![]() The greatest efficacy for PEG is noted during the second week of therapy, although higher doses have been used successfully for the overnight treatment of constipation.Ī randomized multicenter trial that compared standard and maximum doses of PEG 3350 and PEG 4000 showed most patients had their first stool within one day of initiating PEG treatment. A study that followed patients with chronic constipation for 6 months showed benefit of PEG compared with placebo and no electrolyte abnormalities or intestinal malabsorption. PEG 3350 (MiraLAX ®, Merck & Co., Whitehouse Station, NJ), is a common OTC laxative used in the treatment of chronic constipation that does not contain any salt that can be absorbed. PEG solutions may be useful for the short-term treatment of fecal impaction in patients that are refractory to other medications and can be used safely. This study showed a complete improvement from chronic constipation in 77% of patients that used PEG versus 20% of patients in the placebo group. The same patients were randomized to continue PEG or a placebo for 20 weeks. A study with 70 patients followed for 4 weeks treated with a PEG-electrolyte solution, 250 mL once or twice daily, there was marked improvement in bowel frequency, stool consistency, and straining on defecation. PEG has been shown to be effective in the treatment of chronic constipation. ![]() 16 Most of these solutions has been shown to be dose dependent, increasing the amount of stools with increasing dosage of PEG. 1 These solutions have electrolytes added to avoid side effects from dehydration and electrolyte disturbances and have been shown to be safe for preparation for diagnostic colonoscopy, barium x-ray examinations, and colon surgery. 18 PEG is commonly used in solutions for colon cleansing as polyethylene glycol electrolyte lavage solutions (PEG-ELS) and sulfate-free electrolyte lavage solution (SF-ELS). Polyethylene glycol (PEG) is a isosmotic laxative that is metabolically inert, which binds to water and keeps water retention inside the lumen. Sodium sulfate is a component of some bowel lavage solutions for colon cleansing prior to diagnostic and surgical procedures, 15, 16 but significant absorption may occur in the jejunum that may cause electrolyte disturbances. Even patients who are otherwise healthy may develop these complications as a result of excessive use. Magnesium containing laxatives are not recommended in patients with renal insufficiency or cardiac dysfunction because the high risk of developing electrolyte disturbances and volume overload from the absorption of magnesium or phosphorus. Other side effects include hypermagnesemia-induced paralytic ileus and hypermagnesemia in patients with renal failure. 14 The use of magnesium in older adults should be used with caution because the high profile of gastrointestinal side effects and magnesium toxicity. Magnesium sulfate is a more potent laxative that tends to produce a large volume of liquid stool and abdominal distention. Standard doses of 40 to 80 mmol of magnesium ion usually provokes a bowel movement within 6 hours. 13 Magnesium oxide has been considered safe to use on a regular basis in mildly constipated patients. Magnesium, sulfate, and phosphate ions are poorly absorbed by the gut and thereby create a hyperosmolar intraluminal environment. Patients also must be encouraged to drink water and maintain hydration when increasing fiber intake. If the constipation has not improved, then commercially available fiber supplements should be tried. To improve the tolerance and adherence you may start with low doses of fiber and increase their dietary fiber intake gradually over the next weeks until ∼20 to 25 g/d. In some patients, these agents also delay gastric emptying and depress appetite. Insoluble fiber, such as cereal bran, may cause significant abdominal gas and bloating, creating discomfort. The recommended amount of dietary fiber is 20 to 35 grams per day (g/d) and this can be obtained from whole wheat bread, unrefined cereals, citrus fruits, and vegetables. 5, 6 Dietary fiber appears to be effective in relieving mild to moderate, but not severe constipation. ![]() A correlation between increasing the daily fiber intake and fecal weight as well as colonic transit time has been demonstrated. Constipation has been associated with a deficiency of dietary fiber in Western society for decades.
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