Makindo Medical Notes

💩 Ispaghula husk (psyllium seed husk; brand names Fybogel®, Ispagel®) is a bulk-forming laxative that works by increasing stool bulk and water content. It is gentle, well-tolerated, and safe for long-term use when combined with adequate hydration.

🧠 About

• Natural polysaccharide derived from the husks of Plantago ovata seeds.
• Acts locally within the gut — not systemically absorbed.
• Considered the most physiological and safest laxative class for chronic constipation.
• Usually effective within 2–3 days of starting therapy.

⚙️ Mechanism of Action

• Absorbs and retains water within the intestinal lumen, forming a soft, bulky gel.
• This increased bulk stretches the bowel wall and stimulates mechanoreceptors to trigger peristalsis via the enteric nervous system.
• Softens stool consistency, easing passage without causing urgency or cramps.
• Also binds bile acids and cholesterol — may modestly lower serum cholesterol with regular use.

🎯 Indications

• Chronic or functional constipation.
• Constipation in pregnancy and postpartum period (safe choice).
• Postoperative or post-anal surgery management to avoid straining.
• Irritable Bowel Syndrome (IBS) with alternating constipation and diarrhoea (regulates bowel habit).
• Adjunctive therapy for mild chronic diarrhoea (absorbs excess fluid).

💊 Dose and Administration

• Fybogel®: 1 sachet twice daily after meals.
• Ispagel Orange®: 1 sachet 1–3 times daily.
• Mix the granules in a full glass of water (at least 150–250 mL) and drink immediately before it thickens.
• Encourage the patient to drink 1.5–2 L of fluids per day to prevent obstruction.
• Effect is gradual — typically within 24–72 hours.

⚠️ Cautions and Patient Counselling

• Ensure adequate hydration, mobility, and regular access to toileting facilities.
• Do not take dry powder without fluid — risk of choking or oesophageal obstruction.
• Space doses at least 2 hours apart from other oral medications (may reduce absorption).
• May initially cause bloating or flatulence, which usually settles within a few days.
• Stop and seek medical advice if abdominal pain or vomiting develops.

🚫 Contraindications

• Intestinal obstruction or ileus.
• Stenosing bowel disease or colonic atony.
• Dysphagia or swallowing difficulty (risk of oesophageal blockage).
• Faecal impaction or severe constipation requiring disimpaction.
• Acute inflammatory or infective bowel disease (risk of perforation).

💊 Side Effects

• Common: Flatulence, abdominal distension, mild cramps.
• Rare: Gastrointestinal obstruction or impaction if taken with insufficient water.
• Very rare: Hypersensitivity reactions (rash, bronchospasm, anaphylaxis).

🧩 Comparison: Bulk-Forming vs Other Laxatives

📋 Practical Points

• Suitable for long-term use, including in older adults and pregnancy.
• Combine with dietary fibre, hydration, and physical activity for best results.
• Switch to osmotic laxatives (e.g. macrogol) if ineffective or if patient is immobile/dehydrated.
• Advise patients to maintain a regular bowel routine, ideally after meals.

📚 References

• BNF: Ispaghula Husk
• NICE CKS: Constipation in Adults (2024)
• Ford AC et al. BMJ 2014;349:g6614. “Efficacy of fibre and laxatives in chronic constipation.”