AbsorbentsAdsorbents coat the wall of the GI tract and adsorb bacteria or toxins that are
causing the diarrhea. Adsorbents include kaolin and pectin, which are combined
in the over-the-counter drug Kaopectate, and other antidiarrheals. Pepto-Bismol
is considered an adsorbent because it adsorbs bacterial toxins. Bismuth salts can
also be used for gastric discomfort. Colestipol and cholestyramine (Questran)
are prescription drugs that have been used to treat diarrhea.
Anti-Diarrhea CombinationsAnti-diarrhea combinations are miscellaneous antidiarrheals that include colistin
sulfate, furazolidone, loperamide, lactobacillus, and octreotide acetate. You may
know these brand names drugs to alleviate diarrhea: Lomotil (diphenoxylate
HCl with atropine sulfate) and parepectolin (paregoric, kaolin, pectin, alcohol).
Most contain a synthetic narcotic ingredient.
CONSTIPATION
Constipation is the accumulation of hard fecal material in the large intestine. It
is a common occurrence for the elderly due to insufficient water intake and poor
dietary habits. Other factors that cause constipation are fecal impaction, bowel
obstruction, chronic laxative use, neurologic disorders such as paraplegia, a lack
of exercise, and ignoring the urge to have a bowel movement. Drugs such as
anticholinergics, narcotics, and certain antacids can also cause constipation.
Constipation can be treated nonpharmacologically and pharmacologically.
The nonpharmacological approach is to include bulk (fiber) and water in the
patient's diet and have the patient exercise and develop routine bowel habits. The
normal number of bowel movements is between 1–3 per day to 1 to 3 per week.
Normal bowel movements vary from person to person.
The pharmacological approach is to administer laxatives and cathartics to
eliminate fecal matter. Laxatives promote a soft stool and cathartics promote a
soft-to-watery stool with some cramping. Harsh cathartics that cause a watery
stool with abdominal cramping are called purgatives. Frequency of the dose
determines whether the drug acts as a laxative or a cathartic.
Laxatives should be avoided if there is any question that the patient has an
intestinal obstruction, severe abdominal pain, or symptoms of appendicitis,
ulcerative colitis, or diverticulitis. Most laxatives stimulate peristalsis. Laxative
abuse from chronic use of laxatives is a common problem, especially with the
elderly. Dependence can become a problem.
CHAPTER 18 Gastrointestinal System^337