Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 524

Probiotics are widely available as a non‐pharmacological treatment option for constipation as components of bio yoghurts and dietary supplements. The faecal flora changes with increasing age, mostly by a fall in the numbers of bifidobacteria.⁷⁰ It remains unclear if this is the cause or the effect of constipation. Large, randomized controlled trials have failed to show a significant benefit from treatment with probiotics.

Misoprostol, a prostaglandin agonist, stimulates intestinal secretion and intestinal transit. Its use is limited by the common occurrence of side effects, including abdominal pain and cramping.⁷¹ Its use is reserved for patients with refractory constipation.

Colchicine, well known for causing diarrhoea in the acute treatment of gout, may be used in patients refractory to other medications.⁷² Colchicine frequently causes increased symptoms of abdominal pain, limiting its use.

Glycerine suppositories have long been used as an over‐the‐counter agent for stimulating bowel movements. The medical literature is lacking in assessments of their effectiveness.

Neostigmine, an acetylcholinesterase inhibitor, produces prompt colonic decompression. The use of neostigmine is reserved for hospitalized patients with acute colonic pseudo‐obstruction, and benefit has been seen in the treatment of refractory constipation.⁷³