Download Normalization of bowel function in constipation and diarrhea

The informed patient
Normalization
of bowel function
in constipation
and diarrhea
(Plantago ovata seed shells)
Publisher:
www.drfalkpharma.com
© 2008 Dr. Falk Pharma GmbH
All rights reserved.
9th edition 2008
The informed patient
Normalization
of bowel function
in constipation
and diarrhea
(Plantago ovata seed shells)
1
The informed patient
Contents
Foreword
4
Our digestion: how does it work?
6
What causes constipation?
15
Laxatives: how they work
– Irritant laxatives
– Osmotically active laxatives
24
24
27
Lubricants and bulking agents: how they work
28
What can you do if bowel
movements remain irregular
despite – or because of – laxative use?
30
What causes diarrhea?
36
Mucofalk®
38
3
Foreword
Dear reader,
You may be one of the large number of people who
suffer, often over a period of many years, from
chronic constipation. This disorder is often accompanied by other symptoms, such as distended
abdomen, bloating, feeling of fullness, pain and/or
increased passage of intestinal gas. These complaints
can be unpleasant, to say the least, and can significantly affect your general health and quality of life.
Many people are reluctant to talk about constipation
and its related complaints and therefore do not consult their physician. Instead, they may try to help
themselves by the use of supposedly healthy laxative
teas and laxatives that are universally available without a prescription.
For a while, this may be adequate. More often, however, one find that after only a short period of using
these agents one needs ever increasing doses or
must switch to a different, usually stronger, preparation to achieve the desired effects. This, in turn, also
becomes inadequate in short course and it is only a
matter of time before the constipation and its symptoms again worsen, the stools become irregular and
hard, and other problems, such as painful bloating,
occur. It is usually at this time that people overcome
their reluctance and consult a physician for advice.
How will your doctor advise you? First and foremost,
you should stop taking the laxatives that you have
become more or less dependent on! Your physician
will tell you that your bowel may actually have been
damaged by these drugs and that this will not help
you in the long run. Instead, you need to make
4
The informed patient
changes in your life (dietary habits, fluid intake, activity and stress management). If this alone does not
help, you should use only bulking or high-fiber agents
that do not negatively affect bowel function but actually promote normal bowel activity.
This brochure also provides information on diarrhea,
the treatment of certain forms of which can be supported with bulking agents such as psyllium. It will
not always be easy to follow these recommendations.
Why it is important to do so will be explained in this
brochure, which will also provide you with suggestions that can make your compliance more successful.
5
Our digestion:
how does it work?
After initial intake and chewing in the mouth, food and
beverages pass into the esophagus on swallowing
and reach the stomach. In the stomach, the food is
reduced further in size and mixed with gastric juices,
after which the mixture is passed in measured portions into the small bowel. Nutrients such as carbohydrates, proteins, fats, together with minerals and vitamins are predominantly absorbed in the upper segments of the small bowel and pass into the blood.
The remaining, indigestible components of food,
especially vegetable fiber, are mixed with digestive
juices from the small bowel, pancreas and gallbladder,
and pass from the small bowel into the large bowel,
or colon.
Anatomy of the small and large intestines
Stomach
Duodenum
Transverse colon
Ileum
Cecum
Appendix
Jejunum
Descending colon
Sigmoid colon
Rectum
Anatomy of the small bowel and colon.
6
The informed patient
About 1.5 to 2 liters of small bowel contents pass into
the colon each day.
The colon consists of three segments: the right
(ascending) and left (descending) colon are connected
by a transverse segment. The fluid contents of the
small bowel first reach the ascending colon, where
they remain for up to two days. During this time,
water and important mineral substances are extracted
and made available to the organism. This also results
in an increasing concentration of the bowel content
and the transformation to stool begins.
At this point, usually after a meal, the stool is propelled by forward movements of the bowel from the
right into the left colon and further thickened. Once it
has reached the rectum, the final segment of the
bowel, the urge to defecate sets in and a bowel
movement occurs.
7
The path of nutrition
Food and beverages
Daily intake:
ca. 1 kg of food and 2 liters of beverages
Retention
time
Mouth
Tips:
Seconds
Chew your food
completely
Esophagus
Take adequate
fluids with each
meal
Stomach
Eat a lot of
high-fiber
foods
Small bowel
Seconds
1-4 hours
2-8 hours
Colon
10-40 hours
Anus
Bowel movement
(100-200 g/day)
8
The total duration of
gastrointestinal transit
ranges between
30 and 100 hours
The informed patient
The frequency of bowel movements and the
amount of stool are affected by different factors:
The larger the amount of indigestible vegetable
fiber in the diet, the higher the stool volume.
The stool also does not become hard and therefore
it can pass more quickly through the colon, be concentrated and finally evacuated. The effects of
dietary fiber depend on adequate amounts of fluid,
which typically means a daily fluid intake of at least
2 liters.
The VFED beverage column
4 cups of tea or coffee
600 ml
1 glass of a low-fat dairy
200 ml
product (e.g. buttermilk)
1 large glass of fruit juice
250 ml
1 large glass of vegetable
250 ml
juice (e.g. tomato juice)
1 bottle of mineral water
700 ml
Recommended daily fluid
intake
2000 ml
Remember, you should drink at least 2 liters of fluid
every day!
9
High-fiber foods include whole grain products such
as whole grain bread (finely milled whole grain bread
is recommended for persons with diverticular disease) and muesli, vegetables, salads, legumes, fruit,
linseed and bran. These foods contain the indigestible
substances collagen and elastin.
Whole grain bread with aromatic tomatoes, delicious spices and
herbs, and fresh cottage cheese is just as appealing to you as to
your gut.
Advantages of high-fiber foods:
– Prevention and treatment of constipation
– Prevention of intestinal diseases such as diverticulosis and possibly even cancer
– Improvement in important intestinal flora
– Satiety without “empty calories”
10
The informed patient
“Eat more vegetables and less animals”
That is a motto for bowel health. Healthy nutrition
for the bowels is high in essential vitamins and
minerals and keeps or makes the body fit and trim.
Whole grain muesli with fruit is the right way to start a bowelhealthy, active day (Source: Dr. Grandel).
11
When the diet is low in fiber too little fiber reaches
the colon. As a result, the stool becomes too concentrated and hard and its transport is delayed. Typically,
a low fiber diet consists of food made from bleached
flour, pudding, sauces and sweets. Meats and cheese
contain very little fiber and may divert you from better,
more reliable sources of fiber.
Low-fiber foods
(Not bowel-healthy)
White bread
Biscuits and rolls
Crackers
Pudding
High-fiber foods
(Bowel-healthy)
Whole grain bread
Whole grain rolls
Crisp bread
Fruit groats
Beverages may also affect the activity of the colon.
While mineral water, juices and herbal teas have a
positive effect, large amounts of strong black tea and
cocoa may cause constipation or make it more
severe. You should not drink more than four cups of
black tea or cocoa each day. Sour dairy products such
as buttermilk or kefir, as well as coffee promote good
bowel function. In the morning, a glass of mineral
water, possibly mixed with some prune juice, helps
get the bowels moving.
12
The informed patient
What happens in the colon?
In the colon, water is extracted from the mass of
digested food, or chyme, which is kneaded by the
action of the bowel musculature. If transit is prolonged, these effects on the chyme may be excessive, resulting in the extraction of too much water.
As a result, the stool becomes harder and more
difficult to transport to the rectum.
Normal digestion: Water and important salts are extracted
from the chyme and made available to the organism. The bowel
contents become thicker and stool forms.
Constipation: The chyme is over-processed and too much water
is extracted. The stool becomes hard and more difficult to transport
to the rectum.
13
Because the muscular movements in the colon
are regulated by the vegetative nervous system
and, hence, outside the scope of voluntary control,
psychic (e.g. stress), emotional (e.g. anxiety)
and environmental factors also play an important
role for well-regulated digestion and bowel movements.
For example, changes in location when traveling or
pregnancy can lead to constipation, while anxiety and
feelings or helplessness or insecurity tend to cause
constipation. Who has not experienced changes in
stool frequency and/or consistency before an examination, a dentist visit or a long-distance flight?
These issues should also be considered when you are
evaluated for constipation and treatment options are
explored.
14
The informed patient
What causes constipation?
Before we consider this question, we must first be
clear on what constipation is and at what point it
begins.
The widely held belief that daily bowel movements are necessary is not shared by physicians.
Daily bowel movements are not required and a
person who has a bowel movement only every
two days is not necessarily sick.
As discussed above, the food, depending on its composition, may remain for a shorter or longer time in
the bowel. A low-fiber diet generally requires much
more time to transit the bowel than does a diet high
in fiber taken with adequate liquids.
Finally, no one must fear being “poisoned” if a bowel
movement is delayed for one or two days.
Physicians generally apply the term “constipation”
to those cases in which bowel movements occur
less than three times per week, is accompanied
by significant complaints or is associated with
complaints such as abdominal pain and flatulence.
Constipation may be due to organic causes, such as
scar tissue formation in the bowel, as may occur as
a result of inflammation, or thickening of the bowel
wall, due, for example, to a tumor. Other diseases,
which have nothing to do with the bowel, such as
reduced function of the thyroid gland, may also cause
constipation. Similarly, diabetes that has been poorly
15
controlled over a number of years may be associated
with constipation. The physician will look for these
causes before he starts any treatment. It may be
advisable to consult a gastroenterologist, who specializes in diseases of the stomach and intestinal tract, in
this search for the causes of constipation.
In many cases, however, such organic causes may
not be present. These cases are called functional
constipation. There are convincing reasons to believe that the main cause of functional constipation lies in the profound changes in diet common
to developed Western industrial nations. For many
years, the content of carbohydrates and dietary
fiber has decreased in favor of fats, refined sugars
and proteins. Our bowels, however, are dependent
for normal function on an adequate supply of carbohydrates and fiber.
16
The informed patient
What does this mean? Functional constipation is
due in large part to our civilized lifestyle. Five factors in particular have bad effects:
The composition of the diet
Tip: Eat more vegetables and less animals!
Our diet is weighted too heavily in favor of animal
proteins at the cost of vegetable components. The
average German consumes too much fat, alcohol
and refined sugar. The proportion of meat and cured
meat products in the German diet is also too high.
On the other hand, the average intake of dietary
fiber stands at about 22 grams per day, which is far
below the minimum recommended daily allowance
of 30 grams. Your consumption of dietary fiber is
adequate when your daily diet includes at least
500 grams of vegetables and potatoes, 250 grams
of fruit (for example, two apples) and four slices
of whole-grain bread. If you orient your diet to the
VFED nutrition pyramid (see page 20/21), you will
always be in the safe zone.
17
In addition, our food is so highly processed that little
is left for the bowel to do. Many foods today are
essentially pre-digested. Fast food, sweets and soft
drinks are not good for the gastrointestinal tract.
The proportion of vegetable fiber is so low that little
indigestible matter is left to be excreted from the
bowel. Drinks, too, are often loaded with calories
(sugar, alcohol) and also do not leave behind any
indigestible remains. The colon is inadequately filled
and the stool is excessively thickened, resulting in
a lengthened transit time. This leads to constipation.
Regular bowel movements depend on adequate filling
of the bowel and a soft consistency of the chyme.
This stimulates the bowel by stretching, resulting in
forward propulsion of the stool and, finally, an easy
bowel movement.
Bowel-healthy foods such as vegetables can only preserve their
healthy effects when they are fresh and correctly prepared
(i.e., not overcooked; Source: Fissler).
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The informed patient
Inadequate physical activity
Tip: Get regular exercise!
Many people work at a desk and sit the entire day,
something for which our body was not designed. Elevators, escalators, automobiles, busses and trains
serve our transportation needs, and there is almost no
need for further motion. At night and on the weekends, there is often time only for household chores
and any remaining free time is spent in front of the
television set. In the household, actual physical work
is made increasingly superfluous by mixers, washing
machines and clothes driers, dishwashers and other
kitchen gadgets. The less you move, the less your
bowel moves and this results in a slowing-down of
the rate at which the chyme is transported through
the bowel. As this happens, too much water is
extracted and the stool becomes less soft and less
voluminous, which makes bowel movements difficult.
Optimum bowel function requires more physical activity. This is not only good for the bowel: Your cardiovascular system will also thank you for more activity
in the form of walks of increasing length, swimming,
jogging, dancing or bicycle riding and reward you with
improved function and well-being. This will help you
remain or become fit and trim.
19
The informed patient
The nutrition pyramid of the VFED e.V.
(VFED – Verband für Ernährung und Diätetik e.V.)
Choose wisely when it comes to eating and drinking
daily:
small amounts
Iodized
salt
with fluor
daily:
in moderation
daily:
3 low-fat servings
K
Rapseed
Olive
OIL
OIL
weekly:
no more than 2–3
low-fat servings of
meat/sausage, 2 eggs
weekly: 1–2
servings of ocean fish
daily:
at least 4 servings
Wholemeal
flour
Whole
wheat
pasta
Wholemeal
rice
daily:
at least
3–4 servings
daily:
2 servings
WAT E R
daily:
at least
1.5–2 liters
m o re
daily: moderate activity, weekly: 3 x physical exercise/sports
20
21
Inadequate fluid intake
Tip: Drink at least 2 liters daily
Because water is extraordinarily important and the
body must keep itself safe from desiccation, water is
extracted from the chyme in the colon. This liquid
comes not only from food and beverages but also
from digestive juices. The colon absorbs up to
2 liters every day. If the fluid intake in food and beverages is inadequate, however, the stool becomes firm,
then hard. You should drink at least 2 liters of liquid
every day.
Mineral water has no calories but contains large amounts of the
minerals and trace elements required for life. The body requires
2 liters of fluid from beverages (Source: IDM).
22
The informed patient
Hectic lifestyle
Tip: Don’t let the stress get to you and practice
relaxation
Many people’s lives have become more hectic than
every before. The word stress has become a routine
part of their vocabulary. Long drives to work, tension
in one’s career, fear about losing one’s job, and no
time for anything are frequent reasons for delaying
the trip to the bathroom. Bowel movements are
something that are under our voluntary control.
As a result, the stool stays in the bowel longer, it
becomes thicker and at some point one no longer
even feels the urge to go. You should always go to
the bathroom as soon as you feel the urge: This will
help you get used to the urge when it occurs.
Drugs
Tip: Ask your doctor or pharmacist about the
effects of drugs on the bowels
Numerous drugs can cause and/or worsen constipation. Among the most common are certain heart medications, analgesics, antacids containing aluminum
and calcium, some medications for high blood pressure and psychiatric medications used in depression
and other mental disorders.
23
Laxatives: how they work
Tip: Laxatives belong in the hand of the physician
Laxatives only work where they should work: in the
bowel, in particular, in the colon. Basically, all laxatives
work by means of similar mechanisms. They increase
the water content of the stool, which increases its
volume and flexibility, resulting in better transport
through the bowel and simpler evacuation. There
are, however, differences in how the different laxative
achieve this objective and in their specific side
effects.
Irritant laxatives
Tip: Herbal does not automatically mean gentle
Herbal laxatives (senna leaves, aloe, rhubarb root) and
the substances contained in many laxatives not only
prevent the extraction of water in the colon and its
absorption by the body but also promote the extraction of water from the body. While this is useful
for improving the characteristics of the stool, making
it softer and easier to transport, the long-term use of
these laxative can result in the body becoming too dry
and in the loss of minerals essential for life.
24
The informed patient
The word “herbal” makes many people think that
these laxatives are gentle. This is not true in every
case. Laxatives should be kept in the hand of your
doctor, who will in general prescribe them only for a
limited time.
Laxatives that irritate the bowel prevent the absorption of water
from the colon and even promote the excretion of water from the
body into the colon.
At more than 60% of body weight, water is the main
component of our body! As we age, the water content of our bodies declines. Water is necessary for
life. Minerals are needed for numerous processes in
our bodies.
An excessive loss of water and minerals from our
body has far-reaching consequences that we
cannot ignore. These include malfunctions of the
kidneys, nerves and heart.
25
In addition, many laxatives may stimulate the motility
of the bowels to such an extent that it may no longer
respond adequately to its own control mechanisms
and signals.
These many-sided effects of bowel-irritating, so-called
drastic laxatives may initiate a vicious cycle that
soon leads to addiction. Patients may require a higher
dose of the laxative because the bowel’s own motility
is permanently disturbed and damaged when the
control mechanisms and nervous structures in the
bowel wall are constantly stimulated by contact with
laxatives. The loss of minerals, such as potassium,
reduces the motility of the bowel even further. One
of the main reasons for constipation is the improper
use of laxatives.
The wide-spread belief that herbal laxatives, because
they are natural products, generally cause no harm is
false! Especially in long-term use the choice of laxative must be guided by caution.
26
The informed patient
Osmotically active laxatives
(Salts and artificial sugars such as lactulose as
laxatives)
These are laxatives whose exclusive mechanism
of action is to retain water in the colon and attract
water from the body. Typical examples include
sodium bicarbonate, Glauber’s salt (sodium sulfate) or
Epsom salts (magnesium sulfate), so-called saline laxatives. Carbohydrates such as lactose, lactulose, lactitol, mannitol and sorbitol also act in this way.
The use of these laxatives for a short period of weeks
to a few months is harmless, but, when used at too
high doses and for too long, they can result in disturbances of the salt and water metabolism of the
body and even cause the constipation to become
worse. These laxatives also belong exclusively in the
hand of the doctor.
Osmotic agents retain water in the colon and attract further water
into the colon. This can lead to disturbances of the organism’s
water and salt metabolism.
27
Lubricants and bulking agents:
how they work
Lubricants
Lubricants such as paraffin and glycerin facilitate
bowel movement in that they make the stool more
slippery. Paraffin is only rarely used today but the
short-term use of glycerin in the form of suppositories is not harmful.
Bulking agents
Unobjectionable for use over longer periods are
vegetable bulking agents, which must not be confused with herbal laxatives, such as senna leaves.
Bulking agents are natural substances found in plant
products such as linseed, wheat bran or the seeds of
®
certain varieties of plantain (such as Mucofalk ). The
pods of the plantain variety from which Mucofalk® is
obtained is called psyllium.
Often the amount of
dietary fiber contained
in foods such as fresh
salads does not suffice
to get the bowels moving again. In these cases,
the use of bulking agents
is necessary (Source:
Becel Diet Vegetable Oil,
Master-Media).
28
The informed patient
These natural and safe vegetable bulking agents
promote bowel movement by the fact that their
bulking action in the stool binds water. The indigestible dietary fiber increases the volume of the
stool and keeps it soft. These factors combine to
naturally stimulate the bowel to evacuation and
promote adequate emptying of the bowel.
Bulking agents also increase and improve the bacterial flora of the colon, which also increases the stool
volume, makes it softer in consistency and improves
transport. The intestinal flora is part of the defense
system of our body. A good bacterial flora helps keep
the organism fit and healthy. The increased filling of
the colon promotes improved function and the stool
consistency is improved by the binding of water.
.
Bulking agents by their mechanism of action bind water and the
indigestible dietary fiber increases the stool volume. The stool
becomes softer and transport is facilitated.
29
What can you do if bowel
movements remain irregular
despite - or because of - laxative use?
A large variety of laxatives is available and can be
purchased in many places beside pharmacies. Because they are able, initially at least, to solve a troubling, and often embarrassing problem, many patients
consult their physicians only when laxatives, after
a long period of use, no longer produce the desired
effect. In many cases the cause of constipation is the
careless use of laxatives.
In many cases this is due to the fact that the body
has become tolerant of these agents that irritate the
bowel and the above-described vicious cycle has set
in.
How do you break this vicious cycle?
This is not simple - for you or for your doctor!
Because the body has become accustomed to laxatives over a long period it will now initially respond
with increased symptoms once these laxatives are
discontinued. It must go through an actual period of
withdrawal if you wish to become permanently free
of your complaints. Laxatives must be discontinued
slowly and you must carefully start a new diet that
emphasizes foods and drinks rich in vegetable components and liquid. Your physician knows this and will
review with you the importance of this difficult
process. Be aware that, here, patience is a virtue!
30
The informed patient
Increasing
Stool
retention
Disturbed
bowel function
(bowel atonia)
Water and salt depletion
in the body
(low blood pressure)
Sodium deficiency
Stool
retention
Use of
laxatives
Loss of water and
salt in the colon
Potassium deficiency
Disturbed
kidney
function
Disturbances in the
function of the nerves,
which affect the
muscles (e.g. the heart)
Dieticians and nutritionists can assist you in making
the necessary dietary changes. The results are worth
the effort. Your bowel and your entire body will thank
you with optimum function, activity, health and fitness.
31
The diet plan is constructed under the motto: “Eat more vegetables
and less animals!”
(Source: Schneekoppe/Wirths PR).
Once the laxatives have been discontinued, one
should not believe that he no longer needs to take
any other agents. However, you should only use
substances that do not damage the bowel even
after long-term use. This means in particular the
bulking agents, such as Mucofalk®.
32
The informed patient
®
Initially, Mucofalk alone may not be enough,
because you may have become tolerant of other
agents.
Therefore, it may be necessary in some cases to add
other agents, such as lactose (milk sugar), lactulose or
sodium bicarbonate. In cases of refractory constipation, a laxative suppository containing glycerin every
three days may be necessary. Always consult your
physician when you feel that your current treatment is
not sufficient. In no case should you return to the laxatives you may previously have used! The withdrawal
from laxatives is not as simple as purchasing a supposedly harmless herbal laxative tea in the supermarket.
In preparation for treatment with Mucofalk® your
physician may prescribe a solution containing macrogol, which is usually used for bowel cleansing prior to
colonoscopy.
A low-dose macrogol preparation can also be an alternative in the treatment of refractory constipation.
33
As an adjunct to medical treatment you should also
consider how you can change your lifestyle and
behavior to eliminate factors that negatively affect
your digestion.
Primarily, this includes:
– Eat a diet high in fiber (whole grain products,
much fruit and vegetables), but avoid foods that
cause flatulence (e.g. raw cabbage dishes).
– Drink enough fluids (juices, buttermilk, mineral
water). This is especially important when you are
®
using Mucofalk in order that the bulking agents can
adequate swell in the bowel. Avoid “constipated”
beverages such as black tea, cocoa and red wine.
With each dose of Mucofalk® you should take a
glass of water or of fruit juice mixed 1:2 with sparkling mineral water.
– Get adequate exercise and make time for a daily
trip to the toilet. Don’t let your hectic schedule
get in the way!
With these steps and a little patience your digestion
can be adjusted so that in a short time 2-6 sachets or
teaspoons of Mucofalk® will be sufficient and you can
dispense with laxatives for good.
34
The informed patient
Because Mucofalk® regulates bowel function
naturally without harming the bowel, use of this
bulking agent, even for many years, is not associated with the danger of again getting trapped in
the vicious cycle of using laxatives at continually
increasing doses. Instead, the water-soluble
dietary fiber contained in Mucofalk® also lower the
cholesterol level, prevent other diseases of the
bowel and regulate the colon’s natural flora to
improve your immune defenses.
The VFED nutrition pyramid shows how easy it is
to eat healthy (see page 20/21). Foundation of healthy
nutrition are whole grain products, lots of vegetables
and potatoes (at least a pound each day), as well as
fruit (at least one-half pound per day). These foods are
supplemented with healthy, low-fat animal products
such as fish, poultry, lean meat, skim dairy products
and low-fat cheese. The consumption of sugar, highly
sweetened foods, butter, margarine and oil, as well as
alcoholic beverages, should be reduced as much as
possible in order to keep the body active and fit. The
nutrition pyramid also promotes a diet that makes
overweight nearly impossible, or, if it exists, promotes
slow reduction in weight with adequate supply of
essential vitamins and minerals. At the bottom of the
pyramid is the intake of at least 2 liters of low-calorie
beverages each day.
35
What causes diarrhea?
Diarrhea is defined as more than three bowel movements per day that are watery or porridge-like in consistency, with an increased total stool volume. In addition, patients may suffer from bloating, abdominal
pains, nausea and vomiting.
Acute diarrhea persists less than two weeks. If diarrhea lasts more than two weeks, it is considered
chronic.
Diarrhea is not a disease. It is a symptom and represents the body’s rational response for cleansing itself
of damaging substances as quickly as possible. A
common cause of acute diarrhea are bacteria or
viruses. In most cases, acute diarrhea is of short duration and resolves by itself. If diarrhea is accompanied
by fever or when there is blood in the stool, you
should immediately seek medical attention. Because
of the associated loss of water and minerals, diarrhea
can be dangerous for some persons, especially
infants, young children and elderly, debilitated persons.
Factors that cause diarrhea include:
– Disturbed motility of the bowel associated with
accelerated bowel transit.
– Too much fluid in the bowel, possibly due to a
reduced capacity of the mucosal membrane to
absorb water.
36
The informed patient
The most common causes of acute diarrhea:
– “Intestinal flu” - Infection with viruses or bacteria
– Dietary intolerances (e.g. lactose intolerance)
– Food poisoning
– Travelers’ diarrhea
– Drug-induced diarrhea (e.g. antibiotics)
– Anxiety, stress
The most important causes of chronic diarrhea:
– Irritable bowel syndrome
– Inflammatory bowel diseases (Crohn’s disease,
ulcerative colitis)
– Gluten allergy (celiac disease, sprue)
– Laxative abuse
®
What is the action of Mucofalk in diarrhea?
It may strike you as odd that the same drug can be
used to treat both constipation and diarrhea. The
apparently contradictory indications are explained
by the actions of psyllium, which are based on the
bulking properties of the mucinous components, i.e.
its capacity to bind large amounts of water.
The same components also responsible for the diarrhea-inhibiting effects of Mucofalk®, which result in
the desired thickening of the bowel contents. The
stool becomes formed and this simultaneously normalizes intestinal transit.
37
Mucofalk® orange
Granules
Active ingredient:
Indian isphagula husk (Plantago ovata seed shells)
Bulking agents in Mucofalk®:
The bulking agents in Mucofalk® include seed shells
from certain types of plantain (Plantago ovata). These
herbal substances encourage regular bowel movements by attracting water as they swell and increase
the bulk of the stools with their indigestible fibrous
constituents.
Furthermore, bulking agents increase the bacterial
flora, which also adds to the bulk of the stools.The
greater bulk in the bowel stimulates it to function more
efficiently and the higher water content makes the
stool softer.
Herbal bulking agents of this type can be used safely
for relative long periods.
Indications:
Chronic constipation diseases in which easier bowel
movements with soft stools are desirable, e.g. anal fissures, hemorrhoids, following surgery in the rectum
area. As supportive treatment in diarrhea of various
causes and in irritable bowel syndrome.
Dosage instructions:
Unless otherwise prescribed, adults and adolescents
from over 12 years of age take the contents of one
®
sachet respectively one teaspoonful Mucofalk
orange 2 - 6 times daily after stirring into plenty of
liquid (at least 150 ml).
38
The informed patient
1. Please never take the preparation in dry state,
as difficulties in swallowing can occur.
2. Pour the contents of one sachet respectively
one teaspoonful of the granules into a glass.
3. Slowly fill the glass with cold water (at least 150 ml).
4. Stir with a spoon, ensuring that no lumps form, and
drink immediately. Do not take when lying down!
5. Drink another glass of liquid afterwards.
Hint:
Please also note the instructions for use.
Store Mucofalk® orange in a dry place!
39
Further information for patients
with bowel diseases:
– Colon Diverticula and Diverticulosis
31 pages (M80e)
– Discomfort in the anal region
What can it be?
What can you do?
50 pages (M83e)
These brochures can be ordered
free of charge from Falk Foundation e.V.
or the local Falk partner.
FALK FOUNDATION e.V.
Leinenweberstr. 5
79108 Freiburg
Germany
www.falkfoundation.com
M81e 9-11/2008/3.000 Bu