DÄ internationalArchive46/2009The Pathophysiology, Diagnosis and Treatment of Constipation: Potential for Dependence

Correspondence

The Pathophysiology, Diagnosis and Treatment of Constipation: Potential for Dependence

Dtsch Arztebl Int 2009; 106(46): 765. DOI: 10.3238/arztebl.2009.0765b

Schmiedel, V

LNSLNS The dependence-forming potential of substances that irritate the colon is, in my opinion, underrated. Someone who has aided his bowel movements with these substances for a few weeks is hardly likely to achieve normal digestion without laxatives. The lowered frequency of bowel movements—notably reduced after laxative intake has ceased—is not something that a person with constipation is likely to accept, given that reduced bowel motility made him or her reach for the laxatives in the first place. If normal bowel actions are achieved at all in people with constipation who have used laxatives for a number of years, this will happen only after months of good practice and high motivation on the patient’s part, in spite of concerted application of all the methods described in Müller-Lissner’s article.

Hypokalemia, which is described as a rare event if laxatives are used as per the instructions, is nevertheless a common finding when not serum but whole blood is analyzed for potassium. I personally have rarely observed potassium deficiency in serum. However, on analyzing whole blood, such a finding is a lot more common—especially in people with constipation, and then particularly in those taking laxatives. The simplest method to treat constipation was not mentioned: almost all people with constipation are deficient in magnesium—another measurement that becomes obvious in whole-blood analysis.

Because laxatives result not only in potassium deficiency in the smooth intestinal muscle cells but also in reduced magnesium concentrations, potassium substitution (only when deficient in serum and/or whole blood) and administration of magnesium at a high dosage (300–900 mg magnesium ions) is almost always successful. Even if no magnesium deficiency is present, magnesium is effective owing to its saline effects at high dosages. Last, but not least, magnesium salts ingested as a fizzy drink/granulate have a much more agreeable flavor than Glauber’s salt or Epsom salts.
DOI: 10.3238/arztebl.2009.0765b

Dr. med. Volker Schmiedel
Habichtswald-Klinik Werner Wilhelm Wicker KG
Wigandstr. 1, 34131 Kassel
schmiedel@habichtswaldklinik.de

Conflict of interest statement
The author declares that no conflict of interest exists according to the Guidelines of the International Committee of Medical Journal Editors.
1.
Müller-Lissner S: The pathophysiology, diagnosis and treatment of constipation [Obstipation – Pathophysiologie, Diagnose und Therapie]. Dtsch Arztebl Int 2009; 106(25): 424–32. MEDLINE
1. Müller-Lissner S: The pathophysiology, diagnosis and treatment of constipation [Obstipation – Pathophysiologie, Diagnose und Therapie]. Dtsch Arztebl Int 2009; 106(25): 424–32. MEDLINE