Therapeutic proposals for the treatment of idiopathic constipation.

The objectives to be achieved by a medical therapy of constipation are: 1) to protect the patient from excessive use of dangerous drugs (laxatives), 2) to help the patient to understand what is a "normal" intestinal function, 3) to reduce or eliminate pain and 4) to avoid complications. The first step consists in general measures (reduced stress, regular meals and physical exercise) and some modifications in diet habits (greater than 1.5 1 of water a day, vegetables, fruits, whole wheat bread). The pharmacological therapy is based on drugs which act in different ways: a) some contain unabsorbable substances (i.e. cellulose, emicellulose) that increase the volume of the stools: b) unabsorbable sugars (i.e. lactulose, lactose) or salts (Mg-sulphate, citrate and Na-sulphate) that provoke an osmotic effect and stimulate the colonic motility; c) suppositories that stimulate the defecation reflex; d) drugs able to stimulate colonic secretion and propulsive motility (i.e. anthraquinones, oral bisacodyl, phenolphthalein, castor oil, prokinetics). There are many conditions in which medical therapy fails its objective: in these cases it is important to exclude other causes of constipation (i.e. drug-related constipation, endocrine disorders, metabolic diseases, systemic illnesses or lesion of the enteric plexus) in order to obtain an improvement of this symptom.