Plantas com efeito na constipação intestinal - prisão de ventre

Paula ViñasJosé de Felippe Junior

Constipação intestinal ou prisão de ventre

O que é?

Pode ser definido como dificuldade em eliminar as fezes, podendo a eliminação ser dolorosa. Se a pessoa defeca menos de 3 vezespor semana, ou possui sensação de evacuação incompleta, ela possui diagnóstico de prisão de ventre. A prisão de ventre não é sério,mas causa incômodos como acne, cólicas, e ainda pode causar hemorróida devido esforço repetido para evacuar, podendo pequenaquantidade de tecido intestinal vir pela abertura do reto.

O que causa?

1) dieta pobre em fibraSegundo a American Dietetic Association, 35 gramas é a dose diária recomendada para ingestão de fibras. As fibrasencontram – se nas frutas, vegetais e grãos integrais

2) Sedentatismo

3) Maus hábitos intestinaisNão se deve ignorar o reflexo da defecação por estar fora de casa ou em ambientes estranhos.

4)GravidezDevido a mudanças hormonais e pela pressão do ventre sobre o intestino.

5)DesidrataçãoIngerir água e suco facilita os movimentos intestinais e o trânsito da matéria fecal devido ao fato de estarcompletamente hidratada.

6) MedicamentosDiversos medicamentos tem como efeito colateral a prisão de ventre

7) Doenças Sistêmicas, no trato digestivo, neurológico e psicológico

8) IdadeDiminui a movimentação natural do intestino, mas pode também estar relacionado a falta de exercício físico e ingestãode água.

Bibliografia

Werbach, M.D. & Murray, N.D. Botanical Influences on Illness 1ºed. Califórnia: third line press, 1994. 128-130p

Teske , M; Trentini, M M A. Herbarium Compêndio de Fitoterapia. 2º ed. Curitiba: Herbarium, 1995. 258-259p.

Simões , O M C; Schenkel, P E; Gosmann, G; Mello, P C J.; Mentz, A.L.; Petrovick, R P. Farmacognosia da Planta ao Medicamento. 4ºed. Porto Alegre: Universidade, 1999. 557-571p

Fitoterápicos

Os tradicionais fitoterápicos que atuam como laxativos contém antraquinonas que aumentam os movimentos peristálticos do intestino.As preparações contendo sene são mais populares e melhor toleradas comparados com outros tipos de antraquinonas e laxativos quenão contenham fibras. (Godding EW. Laxatives and the special role of senna. Pharmacology 36(Suppll):230-6,1988)

Estão entre os tipos de antraquinonas a Aloe ssp., a Cascara sagrada (Rhamnus purshiana), o ruibarbo (Rheum officinale) e a frângula(Rhamnus frangula) (Werbach, M.D. & Murray, N.D, 1994)

Uso de substâncias que aumentam o bolo fecal

Treatment of chronic constipation with swelling substances

Fortschr Med;100(1-2):16-9, 1982 Jan 14. Matek W; Frühmorgen P; Riemann JF; Demling L

Resumo: In 20 patients with chronic constipation and, in many cases, years of laxative abuse, in a prospective and randomized study,treatment with new, specially prepared swelling substances administered at the recommended doses, was carried out after firststopping the use of laxatives. After only one week of this treatment, a marked increase in the weight of the stools, and a reduction instool transit time (p less than 0.05 in each case) were observed.

Sene - Cassia angustifolia

Parte Utilizada: Na mesma dose, folíolos apresentam efeito laxante mais intenso que os frutos (Simões, C.M.O ., et al., 1999).

Os principais constituintes são substâncias antraquinonicas livres e combinadas: crisofanol, aloe-emodina, antranol, reina, reina-8-glicosídeos, reina diglicosídeo, reina antrona-8-glicosídeo, responsáveis pela ação laxativa.

O sene é utilizado como laxante, purgativo e catárquico, indicada nos casos de constipação por inércia intestinal e em condições queexijam facilidade de defecação como fissuras e hemorróidas (Teske, M., et al., 1995).

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O efeito desse fármaco é obtido algumas horas após a administração oral, pois ocorre absorção e liberação dos heterosídeos nointestino grosso. Neste local, pela ação enzimática da flora bacteriana, ocorre hidrólise, com conseqüente liberação das agliconas.Estas, irão atuar sobre a mucosa, aumentando o peristaltismo (Teske, M., et al., 1995).

Cassia allata

Randomized controlled trial of Cassia alata Linn. for constipation.

J Med Assoc Thai;73(4):217-22, 1990 Apr. Thamlikitkul V; Bunyapraphatsara N; Dechatiwongse T; Theerapong S; Chantrakul C;Thanaveerasuwan T; Nimitnon S; Boonroj P; Punkrut W; Gingsungneon V

Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Resumo: Cassia alata Linn. is a medical plant. Its leaves have been claimed to be effective as a laxative. The studies done so far haveshown no toxicity as a result of consuming Cassia alata Linn. leaves. The plant has been found to contain anthraquinones, presumed tobe the active ingredient causing the laxative effect. The objective of the study was to test efficacy of Cassia alata Linn. leaves fortreatment of constipation compared with a placebo and mist. alba in a multicenter randomized controlled trial carried out in oneprovincial and 5 community hospitals. Eighty adult patients admitted to 5 community hospitals and one provincial hospital with at least72 hours of constipation were included in the study. Twenty-eight patients were in the placebo group, 28 in the mist. alba group, and 24in Cassia alata Linn. group. Each patient was given 120 ml of fluid with caramel color, mist. alba, or Cassia alata Linn. infusion at bedtime. Evaluation was performed after 24 hours whether the patient defecated or not. The characteristics of the patients among thethree groups were not different. Eighteen per cent of patients in the placebo group passed stools within 24 hours, whereas, 86 and 83per cent of patients in mist. alba and Cassia alata Linn. groups respectively, passed stools. The differences observed between placeboand mist. alba, placebo and Cassia alata Linn. were statistically highly significant, P less than 0.001 and clinically important. Minimalself-limited side effects, i.e., nausea, dyspepsia, abdominal pain and diarrhea were noted in 16-25 per cent of the patients.

Psyllium (Plantago ovata )

Parte utilizada: semente (Werbach, M.D. & Murray, N.D, 1994)

Rica em fibras solúveis. Suas fibras absorvem e retêm líquidos, e assim restauram e mantêm a regularidade intestinal. É mais efetiva setomada com dois copos de água por dois ou três dias. (Werbach, M.D. & Murray, N.D, 1994)

Experimental Double – blind Study : In a study of 80 pts. with irritable bowel syndrome, 82% improved following active treatmentcompared to 53% following placebo. (p<0,02). Constipation significantly improved in the ispaglula gp. (p=0,026) while it wasunchanged in the controls (Prior A, Whorwell PJ. Double blind study of ispaglula in irritable bowel syndrome. Gut 28(11):1510-13,1987)

Tratamento Combinado: sene e psillium

A administração combinada pode ser mais efetiva (Werbach, M.D. & Murray, N.D, 1994)

Experimental Blinded Study : 42 pts. who had ≤ 3 bowel movements during 1 wk. of single-blind placebo treatment randomlyreceived either psylliun alone (7,2 g/d) or psylliun and senna (6,5 + 1,5 g/d). Both laxatives increased defacation frequency and wetand dry stool weights, although the added effect of senna was clearly evident. 7/19 pts. in the combination gp. formed asub-population of high-responders to senna and were responsible for most of the increase in stool frequency and dry weight in thisgroup while laxation in the remaining 12/19 pts. in the gp. was similar to those receiving psylliun alone. Both laxatives provided asimilarly high degree of subjective relief and improvement in stool consistency. As assessed by stool frequency and weight, laxation wasattained by 63% of the psylliun and senna gp. compared to 48% of the psylliun gp. (Marlett JA et al. Comparative laxation of psylliunwith and without senna in an ambulatory constipated population. Am J Gastroenterol 82(4):333-7, 1987)

Studio clinico su un nuovo preparato di semi di piantaggine e frutti di senna..

Acta Biomed Ateneo Parmense;57(5-6):179-86, 1986. Bossi S; Arsenio L; Bodria P; Magnati G; Trovato R; Strata A

Resumo: The lack of fiber in the western diet may contribute to the development of several diseases including gastrointestinaldisorders; the clinical effects of a new substance (AGIOLAX) made from plantago seeds and senna pods were studied. 100 patients ofboth sexes, aged from 40 to 60 years (30 with diabetes mellitus, 40 with obesity and 30 with hyperlipidemia) were treated; everyonecomplained a slowness, of different degree, of normal intestinal transit time or chronic constipation. The experiment was carried outwithout the use of a control group. Aim of the present study was to investigate the efficacy and tolerability of the product. In additionto the clinical evaluation of the symptoms, laboratory tests were performed. The patients were treated for 3 months with a daily doseof 2 teaspoons every evening. In the majority of the subjects a good clinical response was obtained; 88% of the patients presented anormalization of the gastrointestinal transit time; only 12% of them did not respond satisfactorily to the substance. Further the drugwas well tolerated by 86% of the patients. In conclusion the authors report a good efficacy and tolerability of the product; thus theyrecommend its use in those disorders characterized by slow intestinal transit time and/or constipation.

A double-blind trial of a celandin, aloevera and psyllium laxative preparation in adult patients with constipation.

Digestion;49(2):65-71, 1991. Odes HS; Madar Z

Intestinal Diseases Unit, Soroka Medical Center, Beer Sheva, Israel.

Resumo: The aim of this study was to evaluate the effect of a novel laxative preparation, composed of celandin, aloevera and psylliumin patients with chronic constipation. Thirty-five men and women were randomized to receive capsules containing celandin-aloevera-psyllium, or placebo, in a double-blind trial lasting 28 days. Symptoms in the last 2 weeks of the treatment period were compared tothose in the 14-day pre-trial basal period. In the celandin, aloevera and psyllium group, bowel movements became more frequent, thestools were softer and laxative dependence was reduced. In the placebo group, all these parameters were unchanged. Abdominal painwas not reduced in either group. The results of this study show that the preparation is an effective laxative in the treatment ofconstipation.

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Influence of senna, fibre, and fibre + senna on colonic transit in loperamide-induced constipation.

Pharmacology;47 Suppl 1:242-8, 1993 Oct. Ewe K; Ueberschaer B; Press AG

I. Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität Mainz, FRG.

Resumo: Retarded colonic transit and disturbed defecation are the most prominent pathophysiological mechanisms in constipation.Both may be influenced by bulking agents and by laxatives such as senna. Direct measurements of the influence of such substances oncolonic transit are rare mainly because of technical problems. We measured gastric emptying, small and large intestinal transit in 24healthy volunteers by a newly developed method employing a metal detector. Twelve persons taking a normal diet received loperamidein a dose sufficient to double the individual transit time. All subjects measured gastrointestinal transit time under normal conditions andwith Sennatin containing purified sennosides 20 mg, Agiocur (30 g) as a fibre product containing 20 g Plantago ovata seeds/husks, orAgiolax (10 g) as a combination of 5.4 g P. ovata seeds/husks + 1.2 g senna pod with a sennoside content of 30 mg. Colonic transitwas reduced by Sennatin and by Agiolax from 39 +/- 4 h to 17 +/- 3 h (p < 0.005). Agiocur did not influence colonic transit (39 +/- 3h). Loperamide prolonged colonic transit from 27 +/- 0.7 to 72 +/- 12 h. This effect was abolished by Sennatin (30 +/- 5 h) andAgiolax (27 +/- 1 h) (p < 0.005), but not by Agiocur (64 +/- 13 h). The same effects were seen when right and left colonic transitwere analyzed separately. Neither gastric emptying nor small intestinal transit were affected by either substance. All of the three studydrugs increased stool weight significantly (p < 0.05). When stool frequency and consistency were compared, the effects were less clear.

Constipação e hemorróidas

Is there a correlation between dietary habits and hemorrhoidal disease?

Presse Med;27(11):513-7, 1998 Mar 21. Sielezneff I; Antoine K; Lécuyer J; Saisse J; Thirion X; Sarles JC; Sastre B

Service de Chirurgie digestive, Hôpital Sainte-Marguerite, Marseille.

Resumo: OBJECTIVES: It is empirically accepted that certain foods play a role in the pathogenesis of hemorrhoids or their acuteexacerbation. The aim of this work was to determine whether there is a relationship between hemorrhoids and certain food-related orcommon toxin-related factors. PATIENTS AND METHODS: Two groups of 50 subjects were compared. Group I was composed of 50patients with hemorrhoid symptoms. Fifty volunteers with no proctologic abnormality were included in group II. We used a diet surveyto compare total calorie, protein, carbohydrate, fat, food fiber, water, alcohol, salt, pepper, pimento, tea, and coffee intake was well assmoking habits. Episodes of constipation were also noted. RESULTS: Overall calorie intake, as well as protein, carbohydrate and fiberintake were similar in the two groups as were use of salt, coffee and tea. Dietary intake in group I was higher for fat (p = 0.02), alcohol(p = 0.01), pepper (p = 0.04, and pimento (p = 0.001). Subjects in group I drank less water (p = 0.008), smoked more (p = 0.01)and were more often constipated (p < 0.001) than those in group II. CONCLUSION: Our findings provide further arguments suggestingthat dietary imbalance or smoking could be involved in the development of hemorrhoids. These factors should be evaluated inappropriate dietary inquiries. Epidemiological surveys would be required to confirm their possible causal effect.

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