Bulk laxative ileus

Intestinal obstruction caused by a laxative drug (Psyllium): A case report and review of the literature

•

Elderly patients receiving psyllium for treatment of constipation must drink a good amount of fluid.

•

It is advisable to avoid bulk laxative treatment in presence of organic bowel obstruction or ileus.

•

Oral contrast materials that contain Psyllium can cause bowel obstruction in some patients.

Introduction

Psyllium in granular dosage form is used as an over – the counter safe laxative drug. It has a considerable hygroscopic propriety which allows it to retain water and expands rapidly to become many times of its original size.

Presentation of the case

21-year-old man presented to the Emergency Department complaining of lower abdominal pain and constipation for five days. He was discharged home on Psyllium for treatment of the constipation. Two days later, he returned to the Emergency Department complaining of increased abdominal distension without passing any stools. The patient was diagnosed to have an incomplete intestinal obstruction resulting from ingesting Psyllium husks without adequate amount of fluids. The patient was treated conservatively.

Discussion

Psyllium has a reputation of being safe and effective medication for patients suffering from chronic constipation, especially in elderly. The patient who ingested Psyllium husks as a herbal medication did not receive adequate amount of fluids. Consequently, he developed intestinal obstruction.

Similar cases have been reported in the English literature including cases of esophageal obstruction in elderly patients and following gastric banding operations. Furthermore, Psyllium administration with oral contrast in computed tomography enterography may precipitate bowel obstruction in the presence of organic obstruction or post-operative ileus.

Conclusion

Psyllium can worsen the constipation if not taken appropriately. It is important to instruct patients who are receiving psyllium ingredients to drink a good amount of fluids to avoid the development of bowel obstruction especially in long-term use of such laxatives.

Abuse of drugs associated with eating disorders

Concomitant bulimia nervosa and drug abuse are common in women. Drugs used by this group include diuretics, emetics, laxatives, and diet pills, as well as alcohol, cigarettes, and illicit street drugs. This paper applies principles from behavioral pharmacology to the problem of drug use by women with bulimia nervosa. The prevalence of use, primary effects, toxicity, detection, tolerance, withdrawal, and effects on appetite and weight are discussed for drugs used by bulimic women to reduce appetite or weight or to induce purging (e.g., diuretics, emetics, laxatives, and diet aids). Alternatives in the diagnosis and treatment of drug use in women with eating disorders are discussed.

Study of constipation in a geriatric hospital, day hospital, old people's home and at home

A study of constipation and related factors was carried out in 439 geriatric hospital patients, 183 people living in two old people's homes, and 78 patients visiting a geriatric day hospital. In addition, a cross-sectional survey of constipation and related factors was undertaken in 138 people older than 74 years and 74 people aged 41 to 50 years living at home. Constipation and the use of laxatives were most frequent in the geriatric hospital (79% and 76% respectively), followed by the old people's homes (59% and 60%), the day hospital (29% and 31%), elderly living at home (38% and 20%) and middle-aged living at home (12% and 5%). The results suggest an increased risk of constipation for the persons walking less than 0.5 km daily [relative risk (RR) = 1.7], walking with help (RR = 3.4), chairbound (RR = 6.9) and bedbound (RR = 15.9). The relative risk of constipation increased for the persons living in the old people's homes (RR = 1.7) and the geriatric hospital (RR = 2.2), and also with advancing age (between 75 and 84 years, RR = 2.9; over 84 years, RR = 4.9). The prevalence of constipation was directly correlated to fecal and urinary incontinence.

Colonic impaction in guinea pigs fed a chemically defined diet: a case report

Pathogen-free female Hartley guinea pigs were divided into four diet groups to determine optimal nitrogen requirements for growth, pregnancy and lactation. Three chemically defined test diets varying in total nitrogen were compared with commercial guinea pig feed. Within 13 days, 24 of 78 animals from the three test diet groups died or required euthanasia. Affected guinea pigs were depressed, lost weight and had distended abdomens. Distension, impaction and, in most cases, rupture of the spiral of the ascending colon and subsequent peritonitis were observed at necropsy. Husbandry changes which resulted in a decreased incidence of impactions included increased acclimatization time on commercial feed post-shipping, decreased animal density per cage and cessation of water medication with oxytetracycline.

Protective effect of anticholinergic drugs and psyllium in a nosocomial outbreak of Norwalk gastroenteritis

An outbreak of Norwalk agent gastroenteritis occurred in a chronic-care hospital in Tennessee in April 1981. Fifty-five per cent of the elderly psychiatric patients and 61 per cent of the nursing employees on one floor became ill. Infection was most likely to have spread from patient-to-patient by nursing employees. Certain chronic medications seemed to protect patients from symptomatic infection. Anticholinergic drugs appeared to mask the symptoms of this disease; psyllium ('Metamucil') may have prevented infection in some patients. We suggest that prospective studies be undertaken to confirm the possible value of psyllium in averting infection with Norwalk agent.