factors. To know if you suffer from chronic constipation, the diagnostic criteria are the following:
-Excessive straining
-Hard stools
-Feeling of incomplete evacuation
Feeling of anorectal blockage/obstruction -Less than three bowel movements per day
-Less than three bowel movements per week.
A high percentage of the population may suffer from constipation, especially in the elderly, women, and males in childhood. Consultations in primary and specialized care are relevant in this sense: constipation is a common cause in consultations with the primary care pediatrician, as well as in consultations with the specialist. For its diagnosis it is essential to take a clinical history, analytical tests, physical examination with rectal examination, and the practice of an opaque enema, colonoscopy and biopsy to rule out pathologies. Manometry and examination of intestinal and colonic transit, by means of expired H2 breath test or markers, are measures that help in the pathophysiology and etiological diagnosis.
Treatment of chronic constipation and indications
In the past, treatment was carried out with laxatives (laxative abuse). Currently, and after the implementation of hygienic-dietary measures, treatment begins with the administration of soluble fiber in an amount greater than 10 g/day. Due to the appearance of flatulence or when fiber fails, osmotic preparations, synthetic disaccharides such as Lactulose (15-45 ml/day) and Lactilol (10-20 g/day) are used. Lactitol and Cinitapride produce less flatulence than Lactulose. These osmotic preparations, as well as prebiotics, can also be administered as adjuvant therapy to fiber intake, accelerating its action when this is the first choice treatment.
The intake of Lactilol is fully indicated in children (250-400 mg/kg/day), pregnant women, diabetics, patients with lactose intolerance and elderly people, whether healthy or institutionalized. Caution is important in patients with renal insufficiency.
Complications: Fecaloma
Fecal impaction is often a complication of concurrent diseases, pharmacological treatments (analgesics or other drugs that cause acute or chronic constipation). Also, and due to the lack of mobility, in elderly people. Enemas and oral Lactilol can be used to empty the rectum.
In conclusion, the efficacy, tolerability and safety of osmotic preparations (Lactulose/Lactitol) in children, pregnant women and elderly population is fully demonstrated. Lactulose is effective and well tolerated, although it sometimes produces belching, gas and diarrhea. Lactilol, compared to Lactulose, has fewer adverse effects, is superior in terms of therapeutic compliance, and has demonstrated efficacy and safety compared to Lactulose, making it the drug of choice in the treatment of chronic idiopathic constipation, as well as Cinitapride in combination with methyl cellulose.