Which laxative is best for older people?

Constipation occurs in 40% of people over 60 years of age, which indicates the high prevalence of this unpleasant phenomenon in older people. In fact, the problem of constipation occurs so often among them that it is considered almost normal. However, it is possible and necessary to achieve improvement in well-being: for this it is important to select competent treatment for constipation in older people and organize further prevention.

One recent study found that constipation in older adults increases the risk of developing cardiovascular disease, especially in postmenopausal women. Chronic constipation increases the risk of cardiovascular disease by 23%1.

In the understanding of most, constipation is a disorder of the intestines, which is manifested by the absence of regular bowel movements. Many older people in this case begin to take laxatives for constipation, but it is important to know that some groups of drugs can be addictive, moreover, they have a rather aggressive effect on the intestines and have a fairly large list of side effects and contraindications2.

Laxatives for the elderly

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Intestinal constipation in old age is not uncommon, so along with changes in diet, doctors often prescribe laxatives for older people.

Such drugs cause increased intestinal motility, accelerated movement of feces and facilitated bowel movements.

[1], [2], [3], [4]

Groups of laxatives used in old age

All laxative drugs are divided into 4 main groups:

Thus, the most effective and safe means suitable for daily use in old age are osmotic and bulk laxatives, and prebiotics.

Pharmacodynamics of laxatives for the elderly

Laxatives may have different pharmacological mechanisms of action. However, all the capabilities of such drugs are aimed at achieving one goal - eliminating constipation and intestinal atony. How can this be achieved?

• The effect of irritating intestinal receptors is created, affecting directly the mucous tissues, thereby enhancing peristalsis and increasing the secretion of mucus into the large intestine (herbal medicines, bisacodyl, etc.);
• The volume of intestinal contents increases, which stimulates the intestinal walls and provokes increased peristalsis (salt preparations, seaweed);
• There is a softening of fecal accumulations, which facilitates bowel movements (oil preparations).

Salt preparations (lactulose, macrogol, magnesium sulfate) are not adsorbed into the systemic circulation, creating an increase in osmotic pressure and retaining fluid inside the intestine. This promotes mechanical stretching of the intestinal walls, which gives rise to increased peristalsis and a more frequent urge to defecate.

Suppositories are designed to irritate the mucous membranes of the rectum, stimulating the urge to defecate. However, this action makes suppositories undesirable in case of exacerbation of hemorrhoids or inflammatory processes in the anus and rectum.

[9], [10], [11], [12], [13]

Laxatives for special categories of patients

Means to facilitate bowel movements should be selected for the elderly, taking into account their underlying diseases:

• For diabetes mellitus, medications should not increase blood glucose levels. Duphalac, Fortrans, and laxative suppositories correspond to these characteristics.

• For peptic ulcers of the digestive system and gastritis, prebiotics or Fitolax are prescribed.

• For bedridden patients, it is recommended to prescribe Macrogol, Forlax.

For persistent constipation, drugs with intestinal irritating properties can be used once. But you need to prepare for the fact that they can cause pain and bloating.

Pharmacokinetics of laxatives in the elderly

Herbal medicines with an anthraglycoside composition are biotransformed in the liver, where chrysophanic acid and emodin are released. The latter are excreted through the kidneys and are also found in breast milk and sweat secretions.

Buckthorn preparations may be slightly absorbed into the bloodstream and excreted by the urinary system: in this case, the urine may change color to red or dark yellow.

Laxatives for older people are prescribed mainly at night, since the effect of the drugs is expected approximately 6-8 hours after their use.

[14], [15], [16], [17]

Contraindications to the use of laxatives for the elderly

The most common contraindications to the use of laxatives for older people are:

• individual cases of intolerance to any components of the drug;
• suspicion of intestinal obstruction;
• the presence of a strangulated hernia, as well as inflammatory processes of internal organs in the acute stage;
• stomach, intestinal and uterine bleeding;
• disorders of electrolyte metabolism;
• appendicitis;
• abdominal pain of unknown origin;
• cystitis.

[18], [19]

Eziklen concentrate for the preparation of solution for oral administration, 2 bottles of 176 ml each

Registration Certificate Holder

IPSEN PHARMA (France)

Dosage form

Medicine - Eziclen

Description

Concentrate for the preparation of solution for oral administration

- a clear or slightly opalescent liquid with a fruity odor.

1 fl. (176 ml)

magnesium sulfate heptahydrate 3.276 g sodium sulfate (anhydrous) 17.510 g potassium sulfate 3.13 g

Excipients

: sodium benzoate 0.098 g, anhydrous citric acid 0.315 g, malic acid 0.315 g, sucralose 0.3025 g, purified water 169.641 g, fruit and berry cocktail flavor 0.7875 g. Fruit and berry cocktail flavor consists of a mixture of natural and synthetic flavors, propylene glycol (E1520 ), ethyl alcohol, acetic acid and benzoic acid (E210).

176 ml - bottles made of polyethylene terephthalate (volume 180 ml) (2) complete with a measuring cup - cardboard packs.

Indications

For colon cleansing in adult patients in preparation for endoscopic and radiological examination of the colon or for surgical interventions requiring the absence of contents in the colon.

Contraindications for use

Hypersensitivity to the components of the product; gastrointestinal obstruction or suspected gastrointestinal obstruction, intestinal perforation, gastric emptying disorders (including gastroparesis), intestinal obstruction, toxic colitis or toxic megacolon, profuse vomiting, severe dehydration, congestive heart failure, ascites, severe renal failure (GFR <30 ml/min/1.73 m2), active phase of inflammatory bowel diseases (such as Crohn's disease, ulcerative colitis); pregnancy, breastfeeding period; age up to 18 years.

Carefully:

elderly age; mild to moderate renal dysfunction; liver dysfunction; simultaneous use of drugs that affect the concentration of electrolytes: calcium channel blockers, diuretics, lithium preparations or other drugs of similar action; simultaneous use of drugs that prolong the QT interval; decreased motility of the gastrointestinal tract (including in history), the presence of surgical interventions on the gastrointestinal tract, which led to impaired motility; in patients with an impaired gag reflex, with a tendency to regurgitation and aspiration; in exhausted, weakened patients; in patients with clinically significant cardiac dysfunction; in patients at high risk of developing water and electrolyte disorders (including hyponatremia and hypokalemia).

pharmachologic effect

Combined osmotic laxative.

The mechanism of action is primarily due to the saturation-limited process of active transport of sulfates. When the absorption saturation threshold is reached, sulfates remain in the intestinal lumen.

The osmotic effect of unabsorbed sulfates and the ingestion of a significant volume of water causes water retention in the intestines, which provides a laxative effect, causing profuse watery diarrhea, and leads to bowel cleansing.

Drug interactions

This drug should be used with caution in patients receiving therapy with drugs that affect the concentration of electrolytes: blockers of “slow” calcium channels, diuretics, lithium preparations or other drugs of similar action.

Caution should be exercised when taking drugs that prolong the QT interval concomitantly.

Diarrhea when using this product is an expected effect; ingestion of other medications within 1 - 3 hours after starting to take the drug and before the end of the intestinal cleansing process can lead to their leaching from the gastrointestinal tract and impaired absorption. The therapeutic effect of drugs administered regularly orally, having a narrow therapeutic range or short half-life (for example, oral contraceptives, antiepileptic drugs, hypoglycemic drugs, antibiotics, levothyroxine sodium, digoxin, etc.) may be altered.

Dosage regimen

Taken orally. The dose and regimen of use are determined by the doctor individually.

After the procedure, in order to replace fluids lost in preparation for the procedure, patients should drink enough fluids to maintain an appropriate level of hydration.

Side effect

From the immune system:

frequency unknown - hypersensitivity reactions (including urticaria, itching, rash, erythema, dyspnea, feeling of constriction in the throat).

From the nervous system:

infrequently - headache, dizziness.

From the digestive system:

very often - bloating, abdominal pain, nausea, vomiting; uncommon - discomfort in the anorectal area, dry mouth.

From the urinary system:

infrequently - dysuria.
General reactions:
very often - general malaise; infrequently - fever.

From the laboratory parameters:

uncommon - increased activity of aspartate aminotransferase, creatine phosphokinase, lactate dehydrogenase in the blood; increased concentration of phosphorus in the blood; hyperbilirubinemia; deviations in the results of biochemical blood tests, including hyponatremia, hypokalemia, hypocalcemia and hyperuricemia, increased activity of alkaline phosphatase, CPK, LDH and creatinine content in the blood serum; rarely - increased amylase activity in blood plasma.

special instructions

This remedy is not used to treat constipation.

Given the potential risk of developing serious electrolyte disturbances, the benefit/risk ratio should be carefully assessed before using this drug in high-risk groups. Before using the product, contraindications for its use must be excluded. Particular attention should be paid to the use of special precautions, including the need to maintain adequate hydration.

All patients should be warned to maintain adequate hydration before, during, and after taking this medication. If a patient develops excessive vomiting or signs of dehydration after taking the drug, rehydration measures should be taken to avoid the potential risk of serious complications associated with fluid and electrolyte imbalance (such as seizures, cardiac arrhythmias). In addition, preliminary laboratory tests are recommended (determining the concentration of electrolytes, creatinine and blood urea nitrogen). Patients should be advised to drink as much water or clear liquids as possible to maintain an appropriate level of hydration.

In malnourished, debilitated patients, elderly patients, patients with clinically significant impairment of renal, hepatic or cardiac function, and in patients at high risk of developing electrolyte disturbances, biochemical tests should be performed to determine serum electrolyte concentrations and renal function should be assessed before and after treatment. use of this tool.

Patients with dehydration or fluid and electrolyte imbalances should receive appropriate therapy to correct them before taking a colon cleanser. In addition, caution should be exercised when using the drug in patients with medical conditions or in patients taking medications that increase the risk of fluid and electrolyte imbalances (including hyponatremia and hypokalemia) or increase the risk of potential complications. Monitoring of such patients is necessary.

The drug should be used with caution and only under the supervision of medical personnel in patients with an impaired gag reflex and in patients with a tendency to regurgitation and aspiration.

The drug should be used with caution in cases of decreased gastrointestinal motility, incl. if there is a history of surgical interventions on the gastrointestinal tract, which led to decreased motility.

Taking this drug may cause a temporary mild to moderate increase in uric acid concentrations, which should be considered before prescribing the drug to patients with manifestations of gout or hyperuricemia.

This product contains sodium. This must be taken into account when using it in patients who are on a sodium controlled diet

This product contains potassium. This must be taken into account when using it in patients with reduced renal function or in patients who are on a diet with controlled potassium intake.

Use during pregnancy and breastfeeding

Restrictions during pregnancy - Contraindicated. Restrictions when breastfeeding - Contraindicated.

Contraindicated for use during pregnancy and breastfeeding.

Breastfeeding should be stopped while taking the drug and up to 48 hours after the last dose.

Use for renal impairment

Restrictions for impaired renal function - With caution.

Use is contraindicated in severe renal impairment.

Use with caution in cases of mild or moderate renal impairment.

Use for liver dysfunction

Restrictions for liver dysfunction - With caution.

Use with caution in case of liver dysfunction.

Use in elderly patients

Restrictions for elderly patients - Use with caution. Use with caution in elderly patients.

Use in children

Restrictions for children - Contraindicated. Use in children and adolescents under 18 years of age is contraindicated.

Side effects of laxatives for older people

When prescribing laxatives, older people should especially pay attention to the possible side effects of the proposed medications, so carefully read the instructions before using the drug.

The most common side effects that laxatives can cause are:

• increased gas formation, diarrhea, attacks of nausea and vomiting;
• colicky abdominal pain;
• convulsions;
• fluid and electrolyte imbalances;
• allergic manifestations, skin rash.

If side effects occur, be sure to notify your doctor.

[20], [21]

Names of laxatives for the elderly

As we have already said, laxative medications are divided depending on the mechanisms and methods of their action:

• receptor irritants of the intestinal walls (rhubarb, buckthorn, zoster, senna, sabura, isafenin, phenolphthalein, castor oil, etc.);
• agents that stretch the intestinal walls (sodium and magnesium sulfates, salts, lactulose, flax, seaweed, etc.);
• fecal softeners (oily preparations, antispasmodics).

Stools close in quality to natural can be expected after taking Kafiol, petroleum jelly, seaweed, sulfur, etc.

More diluted stools are expected after taking herbal remedies (rhubarb, senna, buckthorn), castor oil, phenolphthalein, bisacodyl, oxyphenisatin, etc.

Diarrhea-type stools can be caused by salt preparations (magnesium and sodium sulfates).

[22]

Directions for use and doses

Rhubarb rhizome - produced in tablets of 0.3 and 0.5 g, as well as in powder, used to treat chronic constipation. Apply orally before going to bed from 0.5 to 1.5 g at a time, or 0.5 g three times a day before meals. The drug is not recommended for use in children under one year of age. From one year of age, it can be used in a dose of 0.1 to 0.5 g as prescribed by a doctor.

Buckthorn, bark - sold in packages of 100 g. Take 100 ml orally in the form of a decoction (40 g of raw material per 0.4 liter of water) in the morning on an empty stomach and before bed. Can be combined with other laxatives, in particular saline ones.

Buckthorn, liquid extract – used orally from 20 to 40 drops in the morning and evening.

Buckthorn, tablets (dry extract) - take 1-2 tablets immediately before going to bed.

Zhoster fruits - sold in packages of 100 g. Used as a 100 ml decoction before bedtime (one tablespoon of raw material is brewed in 200 ml of boiling water).

Senna, leaves - available in boxes of 100 g. The drug is used orally, a tablespoon of infusion three times a day (to prepare the infusion, take 10 g of leaves per 100 ml of water). The drug acts gently and effectively, so it is often used in childhood.

Kafiol is a combined medicine consisting of senna leaves and fruits, as well as plum fruits, figs and petroleum jelly. Produced in the form of briquettes for chewing. Use half or a whole briquette at a time before bedtime. If constipation is chronic and persistent, it is allowed to consume kafiol twice a day. The maximum dose of the drug per day is 5 briquettes, the maximum duration of treatment is up to 2 weeks.

Knotweed is produced in the form of dry raw materials in packages of 100 g. Use an infusion of the plant (10 g of raw material per 100 ml of water) a tablespoon three times a day for atony and intestinal spasms.

Licorice root, powder – used orally, 1-2 tsp. powder up to 3 times a day, in childhood - a quarter or half a teaspoon.

Stomach collection is a herbal mixture consisting of buckthorn, mint, nettle, calamus and valerian. Used for brewing (one tablespoon per 200 ml of boiling water). Drink half a glass in the morning and at night.

Laxatives with dietary fiber

The main advantages of drugs from this group are lack of addiction, mild effect, and good tolerability. Laxatives with indigestible fiber can be taken for up to several months

• Mukofalk
  . The drug is based on powder obtained from the shell of plantain seeds. They contain hydrophilic fibers that attract water, swell and increase the volume of the intestinal contents, while simultaneously making them soft. Mucofalk is not addictive, so it can be used daily, one sachet up to 6 times a day.

• Naturalax
  . The composition with Mucofalk is almost identical, therefore the mechanism of action of the drug is similar. Available in powder, which is dissolved before use.

• Fiberlex
  . The granules contain crushed plantain oval powder. For chronic constipation, you can drink Fiberlex daily for up to 4 weeks.

When using laxatives with dietary fiber, you must not forget to drink plenty of water - up to 2 liters per day. Lack of fluid in the body causes intestinal irritation.

What is constipation

Difficult, systematically insufficient bowel movement (defecation) - this is the definition of constipation given in official medicine . Synonyms for this problem are “obstipation” and “constipation”. According to the International Classification of Diseases (ICD-10), constipation is a disease, but the World Organization of Gastroenterology calls it a symptom because it can indicate severe problems with the digestive tract. Constipation itself, if not constant, is not dangerous to health. Chronic meets the following criteria:

• manifestations last more than six months, over the last 3 months there have been at least 2 main symptoms;
• lumpy, hard stools every 2nd or 3rd bowel movement;
• the need to push hard with every 2nd or 3rd bowel movement;
• less than 3 successful bowel movements per week;
• a constant feeling of “blockage” in the rectal area in 25% of cases of defecation (during and after);
• the desire to empty the intestines even after defecation has been completed in 25% of cases;
• the need for mechanical stimulation of stool output in the anorectal area.

If bowel movements have not occurred for several days, this condition is defined as acute constipation, which can be facilitated by rectal obstruction - often due to tumors or inflammation . There are much more common causes of this condition; depending on them, constipation is divided into:

• nutritional – occurs when there is a decrease in the consumption of fiber (plant fiber), lack of water and a “starvation” diet (often observed in bedridden patients);
• mechanical - provoked by organic changes in the intestines, injuries;
• dyskinetic - appears against the background of functional disorders of the gastrointestinal tract (GIT), anomalies of innervation (nervous regulation) of the colon, with irritable bowel syndrome, under the influence of psychosomatic factors.

Constipation occurs more often in older people because they experience natural age-related changes in the functioning and condition of the digestive system. Thinning of the mucous membranes of the stomach and intestines occurs, interaction between segments of the gastrointestinal tract is disrupted, and atony (decreased tone) of the intestine develops. General physical activity decreases, hormonal levels change (especially in women), which also affects the activity of the gastrointestinal tract. The situation may be affected by:

• diabetes;
• hypothyroidism (lack of thyroid hormones);
• general muscular dystrophy (weakness);
• long-term use of certain medications.

Folk remedies for constipation for older people at home

Medicinal herbs are recommended to be used only after consultation with the attending physician. Infusions and decoctions made from plant materials have quite a few contraindications, so such products should be used with caution.

Remedies for constipation for older people at home, offered by traditional medicine:

• Compote of dried fruits, which must contain raisins, prunes, and dried apricots. They have a mild laxative effect. Directions for use: leave for 24 hours, drink 0.2 liters in the morning before meals.
• Boiled beet salad seasoned with vegetable oil stimulates contraction of the intestinal tube walls in older people. If gastritis is diagnosed, then the root vegetable should not be eaten.
• Fresh one-day fermented milk drinks - yogurt and kefir - in combination with vegetable oil. To prepare the medicine, you need to add one tablespoon of oil to 0.2 liters of drink.
• It is advisable to include bran in the daily diet of older people to relieve constipation. The recommended dosage is adding three to four tablespoons daily to first and second courses.
• Flax seeds are a good remedy for normalizing bowel movements. Method of preparing the drug: leave one and a half teaspoons of flax seeds poured with boiling water until mucus forms. You need to take half a glass of mucus only, excluding seeds, during the day.
• Elderberries are another folk remedy for constipation for the elderly. To prepare it, you need to boil the washed black elderberries together with sugar for 20 minutes in an enamel pan over low heat. For one liter of berries you need to add one glass of granulated sugar. It is recommended to take three tablespoons of the resulting product before meals in the morning and evening.

Many people have the impression that constipation medications for older people at home are preferable to medications. However, there are also restrictions on their use, so the use of traditional recipes also needs to be agreed with your doctor.

Medicines and traditional medicine for the treatment of constipation in older people have the following general contraindications:

• intestinal obstruction;
• gastrointestinal ulcer;
• intestinal bleeding.

Side effects of taking medications for constipation may include allergic reactions due to individual intolerance to the components, increased gas formation, diarrhea, and flatulence.

Constipation in older adults is a serious problem that needs to be addressed. This can be done by choosing the right medications. Moreover, treatment must be not only effective, but also safe.

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Treatment of constipation in older people

Due to natural changes in the body, stool retention can be chronic, and in such a situation, a gastroenterologist can prescribe regular intake of medications that improve peristalsis (rhythmic contractions of the walls) of the intestine, facilitating its emptying , but you should not rely only on pills. Elderly people should find out the exact cause of constipation and take a number of additional measures (in some cases they replace taking pharmaceutical medications):

• Pay attention to your diet. Fresh (if possible) vegetables and fruits should take up more than half of the daily plate in order to supply the body with fiber that stimulates intestinal activity. At the same time, it is advisable to reduce the amount of bread consumed (especially from premium wheat flour), baked goods, and pasta - they make stool harder.
• Don’t forget about fluids: dehydration of the body leads to caking of feces retained in the colon. Drink 1-1.5 liters of clean water (if there are no heart diseases), of which 200 ml on an empty stomach, to stimulate the intestines after waking up. Try to regularly include weak broths, compotes, herbal teas, and juices in your menu. Warm mineral water will also be useful. You shouldn't overuse coffee.
• Remember about fractional meals: the smaller the portions, the easier it is for the digestive tract. Frequent meals (5-7 times) help stimulate intestinal function. You can't take long breaks.
• Try to eat pureed food, especially if it is meat or fish or cereals.
• Avoid a sedentary lifestyle (with the exception of bedridden elderly people): try to walk in the fresh air every day, and, if possible, do physical exercise (not intense). Playing sports will also be beneficial if there are no contraindications for health reasons.

Compliance with dietary requirements plays an important role in the treatment of constipation and provides half of the positive treatment result. In the presence of chronic diseases of the digestive tract, an individual diet is selected for the patient: for example, if stool retention is accompanied by spastic pain, the content of dietary fiber in the diet should be reduced. Medicines are selected by the doctor according to specific symptoms, since they often do not solve the problem, but only facilitate the process of excreting feces.

Names of medications for constipation in older people

Most often, to normalize the process of bowel movements, people of all ages use medications in the form of tablets. In medical practice, they are conventionally divided into two groups: instant-acting drugs that promote rapid evacuation of intestinal contents, and drugs that act more slowly but more gently.

Soft tablets for constipation in older people include only Normaze and Prelax, which are prebiotics. The remaining tablets are considered quick drugs, among them having an irritating effect: Senade, Guttalax and Endofalk, which increases osmotic pressure.

The following laxatives are most effective for constipation in older people:

• Bisacodyl
  - acts as an irritant, increases the secretion of intestinal mucus. The drug contains a chemical substance of the same name. The result appears after 6 hours, and when taken in the evening before bed - after 8 hours. Contraindications for the use of Bisacodyl are hemorrhoids, intestinal obstruction, spastic constipation, internal bleeding (from the gastrointestinal tract and uterus), water-salt imbalance, cystitis. Elderly people are prescribed 1 to 3 tablets once, either at night or 30 minutes before breakfast. Taking the drug with plenty of water is a prerequisite for taking it correctly.

• Picolax
  - a drug for the treatment of constipation in the elderly, acting as a receptor irritant. The active substance is sodium picosulfate. The drug is available in the form of tablets and drops. Effective six hours after consumption. The product must be taken in the morning or before bedtime. You need to take the medicine with plenty of water. The dosage is prescribed to each elderly patient individually. Picolax can only be used for ten days. Despite the good tolerability of the drug, older people must first obtain a prescription from a specialist.

• Lactusan
  - a probiotic that reduces intestinal acidity and stimulates the growth of acidophilus bacteria. The active ingredient of this drug for constipation is lactulose syrup. Can be purchased in syrup or tablet form. Elderly people are recommended to take 4-5 tablets or 10 ml of syrup in the morning and evening with meals. Long-term therapy of up to 14 days is required to achieve results. A side effect in the first three days of use may be flatulence. Contraindications to the use of Lactusan: lactose deficiency and galactosemia.

The fastest way to relieve constipation in older people is with topical products. These include rectal suppositories and Microlax microenemas. Such drugs have a laxative effect within five minutes after use, but act for no more than 30 minutes. These remedies do not work if tumors or scarring in the intestines are present in older adults.

Depending on the composition, suppositories are divided into natural preparations for constipation and synthetic ones. Suppositories based on plant materials, for example, Rectative are made from chestnut seeds; to achieve results, you must undergo a course of treatment. Synthetic rectal suppositories Bisacodyl act faster. If older people suffer from chronic constipation, they may be prescribed gas-forming suppositories, for example, preparations with rhubarb extract: Calciolax, Ferrolax.

The most popular topical medications for constipation for older people are:

• Sea buckthorn candles
  - not only normalize bowel movements, but also have an analgesic, anti-inflammatory, and wound-healing effect on the walls of the rectum. Made from sea buckthorn oil. Directions for use: after a cleansing enema, before bedtime. The course of treatment lasts from seven to ten days. When using sea buckthorn suppositories, local side effects such as swelling of the anorectal area, redness, and burning sensations may occur.

• Glycerin suppositories
  - a remedy for constipation, stimulating intestinal motility, accelerating the movement of its contents. Suppositories are made on an oil base. Directions for use: once a day, after breakfast. Contraindications for use: tumors and inflammatory bowel diseases, hemorrhoids, rectal fissures.

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Constipation medicine for older people

Drugs designed to restore normal bowel movements may be intended for internal or local use . The latter are suppositories with a laxative effect and enema solutions, which are considered relatively safe because they only work locally. Oral medications (tablets, powders, syrups) are more common, but may have a long list of contraindications and side effects. Laxatives for the elderly are divided into the following groups:

• Osmotic - based on salt of artificial or natural origin, they have the property of drawing liquid onto themselves, which leads to the prevention of its absorption in the intestines. Thanks to this, stagnant stool softens. The advantage of such drugs is that they are not addictive, but long-term use of them can provoke dehydration of the body, so an increase in the daily volume of fluid during use is required.
• Irritating - may contain natural and synthetic components, stimulate irritation of intestinal receptors to speed up the movement of feces. The most popular laxatives for constipation for the elderly, especially with intestinal atony, give a quick effect, but are addictive and are prohibited for long-term use.
• Detergents are capable of softening feces and promoting their evacuation due to the active formation and excretion of bile, which stimulates intestinal peristalsis. Based on vegetable oils or petroleum jelly, they require caution in the presence of diseases of the hepatobiliary system (problems with the liver, gall bladder, pancreas).
• Prebiotics – work on natural oligosugars (lactulose, inulin), help restore intestinal microflora. During the fermentation of active substances, organic acids are released, stimulating the nerve endings of the intestinal mucosa. The effect of probiotics is complex: irritating, osmotic and therapeutic. They are prescribed for long-term treatment, since they do not give immediate results, but their effect is prolonged, and there are no side effects from them (with the exception of increased gas formation).
• Fillers - can be of natural origin or based on methylcellulose; they swell when ingested and in contact with water. They are not digested, they stimulate stretching and contraction of the walls to push out the filler. They do not give an effect immediately, they last up to 3 days. In the elderly, they are used only in the absence of intestinal atony (when the muscles work correctly) and inflammatory processes in the gastrointestinal tract.

Pills

The most common form of medication that helps with constipation in the elderly and others is tablets. Doctors conditionally divide them into immediate-acting drugs that help quickly evacuate feces, and slower, but milder ones. Among the tablets, the latter only fully include prebiotics - Normaze, Prelax. The rest (especially the irritating Guttalax, Senade; osmotic Endofalk) are considered fast. The most effective laxatives for constipation in the elderly:

• Bisacodyl is an irritant, works on the substance of the same name, increases the secretion of intestinal mucus. It begins to act after 6 hours, when taken at night – after 8 hours. Prohibited for intestinal obstruction, bleeding from the gastrointestinal tract and uterus, hemorrhoids, cystitis, spastic constipation, water-salt imbalance. Elderly people are prescribed up to 1-3 tablets per dose in the evening or half an hour before breakfast, a single dose. Be sure to take the medication with plenty of water.
• Picolax is a product based on sodium picosulfate in the form of drops and tablets, an irritant of intestinal receptors. The therapeutic effect develops 6 hours after administration. The tablets are taken in the morning or evening with plenty of water, the dosage is set individually. The product cannot be taken for more than 10 days. Picolax is well tolerated, but in the elderly it should be used only as prescribed by a doctor.
• Lactusan is a drug that reduces intestinal acidity, based on lactulose syrup, and is a probiotic. Available in the form of syrup and tablets, it stimulates the growth of acidophilus bacteria. Prohibited for lactose deficiency, galactosemia. The elderly are given 4-5 tablets in the morning and evening with food or 10 ml of syrup. Therapy is long-term, up to 2 weeks. Flatulence is possible in the first 3 days.

Laxative suppositories

The fastest results are provided by local laxatives: microenemas (Mikrolax) and rectal suppositories - they can begin to act after 5 minutes, but work no longer than half an hour. If there are tumors or scars in the intestines, such remedies are powerless. Suppositories can have different compositions: natural ones (Rectative - on chestnut seeds) will have to be used in a course, and synthetic ones (Bisacodyl) will act faster. For chronic constipation, gas-forming suppositories can be prescribed - Ferrolax, Calciolax or with rhubarb extract. Most Popular:

• Sea buckthorn suppositories - in addition to influencing the process of bowel movement, these suppositories containing sea buckthorn oil have a wound healing and anti-inflammatory effect on the walls of the rectum and reduce pain. Used at night, after a cleansing enema, the duration of treatment can be 7-10 days. Local adverse reactions: burning, redness, swelling of the anorectal area.
• Glycerin suppositories are prohibited for hemorrhoids, rectal fissures, inflammatory and tumor diseases of this organ. The oil base of the product stimulates the contraction of intestinal walls and accelerates the movement of feces. Glycerin suppositories are used after breakfast, 1 time per day.

For bedridden elderly people

Mild regular stimulation of intestinal peristalsis, which is performed by physical activity, which is inaccessible to bedridden elderly people, is the main task of the drugs that are prescribed to them. Laxatives with an immediate effect are unacceptable here: choose lactulose, polyethylene glycol, and macrogol recommended for the treatment of chronic constipation. Gastroenterologists advise:

• Duphalac is a lactulose syrup, a probiotic that changes the flora of the colon, increases the acidity in its lumen, stimulates peristalsis, softens stool. It does not affect the mucous membrane and smooth muscles. Prohibited for rectal bleeding, lactase deficiency, suspected appendicitis. The dosage is selected individually by the doctor and can be used continuously (longer than six months). Absolute analogues are Portalak and Normaze.
• Forlax is a macrogol-based powder that has an osmotic effect and increases the volume of intestinal contents. The effect appears 24-48 hours after administration, the product is allowed even for children. Forlax can be used for 3 months, dosage – up to 4 sachets per day. The powder is diluted with warm water (50 ml), the medicine is drunk morning and evening. Adverse reactions occur rarely; contraindications include Crohn's disease, unspecified abdominal pain, and intestinal obstruction.

List of the best laxatives for the elderly

Select means that facilitate stool passage for the elderly based on the safety and effectiveness of the means. The following selection criteria are:

• Forlax
  . Refers to osmotic laxatives. Begins to act within 12-24 hours. You can take it without a break for up to three months.

• Lactulose
  . Refers to prebiotics. Can be used for 6 months, lactulose optimally removes breakdown products of protein foods. Contained in such drugs as Duphalac, Normaze, and a cheap analogue - Portalac.

• Fitomucil
  . The drug contains plum fruits and psyllium seed husks; due to these natural components, feces are softened and intestinal motility is enhanced. The medicine has a mild effect; when using it, there are no cramps or bloating. The laxative effect develops after 12-48 hours.

For chronic diseases of the liver and pancreas, treatment can be supplemented with enzymes. They improve the flow of bile, which also has a positive effect on intestinal function.

What laxatives can be taken long term?

Disruption of the natural functioning of the intestine, which gets used to constant external (drug) stimulation, a decrease in its general tone, dehydration of the body, loss of minerals and electrolytes are the main problems that arise with long-term use of osmotic and irritating drugs. They cannot be used for permanent treatment: only once, in case of urgent need. If laxatives are needed for long-term therapy, the following are allowed:

• probiotics (Duphalac, Poslabin, Normaze);
• fillers (Fortrans, Lavacol, Mucofalk);
• herbal preparations.

Among laxatives suitable for long-term use, doctors highly appreciated the mild osmotic drug Forlax, described above and recommended for bedridden elderly people. Gastroenterologists advise:

• Phytomucil is a herbal remedy based on the husks of plantain seeds and plum fruits, which softens stool, stimulates the secretion of bile, which helps food be better digested and excreted in a timely manner . For elderly people, 1-4 sachets are recommended (the drug is in powder), the contents are diluted in water or juice. After 15 minutes you should drink another glass of warm water. No side effects have been recorded; the only contraindications are individual intolerance to the composition. The duration of treatment is determined by the doctor.
• Prelax is a lactulose-based syrup that acts as a dietary supplement (BAA) to food. Stimulates the movement of feces through the rectum, removes toxins, and does not reduce the ability of the gastrointestinal tract to absorb vitamins. Prohibited only for galactosemia; side effects may include flatulence. Prelax is prescribed 2-6 ml with food 3 times a day. The course of treatment lasts 3 weeks.

Natural laxatives for constipation for the elderly

An important point in the treatment of defecation retention is the adjustment of the daily diet, therefore the main natural laxatives are food. They are selected individually based on symptoms, and in parallel with this, a list of food prohibitions must be taken into account:

• If you have bloating, you should not consume legumes, cabbage, spinach, sorrel, apple and grape juices, as they increase gas formation.
• Sources of tannins delay the natural process of bowel movement, so no blueberries, coffee, cocoa, or red wines in the diet. Among the cereals, rice and semolina are prohibited, especially those cooked to the state of viscous porridge.

Natural remedies for constipation for the elderly include medicinal herbs: they act more gently than pharmaceutical drugs, are less likely to cause adverse reactions, but do not exclude individual intolerance. Vegetable oils and vegetable juices have a similar effect: from onions, pumpkins, beets, carrots, tomatoes. The following herbal laxatives work well for constipation:

• Senade (on senna leaves);
• Agiolax (senna and plantain;
• Kafiol (senna, fig, plum, petroleum jelly);
• Musinum (buckthorn bark, anise, senna, boldo).

Foods that speed up bowel cleansing

Gastroenterologists advise all elderly people to actively consume sources of fiber (excluding those with severe spastic pain), which include fresh vegetables. Carrots and beets are considered especially important; they are required daily for anyone suffering from constipation. It is advisable to season them with vegetable oil to increase the effect by enhancing intestinal motility. This also helps:

• rye bread (for gastritis and high acidity of the stomach is prohibited) and with bran;
• fruit and vegetable juices (not packaged - homemade);
• dried fruits (prunes, figs - be sure to steam them);
• fresh fruits;
• fresh fermented milk drinks or yesterday’s (old kefir, yogurt, fermented baked milk, sourdough have the opposite effect);
• berries, figs;
• porridge cooked in water (oatmeal, barley, buckwheat);
• honey;
• kvass;
• cream, sour cream.

Laxatives

Modern laxatives for constipation for the elderly help get rid of the nagging pain and discomfort that often accompanies difficult bowel movements. There are the following types of such drugs:

• agents that irritate intestinal receptors;
• medications for constipation that inhibit water absorption;
• drugs that soften stool;
• drugs that help increase the volume of intestinal contents.

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Folk remedies

In case of chronic stool retention, doctors advise avoiding heavy medications as much as possible, using herbal preparations or herbal medicine instead. Infusions and decoctions of herbs gently stimulate intestinal activity, help prevent caking of feces, facilitate their movement and the process of excretion, but must also be selected with caution . Some herbs (senna, buckthorn bark) have a pronounced laxative property, so products based on them are taken in small doses.

Flaxseed infusion

For those who are looking for an effective remedy for constipation for the elderly, gastroenterologists advise trying an infusion of alpine toadflax , the only drawback of which is the absence of this herb in most pharmacies. It should be collected during flowering and dried yourself. Additionally, it has a beneficial effect on the outflow of bile and is recommended for hypotonic bile duct dyskinesia. The product is prepared and used as follows:

1. Pour 1 tbsp. l. raw materials with a glass of boiling water.
2. Cover with a lid, wrap in a towel, leave for an hour.
3. Strain, divide the daily dose of 100 ml into several doses. You should not drink this product for more than 7 days due to toxicity.

Linseed oil

Not the safest, but a very powerful remedy for constipation, bloating, flatulence, heartburn, and intestinal colic is flaxseed oil , which is superior to other vegetable oils in its beneficial properties. Increasing immunity, stimulating metabolic processes, improving the functioning of the digestive tract are the main advantages of this product. Flaxseed oil can treat and prevent constipation by doing this:

• Mix yogurt or drinking yogurt without additives with flaxseed oil (1 teaspoon each), take before bed for a week. If stool retention is chronic, the product should be used in the morning on an empty stomach for a month.
• Grind the washed and dried shells of 3 chicken eggs, add 1 tsp. flaxseed oil and lemon juice. Consume on an empty stomach in the morning. Duration of treatment is 3-4 weeks.
• Use 1 tsp. pure flaxseed oil before main meals (10-15 minutes before) regularly. If there are no adverse reactions, this can be done for 2-3 months, then take a break for 30 days and repeat the course.

Medicinal plants

Laxative herbs include buckthorn bark, senna grass, black elderberry inflorescences and leaves, licorice and dandelion root, anise fruits, cassia leaves, and jostera . Based on them, preparations are produced that normalize intestinal function, but these herbs can also be used alone. Keep in mind that such treatment should be carried out for 3-4 weeks, there will not be an immediate effect. The simplest folk recipes:

• Mix buckthorn bark, licorice root, anise and fennel seeds (6:2:1:1). Infuse 1 tbsp. l. in 250 ml of boiling water for an hour. Drink 100 ml warm at night.
• In a water bath, bring 200 ml of water and 1 tbsp to a boil. l. mixtures of nettle, yarrow and buckthorn (1:1:1). Simmer over low heat for 5 minutes, remove and wrap in a towel. After 3 hours, filter the broth and drink half a glass in small sips before bed.

Folk remedies for constipation

You can normalize intestinal function with the help of traditional medicine. When choosing them, it is necessary to take into account that raw materials of natural origin can also severely irritate the mucous membranes of the gastrointestinal tract, which causes unpleasant symptoms.

The following have a mild laxative effect:

• Wheat bran
  . It is recommended to pour a spoonful of bran into a glass of kefir and drink the drink before bed.

• Beet
  . If you have difficulty defecating, it is advisable to eat boiled beets every day.

• Mixture of dried fruits and senna
  . One hundred grams of prunes and raisins need to be rinsed and chopped. Then one hundred grams of Alexandria leaf (senna grass) and a spoonful of vegetable oil are added to this mass. You should eat a teaspoon of this paste daily in the evening, with one or two glasses of water.

• Prune compote
  . It is boiled without sugar and drunk together with dried fruit pulp softened into puree.

In the first days of using folk remedies for constipation, you should carefully record all your sensations. The appearance of pain, allergic reactions, or increased blood pressure indicates individual intolerance to the selected recipes, so they must be discontinued.

Any laxatives cannot be used for intestinal obstruction; its development is indicated by severe pain of an unknown nature in the abdominal area.

Choosing a good medicine with a laxative effect for the elderly is not as easy as it seems. To ensure that the drug does not cause adverse reactions, it is necessary to take into account not only its mechanism of action, but also contraindications, the possibility of long-term use and combination with other medications. Only a qualified gastroenterologist or therapist can select such a remedy for a patient, so if constipation occurs, contacting these specialists is mandatory.