Experiences in the Treatment of Constipation in Pregnancy with a Herbal Drug - Herbolax (A Study of Two Hundred Cases)
Subuj Sen Gupta, M.B.B.S., D.G.O. (Hons.), M.D. (Obst. & Gynaec.) Gynaecologist U. Trivedi, B.Sc., M.B.,B.S., D.G.O. Junior Medical Officer and J.N. Pobi, B.Sc., M.B.B.S., Junior Medical Officer M.A.M.C. Hospital, Durgapur, India.
During pregnancy there is a natural tendency to constipation due to the effect of progesterone on smooth muscles, often aggravated by over-administration of iron preparations. Regular bowel action may be restored by a diet containing plenty of roughage. Purgatives should be avoided as violent bowel action stimulates uterine contractions. Mineral lubricants such as liquid paraffin are not suitable for regular use as the absorption of fat soluble vitamins A and D is impaired.
Apart from obstetric cases, this complaint of constipation is also commonly encountered in gynaecological patients, mainly in post-operative cases and also in aged ladies, due to weakness of the abdominal muscles and the muscles of the pelvic floor. It is doubtful whether constipation really produces any symptoms, apart from a little discomfort due to retained faeces which seems to be mainly mechanical, and possibly a slight headache. The physician is sometimes compelled to prescribe medicines in order to relieve the patient from distress.
Herbolax (The Himalaya Drug Co.) - a herbal preparation has been claimed to be a very safe and effective drug in relieving constipation. This study investigates the efficacy of Herbolax in treating 200 cases admitted to the Maternity and Gynaecological Ward of M.A.M.C. Hospital.
MATERIAL AND METHODS
Two hundred cases were selected for this study. They had not had bowel movement for two to three days. The cases were drawn both from obstetric and gynaecological units. The obstetric cases were taken from all three trimesters and also from post-natal cases.
All the patients were given Herbolax 2 tablets at bed time and the time of evacuation of bowels the next day was asked and noted. If they had one or two gentle and soft evacuations in the morning, the response was marked as ‘Good’, and even if bowel moved during the day, the response was recorded as ‘Good’. If the response was only after the second dose of 2 tablets on the next day - response was deemed ‘moderate’. The response was recorded as ‘poor’, if no bowel movement occurred even after 2 tablets at bedtime for two consecutive days.
One hundred forty patients (70%) had bowel movements on the very next day after the first dose, 55 patients (27.5%) required a second dose (moderate response). Five patients did not have bowel movements even after the second dose. Enema relieved all of these except one who was admitted with 32 weeks pregnancy, constipation, acute pain in epigastrium and pyrexia. She gradually developed abdominal distension. Laparotomy revealed a ruptured amoebic liver abscess.
Herbolax has been found to be a very effective and safe drug in treating constipation in obstetric and gynaecological cases. It is particularly of value in post-partum cases, with episiotomy stitches. Initially we were a little hesitant to use it in cases of threatened abortions or antepartum haemorrhages who just had stoppage of bleeding, but with experience we learnt that Herbolax can also be used safely in these conditions. In no case of pregnancy the uterus was affected by its action. The total response to Herbolax was 97.5%, which proves its efficacy beyond doubt.
(Capsule, (1986): (Feb./Mar.) 133-134.)
Role of Herbolax in radio-diagnosis
Prakash Gupta, M.B.,B.S., D.M.R.D., M.N.R.H.S., Consultant in Family Medicine and Radio-diagnosis District Hospital, Hamirpur, Himalachala Pradesh, India.
Plain radiography of the abdomen is a prerequisite for all types of special investigations of the urinary system, gall bladder or gastrointestinal system. In addition, it provides considerable diagnostic clues regarding the abdomen, and one can arrive at a right diagnosis provided a good X-ray of the abdomen is available. Gaseous distension, faecal matter, subcutaneous fat and a bony cage pose a lot of difficulty in assessing the soft tissue pathology of the abdominal viscera. To eliminate shadows due to faecal matter and gas, the patient is prepared the night before with light meals and certain drugs that can expel or absorb gases, and expel faecal matter.
The importance of a good preparation for this purpose cannot be overstressed because a plain X-ray of the abdomen is a boon in rural India, where special investigations cannot be carried out, and a good preparation prior to radiography goes a long way in diagnosing a difficult condition.
Routinely, a large number of laxatives are used at various radio-diagnostic centres in our country to expel the faecal matter. They are given the night before along with charcoal tablets or similar preparations to expel gases.
In our present study, I omitted charcoal preparations and administered only Herbolax tablets, 4 to 6 in number, the night before the examination and got excellent results.
MATERIAL AND METHODS
In a study of 40 patients for plain X-ray of abdomen, K.U.B. (kidney, ureter and bladder), gall bladder region and lumbosacral spine region the following was ordered the night before the X-ray examination:-
Light diet at bedtime
Herbolax, 4 to 6 tablets at bedtime, with cold water
Nil orally in the morning
To report for X-ray examination at 9 a.m.
The results obtained were excellent. There was no gas shadow or faecal matter to obstruct the view and the kidney shadows, gall bladder or spinal vertebrae were well outlined and visualised. Radio-opaque shadows were clear and measurement of the kidney size was possible.
It cannot be overemphasised that a good abdominal preparation results in a good radiograph leading to better diagnosis. Herbolax has done a commendable job in our study.
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