laxative
Laxatives , laxatives ( Singular : laxative ), laxatives , laxatives (obsolete: laxatives , singular: laxative ; of Latin laxare "loosen"), medicaments which the stool promote or defecation and against constipation ( constipation , constipation) can be used . A highly effective laxative is called a Drastikum (plural: Drastika ).
Laxatives are the treatment of choice when actual constipation (i.e., bowel movements less than three times a week despite heavy pressing) cannot be treated by changing diet or lifestyle .
A diet with increased intake of dietary fiber in combination with a sufficient fluid intake and more exercise can help the bowel movements to stimulate and improve stool consistency. Only if these measures fail (after medical clarification) is the use of laxatives indicated.
Working principles of laxatives
Laxatives usually work by increasing the volume of stool inside the bowel. This also increases the pressure on the intestine and it reacts by triggering wave movements ( peristalsis ), which push the intestinal contents further in the desired direction.
The following laxative principles are used in detail.
Swelling agents, fillers and lubricants, including osmotic laxatives
- Swelling agent
- Swelling of the swelling substances ingested by water absorption, e.g. As agar-agar , flax seed , psyllium seed husks , dried plum , wheat bran , bassorin , carboxymethyl cellulose
- lubricant
- Facilitating feces -Gleitvermögens such. B. either paraffinum subliquidum or docusate sodium (whereby docusate sodium should never be used at the same time as paraffin, as docusate sodium increases its absorption)
- Osmotic and saline laxatives
- Retention of water in the intestine via osmosis , e.g. B. sugar alcohols such as mannitol , sorbitol , lactose and lactulose , polyethylene glycol ( macrogol ), saline laxatives such as Epsom salt (magnesium sulfate), Glauber's salt (sodium sulfate) or magnesium hydroxide
Laxatives that influence motility and secretion (stimulating or anti-absorptive-secretory)
- Increase in intestinal motility (for example with anthraquinones , see also prokinetic ), e.g. B. Emodin
- Increasing the release of water into the intestines ( hydragoga ), e.g. B. ricinoleic acid ( castor oil ), anthrachinonglycosidhaltige plant preparations from alder bark , buckthorn berries or senna , bisacodyl , sodium picosulfate
- Triggering the defecation reflex , e.g. B. glycerine suppositories, microclysms ( enema ) with sorbitol , CO 2 formers ( sodium dihydrogen phosphate )
- peripherally acting opioid - antagonism , z. B. alvimopan , methylnaltrexone
Medical use of laxatives
Laxatives are considered to be medically useful,
- before an X-ray diagnosis that requires an emptied bowel
- before an operation or colonoscopy
- in patients being treated with opioids that cause constipation ; in this case, laxatives can be prescribed at the expense of the health insurance company
- with painful defecation, for example with hemorrhoids or an anal fissure
- in the case of constitutional chronic constipation (less than three times a week)
- with long intestinal transit times (longer than 64 hours; so-called slow transit )
- in pregnancy-related constipation ( sodium picosulfate and bisacodyl are indicated for short-term use during pregnancy and breastfeeding)
- in wheelchair patients
Other uses and dangers of laxatives
In some cases, laxatives are not used in a therapeutic way, for example to treat constipation. You will e.g. B. - abusively and usually overdosed - taken for (supposed) weight reduction. However, you cannot lose weight with laxatives. The overdose causes diarrhea , which causes the body to lose vital fluids. As always with diarrhea, this is very unhealthy in the long run and can lead to disturbances in the electrolyte balance. A potassium level that is too low, for example, can lead to impaired heart function and muscle weakness. In addition, continuous use of laxatives can irritate the intestinal mucosa.
Certain laxatives are often used in spring for so-called purification . The aim should be to rid the body of supposedly accumulated "waste products" and thereby give it the opportunity to regenerate . Often the purification initiates a period of fasting, the liberation of physical ballast such as faeces is seen here as a signal to leave. So-called saline laxatives such as Glauber's salt or Epsom salt are usually used for this . Here, too, you should ask a doctor, because taking these drugs can cause severe side effects such as drop in blood pressure and muscle weakness up to reflex failures and the effect of other drugs, for example heart drugs, antihypertensive agents or antibiotics, can be disrupted.
Many, especially older people, also believe that you have to have a bowel movement at least once a day. From a medical point of view, everything between three times a day and three times a week is considered normal. Older people in particular, who are often unable to move much due to illness, and who eat less balanced food, take laxatives because they think they suffer from indigestion. However, it takes time for an emptied bowel to be filled enough to trigger a defecation reflex. Sometimes a laxative is taken again prematurely, under the mistaken assumption that the bowel is already blocked again. Too frequent and / or too high doses of stimulating laxatives can lead to water and electrolyte losses due to the development of diarrhea (see above). Since a loss of electrolyte severely affects the functioning of muscle cells ( depolarization of the membrane potential ), this can lead to life-threatening complications in patients with heart failure, as the symptoms are aggravated and medication, e.g. B. with cardiac glycosides is no longer sufficient.
Correct use of stimulant laxatives should avoid diarrhea - diarrhea is a sign of overdose or overuse.
Previously postulated habituation or dependency effects through long-term use could not be proven in more recent studies.
Summary of the hazards and other undesirable effects
- Wind, abdominal distension , bowel sounds ( borborygmus )
- Coprostasis, delayed defecation
- Intestinal obstruction
- Intestinal colic, abdominal pain
- Diarrhea, fecal incontinence
- Inflammation of the rectum from uvula
- nausea
- Electrolyte imbalances
history
Laxatives are available from around 2400 BC. Demonstrable. In Mesopotamia and ancient Egypt , the castor oil obtained from the seeds of the miracle tree was used for these purposes. The Assyrians knew around 1500 BC In addition to the use of high-fiber foods such as bran , saline laxatives that increase the water content of the intestinal tract.
After the second volume of Jonathan Pereira (1804-1853) and Rudolf Buchheim's Manual of remedies doctrine are to the ancient Greeks, perhaps even before Hippocrates († around 370 v. Chr.) The dried milky juice of the root of Convolvulus scammonia (Purgierwinde) and strong (dramatically ) have used an active laxative (drastic).
From antiquity to modern times, laxatives as well as emetics and bloodletting were part of humoral pathologically based purging (from the Latin purgare = to cleanse) therapies. The aim was the purgation, ie the cleaning of the sick person from excess juices and harmful disease matter by elimination, among other things by vomiting and through the stool after taking purgatives. Other herbal purgers used in addition to castor oil in antiquity were the black hellebore ( snow lily ), the white hellebore ( Weißer Germer ), preparations made from certain types of aloe and milkweed . Rhubarb and Alexandrian senna found their way into medicine in the Western Middle Ages from the Orient .
Historical laxatives include the holy bitter Latwerge Hiera picra and the “golden pills” (laxative pills) in the Nicolai antidotarium as well as the Frankfurt pills and Glauber's salt (sodium sulfate).
literature
- Michael Stolberg : The miraculous healing power of laxatives. Success and failure of premodern disease treatment from the patient's perspective. In: Würzburg medical history reports. Volume 22, 2003, pp. 167-177.
- Claudia Bausewein , Marcus Hentrich: Constipation. In: Eberhard Aulbert, Friedemann Nauck, Lukas Radbruch (eds.): Textbook of palliative medicine. Schattauer, Stuttgart (1997) 3rd, updated edition 2012, ISBN 978-3-7945-2666-6 , pp. 277–281.
Web links
Individual evidence
- ↑ Duden .
- ^ Hunnius Pharmaceutical Dictionary . 6th edition. Walter de Gruyter, Berlin / New York 1986, p. 331.
- ↑ ernaehrung.de
- ↑ heil-heilfasten.de
- ↑ Claudia Bausewein et al. (Ed.): Drug therapy in palliative medicine. (Original edition: PCF2, Palliative Care Formulary, Second Edition ; translated by Kathrin Grüner) Urban & Fischer, Munich and Jena 2005, ISBN 3-437-23670-9 , pp. 16-21.
- ↑ Jonathan Pereira, Rudolf Buchheim: Handbuch der Heilmittelellehre , Volume 2, Leopold Voss, Leipzig 1848, p. 339 ff., Full text in the Google book search.
- ↑ Ralf Vollmuth : purging, purgation. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. Walter de Gruyter, Berlin and New York 2005, ISBN 3-11-015714-4 , p. 1203.
- ↑ Gundolf Keil : "blutken - bloedekijn". Notes on the etiology of the hyposphagma genesis in the 'Pommersfeld Silesian Eye Booklet' (1st third of the 15th century). With an overview of the ophthalmological texts of the German Middle Ages. In: Specialized prose research - Crossing borders. Volume 8/9, 2012/2013, pp. 7–175, here: pp. 20 f. and 42.
- ↑ Christoph Schweikardt: Laxative. In: Werner E. Gerabek et al. (Ed.): Enzyklopädie Medizingeschichte. 2005, p. 3.
- ↑ Gundolf Keil (2012/2013), p. 21.
