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Dtsch Med Wochenschr 2019; 144(16): 1145-1157
DOI: 10.1055/a-0670-5209
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© Georg Thieme Verlag KG Stuttgart · New York

Obstipation – Pathophysiologie, Diagnostik, Behandlung

Constipation – pathophysiology, diagnostics, treatment
Stefan Müller-Lissner
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Publication History

Publication Date:
15 August 2019 (online)

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Abstract

The most relevant risk factors for the development of chronic constipation are neurologic disorders such as Parkinson’s disease, immobility, and some drugs, in particular opioids. A proctologic exam and exclusion of red flags form part of the basic assessment. The currently available laxatives are effective and safe, habituation and tolerance (tachyphylaxis) being an exception. Also long-term intake of laxatives is of no concern when taken in recommended doses (no relevant hypokalemia!). Though the newer compounds (e. g., prucalopride, linaclotide, lubiprostone) are not more effective than the older ones, developing new drugs with alternative mode of action is reasonable since there are patients not satisfied with the currently available substances. Macrogol, Bisacodyl, and sodium picosulfate are the laxatives of first choice. Their selection depends on the individual preference of the patient. Opioids often induce constipation which can be ameliorated by laxatives or PAMORAs (peripherally acting µ-opioid antagonists).

Rund 15 % der deutschen Bevölkerung leiden innerhalb eines Jahres unter Verstopfung, wobei jeder Dritte auf Medikamente zurückgreift und jeder Sechste den Arzt aufsucht [1]. Obstipation ist mehrheitlich nicht durch falsche Lebensgewohnheiten selbst verschuldet. Die Behandlung erfolgt weitgehend als Selbstmedikation. Ein Ileus führt dagegen kurzfristig noch zu weiteren Symptomen (Kolik-artige Schmerzen, Erbrechen) und unterscheidet sich daher deutlich von einer harmlosen funktionellen Verstopfung.

Schlüsselwörter

Obstipation - Laxanzien - gastrointestinale Motilität - Ballaststoff

Key words

constipation - laxatives - gastrointestinal motility - dietary fibre
 

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