Information on: Diabetic Gastroparesis and more

Read more about diabetic: esophagus / stomach / bowels

The Diabetic Bowels: Issues and Challenges, Constipation/Diarrhea.

Constipation: Introduction / Diagnosis / Treatments / Surgery / Pelvic floor & bio-feedback

Diarrhea: Introduction, Small bowel Bacterial Overgrowth / Treatments for diarrhea / General Bowel Tips

Introduction:Constipation in diabetes
Constipation in conjunction with diabetes is a familiar complaint. Constipation is generally defined as the passage of stools less than 3 times per week, straining to pass the stool, and a feeling of incomplete evacuation of the bowels. The stool is characteristically hard, dry and small.

Many of those suffering from constipation are advised to get regular exercise, increase fluids and fibre, and take laxatives. Furthermore, it is generally thought that those who must rely heavily upon laxatives have the added worry of laxative dependency and the consequences of a "lazy" bowel. As will be discussed later, these beliefs are based upon common myths.

 What few people realize is that constipation occurring along with diabetes can be a very challenging problem. Doing all the "right things" and still not having regular bowel movements or having bowel movements only with the aid of laxatives is enormously frustrating.

 Understanding the normal function of the colon is important in appreciating its role to our overall health. The colon helps our bodies to maintain a balance of both water and electrolytes. (Electrolytes are important body salts that regulate nerve function. Examples of electrolytes are: potassium, sodium, chloride, and magnesium). The colon is a vat teeming with bacteria that happily co-exist within us and play a role - yet to be fully understood - in maintaining our health. Much of the stool's weight is represented by discarded colonic bacteria.

Motor activity (motility) of the colon is the muscular action needed to propel a stool along its final journey. Colon or large bowel motility has some unique features. While we sleep, the colon is at rest showing very little activity. However, upon awakening in the morning, the colon also wakes up and begins propulsive movements that last throughout the day. This activity stimulates an urge to evacuate the bowel, usually early in the morning or soon after eating.

The wiring for the bowel's motor activity comes from two main sources: the autonomic nervous systemand the enteric nervous system, which is a network of fine, mesh-like nerves layered within the walls of the gut The main branch of the autonomic nervous system, which controls the upper gut region and the beginning section of the large bowel is the vagus nerve. The rest of the large bowel is connected to another branch of the autonomic nervous system called the sacral nerves, which lead out of the bottom of the spine and through the tailbone.

Constipation, brought about by numerous factors, is a very common complaint in the general population. More challenging are the problems experienced by the diabetic with constipation, which often reflects an autonomic neuropathy or damage to the nervous system within the gut. These nerve problems create a slow gut, or what is called slow transit constipation. A very severe form of slow transit constipation is called colonic inertia. This describes a completely paralyzed colon.

 Caution: Fibre!

  Diabetic neuropathies affect gut motility. Neuropathies can be slowed or even reversed through maintaining tight blood glucose control.

Common Myths. In a published article from the American Journal of Gastroenterology, January 2005, lead author Stefan A. Müller-Lissner, M.D and his colleagues helped to dispel many common myths about constipation. The authors reviewed all pertinent medical literature related to constipation and highlighted some interesting points:

• Contrary to popular belief, toxic substances are not reabsorbed from the colon.

• Constipation caused by hypothyroidism is very rare.

• Fibre-rich diets may help combat constipation, but those individuals who suffer from the more severe constipation related to a motility problem may actually find that fibre makes their digestive symptoms worse.

• Increasing fluids for the treatment of constipation only helps those individuals who are particularly dehydrated.

• There is no evidence to support the belief that rebound constipation might occur after discontinuing the use of laxatives.

• The bowel does not develop a laxative dependency nor, despite possible misuse of laxatives, is there a potential for laxative addiction.

Where to begin?
Usually when one suffers with constipation, a variety of measures - over-the-counter treatments, increased fluids, or time-honoured family remedies - are used to correct the problem. However, in the case of persistent constipation, a logical progression through a variety of laxatives under the guidance of a physician may be in order.

Laxatives:
Laxatives come in many forms and work in different ways. The common categories of laxatives are:

Osmotic laxatives: These laxatives help to "pull" water into the colon and hydrate the stool. Examples are:

• Polyethylene glycol (PEG, Mirlax)

• Lactulose *

• Sorbitol **

• Epsom Salts ***

• Milk of Magnesia

Caution:
* Many people who use lactulose find that it may increase the problems of bloating, gas and abdominal cramping.
 ** Sorbitol is an additive found in numerous food products. Although it contains just over half the calories per gram as table sugar and is, therefore a popular sugar substitute in specialty diabetic foods and candies, it may cause problems with gas, intermittent diarrhea and digestive upset.
 *** Epsom salts, a time-worn treatment for constipation, is not a good choice, especially for someone with high blood pressure or kidney disease.

Stool softeners provide moisture to the stool. Examples:

• Colace

• Surfak

• Dialose

• Docusate

Bulk-forming laxatives, as mentioned, are always recommended, but often increase symptoms. Examples:

• Methylcellulose

• Psyllium

• Bran cereal

Lubricants grease the stool, thereby helping it move through the intestine more easily. Example:

• Mineral oil *

*Mineral oil should only be used at bedtime due to its possible interference with the absorption of fat-soluble vitamins such as vitamins A and E. Mineral oil should not be used by anyone with severe nocturnal acid reflux or problems with vomiting. If oil gets into the lungs it can cause serious pneumonia.

Stimulant laxatives are a last choice and their long-term use is generally discouraged since some evidence suggests they may cause damage to cells within the colon. Examples are:

• Senokot,

• Bisacodyl

• Aloe

Enemas may also be used to evacuate the lower part of the colon, or the region that is called the rectum.