Official AGA Constipation Guidelines Pocket Guide Flipbook.
Issue link: https://eguideline.guidelinecentral.com/i/1060349
13 Side Effects/Problems b Mechanism of Action Bloating, flatulence, iron and calcium malabsorption Stool bulk ↑, colonic transit time ↓, GI motility ↑ Bloating, flatulence Mixed soluble and insoluble fiber, stool bulk ↑ Bloating, flatulence Stool bulking Less bloating Bloating, flatulence Sweet taste, transient abdominal cramps, flatulence, bloating Nonabsorbable disaccharides metabolized by colonic bacteria into acetic and other short-chain fatty acids, which accelerate colonic transit Incontinence due to potency, bloating, abdominal cramps Osmotically ↑ intraluminal fluids Rectal irritation, abdominal cramps Evacuation induced by local rectal stimulation Irritation Incontinence, hypokalemia, abdominal cramps Similar to senna (see Stimulants, Anthraquinones) Malabsorption, abdominal cramps, dehydration, melanosis coli Electrolyte transport altered by ↑ intraluminal f luids, myenteric plexus stimulated, motility ↑ Does not ↑ GI motility Stool soening Magnesium toxicity, dehydration, abdominal cramps, incontinence Fluid osmotically drawn into small-bowel lumen, cholecystokinin stimulated, colon transit time ↓ Avoid in renal failure Lipid pneumonia, malabsorption of fat-soluble vitamins, dehydration, incontinence Stool lubricated Mechanical trauma Evacuation induced by distended colon, mechanical lavage Accumulated damage to rectal mucosa, hyperphosphatemia, mechanical trauma Nausea, diarrhea, abdominal pain, bloating, flatulence, headache Intestinal secretion ↑, chloride channel 2 activator Diarrhea, abdominal pain, flatulence Intestinal secretion ↑, guanylate cyclase-C agonist Abdominal pain, flatulence, nausea, dizziness, diarrhea, hyperhidrosis GI motility ↑, peripheral µ-antagonist c In clinical practice, senna and docusate sodium are commonly used in combination due to their complementary mechanisms of action.