Normalization of bowel function in constipation and diarrhea · a distended stomach, bloating,...

Normalization of bowel function in constipation and diarrhea (Plantago ovata seed shells)

The informed patient

11th revised edition 2017

Publisher

© 2017 Dr. Falk Pharma GmbHAll rights reserved.

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Normalization of bowel function in constipation and diarrhea(Plantago ovata seed shells)


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Contents


Preface 4

How does our digestion work? 6

What causes constipation? 15

How do laxatives work? 24– Anti-resorptive laxatives 24– Osmotic laxatives 27

How do lubricants and bulking agents work? 28

What causes diarrhea? 31

Mucofalk® 33

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Preface

Dear Reader,

Like many people, you have been suffering, perhaps for many years, from chronic constipation, which is often accompanied by other complaints such as a distended stomach, bloating, fullness, pain and/or increased flatulence.

These complaints are unpleasant, painful and affect your overall wellbeing and quality of life.

Many people are reluctant to talk about constipation and its effects and therefore do not consult a doctor. Instead, they often try to treat these complaints them-selves using readily available laxatives or laxative teas.For a while this might work rather well. But, frequently, the constipation and other complaints again worsen. At this point, many people overcome their reluctance and seek medical advice.

What might your doctor recommend? Clearly, you should adapt your lifestyle (dietary habits, fluid intake, exercise and stress management) and perhaps take preparations containing bulking agents or dietary fiber, which support normal bowel function, either instead of laxatives or in combination with them.

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This brochure also contains information on the subject of diarrhea, as bulking agents such as ispaghula husk (psyllium) can also be taken as a supporting treatment for diarrhea caused by various factors.

It won’t always be easy to follow this advice in your every day life. This brochure helps you to understand why it is important and how it can succeed.


After we have thoroughly chewed and swallowed a bite of food or taken a sip of a drink, it travels down the esophagus to the stomach, where it is broken down and passed on to the small intestine in portions, mixed with stomach acid. The nutrients carbohydrates, proteins and fats as well as vitamins and minerals are mainly absorbed into the body in the sections of the small intestine and then reach the blood.

All the other, non-digestible components of the food or drink, in particular plant fi bers, which are referred to as dietary fi bers, then move from the small intestine to the large intestine, after being mixed with digestive juices from the small intestine, the pancreas and the gall bladder.

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How does our digestion work?

Anatomy of the small and large intestine

Stomach (ventriculus or gaster)

Duodenum

Ileum

Cecum and appendix

Transverse colon

Ascending colon Jejunum

Sigmoid colon

Rectum

Descending colon

Anatomy of the small and large intestine.

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Each day, around 1.5–2 liters of the contents of the small intestine are transferred to the large intestine.The large intestine is made up of three parts: the ascending colon, the descending colon, and the trans-verse colon which connects these two parts. The liquid contents from the small intestine first reach the ascending colon. They can sometimes spend up to two days there. During this time, water and important minerals, as well as short-chain fatty acids and vita-mins (produced by bacteria), are absorbed from this liquid and transferred to the organism. This causes the contents of the intestine to thicken and form stool.

Then, usually after a meal, the stool is pushed from the ascending colon to the descending colon, where it continues to thicken. When it reaches the rectum, it triggers the urge to defecate, and a bowel movement then takes place.


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The passage of food and drink

Food and drink

Intake per day:approx. 1 kg food and 1.5–2 liters of drink

Tips:

Chew thoroughly

Drink plenty of fluids each time you eat

Eat more fiber-rich food

Ensure you have a balanced diet

Mouth

Seconds

Retention time

Bowel movements(100–200 g/day)

Total transit time between 30 and 72 hours

Esophagus

Seconds

Stomach

1–4 hours

Small intestine

2–8 hours

Large intestine

10–40 hours

Anus

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The frequency of defecation and the quantity of stool are influenced by various factors:

The more indigestible plant fibers (dietary fibers) are contained in the food, the higher the volume of stool and therefore the softer the stool and the more quickly it is moved onwards, thickened and excreted. In order to benefit from the effect of dietary fiber, which consists in binding large quantities of liquid, it is necessary to drink at least 1.5–2 liters per day.


Fluid intake recommendations from the VFED

2–3 cups of tea or coffee

Max. 1 glass of low-fat

milk product (e.g. buttermilk)

Max. 1 large glass of fruit

or vegetable juice

1–2 cups of fruit

or herbal tea

At least 1 liter of tap water

or mineral water

Recommended daily drink intake

Ensure that you drink at least 1.5–2 liters of low-calorie or calorie-free fluid every day.

300–400ml

200ml

200ml

150–300ml

1000ml

1500–2000ml

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Wholegrain bread with aromatic tomatoes, flavorful herbs and spices and fresh cottage cheese tastes great and is great for your intestines.

Advantages of a fiber-rich diet:

– Prevents and treats constipation– Prevents intestinal diseases like diverticulosis

and possibly even colorectal cancer– Supports vital intestinal flora– You feel full from fewer calories

Fiber-rich foods are wholegrain products such as wholegrain bread and muesli, vegetables, salad, pulses, fruit, flax seed and bran. Animal products only contain low amounts of dietary fiber. However, they contain the indigestible substances collagen and elastin.

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So “More plant-based food and fewer animal products” is the motto for intestinal health. A diet that’s good for your intestines is also rich in essential vitamins and minerals and helps you get, or stay, in shape.


Wholegrain muesli with fruit is the best way to start an active day and promote intestinal health (source: Dr. Grandel).

Low in fiber

(Bad for the intestines)White breadBread rollsCrackersCreamy desserts

High in fiber

(Good for the intestines)Wholemeal breadWholemeal rollsCrispbreadFruit compote

Low-fiber food means that too little dietary fiber reaches the large intestine, causing the stool to become too thick and to harden, meaning it is transported more slowly. This would include, for example, a food mainly made up of ingredients such as white flour, custard, sauces and candies. Meat and cheese contain very little fiber, also they should not be considered as a source of vital dietary fiber.

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Drinks also influence the functioning of the large intestine. Mineral water, juices and herbal teas are beneficial, but very strong black tea or chocolate milk can cause or aggravate constipation. No more than four cups of black tea or hot chocolate should be drunk per day. Fermented milk products such as kefir or buttermilk, as well as coffee, have a positive effect on bowel function. Drinking a glass of mineral water when you get up in the morning, perhaps with a little prune juice, helps to get your intestines moving.

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What happens in the large intestine?

In the large intestine, the food pulp is thoroughly “kneaded” by the intestinal muscles so that water can be absorbed from it. If its journey through the intestine is slowed down, the food is over-processed and too much water is absorbed from it. This makes the stool harder and more difficult to pass into the rectum.


Constipation: The food pulp is over-processed and too much water is absorbed from it; the stool becomes harder and more difficult to pass into the rectum.

Normal digestion: Water and important minerals are absorbed into the organism from the food pulp. The contents of the intestine thicken and form stool.

Because the movement cycles of the large intestine are regulated by the vegetative nervous system (which cannot be consciously controlled), psychological factors (e.g. stress), emotional factors (e.g. anger) and environmental factors also play an important role in the regulation of digestion and defecation.

For example, traveling to different places can cause constipation, as can pregnancy, while anxiety and feelings of helplessness or uncertainty tend to cause diarrhea. You are no doubt familiar with the changes in the consistency and/or frequency of bowel move-ments that occur before an exam or a dentist’s appointment or after a long flight.

These correlations should be taken into account when trying to understand the causes of constipation and possible treatment options.

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Before answering this question, we should clarify at what point exactly someone can be described as suffering from constipation.

The common belief that it is necessary to defecate every day is not shared by doctors. If you are only able to empty your bowels once every two days, this is not necessarily a sign that you are sick.

As already described, depending on the make-up of your food it may spend much longer than this in your intestines. Food that is low in fiber generally takes longer to move through the intestines than fiber-rich food with plentiful fluids.So there is no need to worry about “poisoning” if you do not defecate for one or two days.

Instead, doctors will only diagnose constipation when bowel movements are taking place less than three times per week or are associated with severe complaints, or if there are other complaints such as abdominal pain or flatulence.

Constipation can be the result of organic causes, such as scar tissue in the intestine, which may be caused by inflammations, or wall thickening, e.g. caused by a tumor.Other conditions not directly related to the intestines, such as an underactive thyroid gland, can also lead to constipation.If diabetes mellitus is poorly controlled over many years it can eventually cause constipation. Your doctor will get to the bottom of these causes before beginning treatment. It is recommended that you consult a

What causes constipation?


gastroenterologist (a specialist in stomach and intestinal diseases) in order to work out the precise cause of your constipation.

However, in many cases the above-mentioned causes are not the problem. In these cases, it is referred to as functional constipation. There is good reason to believe that the leading cause of functional constipation is the radical change to our diets in developed countries. In recent decades our carbohydrate and fiber intake has been steadily decreasing in favor of fats, sugars and proteins. But our intestines are dependent on carbohydrates and fibers for optimal functioning.

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Why is this? Functional constipation is largely related to our civilized way of life. There are five main factors which have negative effects:

The composition of our food

Tip: Eat more plant-based food and fewer animal products

We eat too many animal products and too little plant-based food. The average Westerner consumes too much fat, alcohol, sugar and meat. The average fiber intake from fruit, vegetables and wholegrain products, on the other hand, is far too low – around 22 g per day compared to the minimum recommendation of 30 g. To get enough fiber in your diet, you should eat 500 g of vegetables and potatoes, 250 g of fruit (e.g. two apples) and four slices of wholemeal bread every day. If you base your diet on the “nutrition triangle” guide created by the German Association for Nutrition and Dietetics (VFED), shown on page 20/21, you’ll (almost) always be in the clear.

However, possible intolerances to certain ingredients or foods, such as lactose, fructose or gluten, must always be taken into account in individual cases.


Our food is so intensively processed before we eat it that there’s hardly anything left for our intestines to do. Much of what we eat today is ready-made. Fast food, candies and soda are harmful, not just to our digestive tract. The proportion of plant fibers (dietary fiber) they contain is so low that only very little hard-to-digest material must be excreted from the intestines. Drinks are often rich in nutrients (sugar, alcohol) and equally do not leave behind any indigestible residues. The large intestine is not sufficiently filled and the food remains in it become too thick and are transported too slowly, leading to constipation. Only when the large intestine is filled up and, at the same time, the stool is soft, can the bowels be properly emptied. A large volume of stool stretches and stimulates the intestine. This stimulus causes the soft stool to be transported on further, and the bowels can be emptied without any problems.

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Foods such as vegetables which are good for the intestines have a particularly beneficial effect when they are fresh and properly prepared (source: Fissler).

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Lack of physical activity

Tip: Exercise regularly

Today many people work at a desk and spend the whole day sitting down. Our bodies aren’t built for this. Elevators, escalators, cars, buses and trains take us from A to B, meaning that we hardly have to move. In the evening and on weekends we often only have time for household chores, and what little free time we do have is spent in front of the TV. And at home too, the need for physical activity is increasingly reduced by mixers, washing machines, tumble dryers, dish-washers and food processors. This causes intestinal activity to slow down, delaying the transport of the food pulp, which can thus have more water absorbed from it. The stool is then no longer so soft and volu-minous, making bowel movements more difficult.

Optimal intestinal functioning requires more physical activity than is currently commonplace. And exercise isn’t just good for your intestines. If you exercise for a relatively long period of time every day – this could include long walks, swimming, jogging, power walking, dancing, cycling or gardening – your cardiovascular system will function well and you’ll feel the benefit. And you’ll get or stay slim, active and healthy.


Iodizedsalt

Rapseed

OILOlive

OIL

with fluor

K

Wholewheatpasta

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The VFED nutrition triangle(VFED – German Association for Nutrition and Dietetics)

Choose well – be aware of what you eat and drink

daily:3 low-fat servings

weekly: 1–2servings of ocean fish

daily:at least

3–4 servings

daily: moderate activity, weekly: 3 x physical

Wholemealrice

Wholemealflour

WATER

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daily:small amounts

daily:in moderation

daily:at least 4 servings

daily:2 servings

daily:at least 1.5–2 liters

more

exercise/sports

weekly:no more than 2–3low-fat servings ofmeat/sausage, 2 eggs

Too little fluid intake

Tip: Drink at least 1.5–2 liters per day

In the intestines water is absorbed from the food pulp – water is crucial for the body and protects it from dehydration. This liquid comes not just from food and drink, but also from the digestive juices. Each day, up to 9 liters of water are absorbed from the small and large intestine into the body. Only 0.1–0.2 liters are excreted with the stool. Additional fluid is lost via the urine (1.5 liters), and via the skin (sweat) and respiration. If not enough liquid is consumed via

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Mineral water does not contain any calories, but has a high content of essential minerals and micronutrients. The body needs 1.5–2 liters of fluid from drinks every day (source: IDM).

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food and drinks, the stool becomes hard and solid. You should drink at least 1.5–2 liters of fluid every day.There are various foods which have a high water content (e.g. watermelon, cucumber, tomatoes, fruit, various types of cabbage) and can boost your fluid intake.

Hectic lifestyle

Tips: Don’t let yourself get stressed, practice relaxation

Many people today have more hectic lifestyles than in the past. The word stress has sadly become com-monplace. Long commutes, job stress, fear of losing their job, and time pressure from all sides often mean that people put off going to the toilet. The signal that you need to use the toilet can be deliberately suppressed. This causes the stool to spend more time in the intestine and continue to thicken, and after a while you no longer feel the urge to use the toilet – you have forced your body to stop feeling it. You should always go to the toilet when your body signals that it is time for a bowel movement, because you can train your body to start feeling the urge to defecate again.

Medication

Tip: Ask your doctor or pharmacist about the effect of medication on your intestines

Many medications can cause and/or aggravate constipation. These include, among others, certain heart medications, pain relievers, aluminum-calcium-containing antacids, some antihypertensives, as well as psychiatric drugs used to treat depression and other mental illnesses.


Tip: Laxatives should only be used on the advice of your doctor

Laxatives only have an effect where they should, directly in the intestine, particularly in the large intestine. Fundamentally, all laxatives work via similar mechanisms: They increase the water content of the stool and thus the volume and softness of the stool and enable it to be better transported through the intestine and more easily excreted. However, different laxatives achieve this in different ways, and have different side effects.

Anti-resorptive laxatives

Tip: Herbal solutions are not always harmless

Herbal laxatives (senna leaves, aloe, rhubarb root) do not just prevent the absorption of water into the body (anti-resorptive) in the large intestine, but even promote the withdrawal of water (hydragog) from the body. On the one hand, this improves the consistency of the stool, making it softer and easier to transport, but on the other hand long-term use may cause the body to lose water and crucial minerals.

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How do laxatives work?

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The word “herbal” leads many people to think that these laxatives are especially gentle. But this is not always the case. In principle, laxatives should not be used except on the advice of your doctor.

Water is the main constituent of our bodies, making up more than 60%! The older we become, the less water our bodies contain. Water is essential for life. Minerals are crucial for many of the body’s functions. If the body loses too much water and too many minerals, this causes severe dysfunctions that must not be ignored. The kidneys, nerves and heart may suffer from dysfunctions.


Anti-resorptive laxatives prevent the absorption of water from the large intestine and even promote the absorption of water from the body into the large intestine.

Other laxatives can stimulate intestinal movements in such a way that the large intestine can no longer respond adequately to its own control mechanisms and signals.

The widespread belief that herbal laxatives are generally harmless, since they are natural products, is not correct! Particularly when laxatives are used for longer periods of time, they must be chosen carefully.

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Osmotic laxatives

(salts and artificial sugars such as lactulose

as laxatives)

These include laxatives whose effect is to retain water in the large intestine or to draw more water there.Typical examples include Karlsbad salt, Glauber’s salt or Epsom salt, which are known as salinic laxatives. Macrogol/polyethylene glycol, carbohydrates, lactose, lactulose, lactitol, mannitol or sorbitol also belong to this group of laxatives.

Salinic laxatives are rather harmless when used for short periods of time, but excessive consumption can cause dysfunctions in the organism’s water and salt balance, potentially leading to constipation. Also osmotic laxatives should be prescribed by a doctor.

Osmotic laxatives retain water in the large intestine and draw more water into the large intestine. This can cause malfunctions in the organism’s water and salt balance.

Lubricants

Lubricants, such as paraffin and glycerol, make bowel movements easier by making the stool slide more smoothly. Paraffin is only rarely used, with good reason, but glycerol is suitable for short-term adminis-tration in the form of suppositories.

Bulking agents

For long-term or permanent use a safe option is herbal bulking agents or swelling agents, which should not be confused with herbal laxatives such as senna leaves.Bulking agents are forms of dietary fiber contained in, for example, flax seed, wheat bran or the seeds of certain types of Plantago (such as Mucofalk®). The type of Plantago which provides the husks for Mucofalk® is known as ispaghula.

How do lubricants and bulking

agents work?

The fiber content of foods such as fresh salad is often not sufficient to get the large intestine moving again, and it can be helpful to take bulking agent preparations (source: Becel-Diät- Pflanzenöl, Master-Media).

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These natural and safe herbal bulking agents encourage bowel movements, by swelling up in the stool to bind water, increasing the volume of stool through their indigestible fiber consti tuents and keeping the stool soft. This triggers the urge to defecate and ensures a healthy bowel movement.

Bulking agents also increase and improve the bacterial flora in the large intestine, which also increases the volume of stool and makes it softer and easier to transport. The intestinal flora form part of our body’s immune system. Good intestinal flora keep the organism fit and healthy. When the large intestine is fuller, this stimulates better functioning, and the binding with water gives the stool a softer consistency.


Bulking agents swell up to bind water and increase the stool volume as a result of their indigestible fiber constituents. The stool becomes softer and easier to transport.

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Mucofalk® naturally regulates intestinal activity by supporting the actual function of the intestines, which means that it can and should be taken regularly.

Healthy eating doesn’t have to be complicated, as you can see from the VFED nutrition triangle (see page 20/21). The essentials of healthy eating are wholegrain products, ample vegetables and potatoes (at least 500 g per day) and fruit (at least 250 g per day). These foods are supplemented by healthy low-fat animal products such as fish, poultry, lean meat, low-fat milk products and low-fat cheese. The intake of sugar, sugary foods, butter, margarine and oil, as well as alcohol, should be kept to a minimum, in order to keep the body fit and active. The diet promoted by the nutrition triangle also makes it almost impossible to become overweight, may even lead to gradual weight loss and provides sufficient vitamins and minerals. A healthy diet must also include at least 1.5–2 liters of low-calorie or calorie-free drinks each day.

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What causes diarrhea?

Diarrhea refers to bowel movements that occur more than three times in one day and have a watery or pasty consistency and a larger than usual volume. This may be accompanied by flatulence, stomach discomfort, nausea and vomiting.

Diarrhea is described as acute when it does not last longer than 2 weeks. If it lasts longer than 2 weeks, it is classified as chronic diarrhea.

Diarrhea in itself is not a disease, but a symptom and a logical bodily response, e.g. to get rid of harmful substances as quickly as possible. Acute diarrhea is often caused by bacteria or viruses. In most cases, acute diarrhea clears up on its own after a short time. If diarrhea is accompanied by fever or if the stool contains blood, a doctor should be consulted imme-diately. Due to the loss of liquid and minerals that it causes, diarrhea can be dangerous in particular for infants, young children and frail elderly people.

Mechanisms that trigger diarrhea include:– disordered intestinal motility associated with faster

movement of food through the intestine,– too much liquid in the intestine, e.g. if the ability

of the mucosal tissue to absorb water is impaired.

Most common causes of acute diarrhea: – “stomach flu” – viral or bacterial infection– food intolerance (e.g. lactose intolerance)– food poisoning– traveler’s diarrhea– diarrhea as a side effect of medication

(e.g. antibiotics)– anxiety, stress

Most significant causes of chronic diarrhea:– irritable bowel syndrome– inflammatory bowel diseases (Crohn’s disease,

ulcerative colitis)– gluten intolerance/celiac disease– laxative abuse

How does Mucofalk® treat diarrhea?It may seem surprising that the same medication can help with diarrhea and also with constipation. This paradox is explained by therapeutic principle of psyllium seed husk. It is based on the significant swelling capacity of the mucilage (gluey substance) it contains, i.e. their ability to bind large quantities of water.

When Mucofalk® is used to treat diarrhea it thus has the desired effect of thickening the contents of the intestines. The stool becomes malleable and at the same time intestinal transit is returned to normal.

Degradable bulking agents are a source of nutrition for the intestinal bacteria and thus support a healthy intestinal flora.

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Mucofalk® Orange

Granules

Active agent: Ispaghula husk (Plantago ovata seed shells), ground

Bulking agents in Mucofalk®

The bulking agents in Mucofalk® include the seed shells of certain plantain species (Plantago ovata). These vegetable substances promote bowel move-ments by means of bulking as they bind water; their indigestible fiber increases the stool volume.

In addition, bulking agents promote an increase in the bacterial flora, which also increases the stool volume. The fuller the bowel, the more it is stimulated into activity, and, by binding water, the consistency of the stool becomes softer.

Vegetable bulking agents of this kind can be used safely for extended periods.

Indications

Chronic constipation, disorders in which it is desirable to facilitate bowel emptying by softening the stool (in patients with anal fissures and hemorrhoids, for example, and following surgical procedures involving the rectum); for adjunct treatment of diarrhea of various causes, conditions in which an increased daily fiber intake may be advisable, such as in constipation- predominant irritable bowel syndrome.

Dosage and instructions for use

Unless otherwise prescribed, adults and children over the age of 12 years take the contents of one sachet or one level tablespoon of Mucofalk® granules mixed with at least 150 ml of water two to three times per day for chronic constipation and for disorders in which it is desirable to facilitate bowel emptying by softening the stool (following surgical procedures, for anal fissures or hemorrhoids, for example). When used as adjunctive therapy for diarrhea and irritable bowel syndrome, adults and children over the age of 12 years take the contents of one sachet or one level tablespoon of Mucofalk® granules mixed with at least 150 ml of water two to six times per day.

1. Never take the preparation in its dry form, as this can lead to difficulty swallowing.

2. Place the contents of one sachet or one level tablespoon of Mucofalk® in a glass.

3. Slowly fill the glass with at least 150 ml of cool water.

4. Carefully stir with a spoon and ensure that no clumps form. Drink immediately. Do not drink while lying down.

5. Drink a second glass of water afterwards.

Notice

Please also read the patient information leaflet.

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Mucofalk®

The gentle power of plantago ovata

Mucofalk® Orange. Active ingredient: Ispaghula husk, ground (Plantago ovata seed shells). Composition: 5 g of granules (1 sachet or 1 level measuring spoon) contains: active ingredient: 3.25 g of Ispaghula husk, ground. Other ingredients: sucrose (saccharose), citric acid, dextrin (from maize or potatoes), so-dium alginate, sodium citrate 2 H2O, orange fl avouring, sodium chloride, saccharin sodium (contains sodium compounds and sucrose). Indications: chronic constipation, conditions in which easy defae-cation with soft stool is desirable, e.g. anal fi ssures, haemorrhoids and in cases of painful defaecation after rectal or anal surgery, supportive treatment in diarrhoea of various causes, conditions in which an increased daily fi bre intake may be advisable, e.g. in constipation-predominant irritable bowel syndrome. Contraindications: hypersensitivity to ispaghula (plantago, psyllium) or any of the other ingredients, any sudden change in bowel habits (that persists longer than 2 weeks), undiagnosed rectal bleeding, failure to defaecate following the use of a laxative, diffi culty in swallowing and other throat and pharyngeal problems, stenoses of the oesophagus, the cardia or gastrointestinal tract, potential or existing intestinal blockage (ileus), paralysis of the intestine or megacolon syndrome, children under 12 years of age. Side effects: Flatulence and feeling of fullness (generally disappear in the course of further treatment). Abdominal distension and faecal impaction may occur and there is a risk of ileus or oesophageal obstruction, if Mucofalk® is swallowed with insuffi cient fl uid. Hypersensitivity reactions through oral administration or contact with the skin, including rhinitis, conjunctivitis, bronchospasm and in some cases anaphylactic shock. Cutaneous reactions such as exan-thema and pruritus. Interactions: See patient information leafl et. Dosage instructions: adults and adolescents from over 12 years: 1 level measuring spoon or the contents of one sachet after stirring into plenty of fl uid 2-6 times daily. Date of information: 03/2015 www.drfalkpharma.com

Eases chronic constipation – and is indicated for constipation linked to irritable bowel syndrome

Gentle remedy for various causes of diarrhea

Relieves painful bowel movements, e.g. from hemorrhoids

Nature’s recipe for good digestion

M81e 1

1-2/

2017

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Normalization of bowel function in constipation and diarrhea · a distended stomach, bloating,...

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