Chronic constipation is defined as the emission of stools less than three times a week, hard, and with a total daily weight less than 35 g. This can be primary or secondary to numerous digestive and extra digestive diseases. In this paper we will briefly review chronic primary or idiopathic constipation, in which psychological, hormonal, and dietary factors mainly influence. To know if you suffer from chronic constipation, the diagnostic criteria are the following:
-Incomplete Evacuation Sense
- Obstruction sensing / anorectal block
-Less of three bowel movements per week.
A high percentage of the population may suffer from constipation, especially in elderly people, women, and boys in childhood. Consultations in primary and specialized care are relevant in this sense: constipation is a common cause in primary care pediatrician consultations, as in specialist consultations. For its diagnosis, the clinical history, the analytical, the physical examination with digital rectal examination, and the practice of an opaque enema, a colonoscopy and biopsy to rule out pathologies are fundamental. Manometry and examination of intestinal and colonic transit, by expiratory H2 breath test or markers, are measures that help in pathophysiology and etiological diagnosis.
Treatment of chronic constipation and indications
Formerly the treatment was done with laxatives (abuse of laxatives). Currently and after the implementation of hygienic-dietary measures, its treatment begins with the administration of soluble fiber in an amount greater than 10 g / day. Due to the appearance of flatulence or when the 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, like prebiotics can also be administered as adjuvant therapy to fiber intake, accelerating its performance when this is the treatment of first choice.
The taking 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. It is important to be careful in patients with kidney failure.
Complications: The Fecaloma
Faecal impaction is often a complication of concurrent diseases, of pharmacological treatments (analgesics or other drugs that cause acute or chronic constipation). Also, and due to lack of mobility, in the elderly. Enemas and Lactilol can be used orally to empty the rectum.
In conclusion, the efficacy, tolerability and safety of osmotic preparations (Lactulose / Lactitol) in children, pregnant women and the elderly are fully demonstrated. Lactulose is effective and well tolerated, although it sometimes produces belching, gas, and diarrhea. Lactilol comparatively with Lactulose, has less adverse effects, is superior in terms of therapeutic compliance, and has demonstrated efficacy and safety, compared to Lactulose for what it is, of choice in the treatment of chronic idiopathic constipation, as well as Cinitapride in combination with methyl cellulose.