Treatment of Chronic Diarrhea
Dr. Robert Hardi is a gastroenterologist practicing in Chevy Chase and Rockville, MD. Dr. Hardi specializes in the digestive system and its diseases.nHe has special expertise in Inflammatory Bowel Diseases (Ulcerative Colitis and Crohn's Disease) as well as colon cancer screening, in which he has conducted numerous clinical... more
Treatment of Chronic Constipation
Chronic constipation is one of the most frequent complaints in a Gastroenterology practice. The increased frequency is probably attributable to several factors. People don’t drink enough liquids, especially not with no caffeine. Our diet tends to be not rich enough in fiber and air conditioning and heating can lead to dry air, which leads to loss of fluids from the body. Finally, sedentary lifestyle increases constipation, too.
From the above list it is obvious, that the first thing to do is to correct these factors. Walking, judicious exercise are good for people in general, not just to help with constipation. Same is true for being adequately hydrated with water or juices (watch for too much sugar intake!). And a humidifier can go a long way.
Medical treatment of constipation has changed over the last few decades. We realized that some of the old laxatives may actually be harmful, when taken regularly. The use of water soluble fiber to lend soft bulk to the stool is now wide spread. Bran fiber, Psyllium (Metamucil contains psyllium), other inert, synthetic bulk forming agents, such as Citrucel, Fibercon, are very useful, as long as taken with plenty of fluids.
Over the counter osmotic laxatives are very helpful and safe. Miralax, Milk of Magnesia can be taken regularly and they remain effective without causing harm.
There are now several prescription medications for constipation, which does not respond to the above measures. Amitiza has been on the market for almost two decades. It opens up chloride channels in the gut, bringing in fluid. The so-called CG-C receptor agonists work similarly, imitating the effect of cholera toxin, in a controlled manner. Linzess and Trulance belong in this category. They have been around for years and are safe, with the only side effect being diarrhea.
Lastly, the latest addition to our therapeutic armamentarium, is Motegrity. This is the only medication, which actually increases to movement of the gut wall to move stool.
