Constipation, IBS, celiac disease, and driving

Constipation

Difficult or infrequent evacuation of feces is a common disease affecting 18% of adults and usually causes abdominal pain and distention.

It can be associated with neurological dysfunction in diabetes, spinal cord injuries, multiple sclerosis, and metabolic disorders such as hypothyroidism, Cushing’s syndrome, hypokalemia, and hypercalcemia.

It also occurs in scleroderma and in the treatment with some drugs such as anticholinergics, opiates, antacids containing calcium or aluminum, calcium antagonists and iron supplements.

In turn, anal pain with increased sphincter tone for hemorrhoids and fissure causes fecal retention. Also, mechanical colorectal obstructions.

Patients with constipation worsen their discomfort with the driving position, that compresses an already distended abdomen.

The patient feels that the safety belt presses him and frequently does without it, with the risk of having more serious injuries in the event of an accident.

The medical treatment of constipation includes diet guidelines preventing overweight with an increased consumption of liquids, moderate exercise, and appropriate medication, whenever possible without laxatives.

The safest drugs for the treatment of constipation are the products containing magnesium and bulk-forming agents such as Plantago ovata, without contraindications to driving.

Spasmolytics, such as mebeverine, pinaverium, or otilonium would be only indicated for pain and constipation in irritable colon, with normal colonic transit.

Otilonium bromide is a synthetic anticholinergic, that in susceptible individuals can cause tiredness, nausea and epigastralgia.

Prokinetics, such as cinitapride and osmotic laxatives such as lactulose, lactitol and polyethylene glycol, would be indicated in cases of documented slow transit.

Cinitapride can cause somnolence, sedation and in some cases dyskinesia, that interfere with driving.

Patients with constipation frequently self-medicate on an indiscriminate, chronic basis, with laxatives purchased in pharmacies and herbalist’s without medical indication.

Sodium picosulfate and other laxatives of contact can cause abdominal pain and diarrhea.

Osmotic laxatives such as lactulose or lactitol do not have side effects except for flatulence and abdominal distention. In some cases they can cause diarrhea.

Lubricant laxatives such as liquid paraffin do not have side effects interfering with driving.

Advice on Constipation

• Moderate constipation does not interfere with driving.
• However, abdominal distention and flatulence cause a significant discomfort to the driver, particularly in long travels.
• They usually drive in forced positions to reduce the symptoms and unfasten their safety belt with the risk of more serious injuries in the event of accident.
• They should be recommended to force bowel movements with enemas before driving, drink many liquids, and make stops more frequently in order to walk and eliminate gases.
• If they are very uncomfortable while driving, they should be recommended that their companion drives, if possible.
• The driver should be warned of the sedative effect of some prokinetics, that can cause somnolence while driving.

Irritable bowel syndrome (IBS)

It involves nearly 30% of visits to the specialist physician, and its prevalence in the general population is 10-20%, though only a third of those affected visit the physician, for their greater disability and worse quality of life than the rest of the population.

IBS is a combination of relapsing symptoms in the absence of organic injury, characterized by colic abdominal pain that improves with defecation or breaking wind, and changes in the intestinal rate with alternation of constipation and diarrhea.

Two thirds of the patients have other digestive manifestations such as dyspepsia, pyrosis, nausea, abdominal distention, or rectal irritability. Up to 75% complain of asthenia, adynamia, headache, and insomnia.

In women, menstruation exacerbates abdominal pain and flatulence.

IBS worsens with worries, stress, food with lactose, fructose, a great deal of fiber and fats, with alcohol, coffee, tea, tobacco, chocolate, and soft drinks.

It is recommended to avoid this food, not smoking, live a relaxed life, respecting food schedules, and practicing exercise.

These patients frequently use to many laxatives, astringents, spasmolytics, and anxiolytics or antidepressants.

Advice on Irritable bowel syndrome

• In symptomatic periods of IBS with abdominal pain, diarrhea, headache, insomnia, and emotional disorders, it should be advised against driving if the symptoms interfere with driving.
• In long trips our patient should frequently stop in order to rest and be relaxed, he should not eat while driving, and we will remind him to respect meal schedules and not to take digestive irritants.
• We should warn them about the somnolence caused by some drugs used to reduce the anxiety frequently associated with the clinical symptoms.
• Coffee and cola drinks often taken to reduce somnolence worsen the symptoms of IBS. If there is somnolence, the better is to sleep before driving.

Celiac disease of the adult

The typical form of presentation with diarrhea, weight loss, and low size frequently includes in adults anemia, osteopenia, and multiple symptoms of dyspepsia.

4-5% of patients labeled with functional dyspepsia are actually celiac, and the confusion with irritable bowel occurs in 15% of the cases.

The celiac disease can be associated in up to 8% of the cases with neurological symptoms such as cerebellar ataxia, epilepsy, myoclonus and peripheral neuropathy.

Celiac drivers should follow a strict diet without gluten.

Advice on Celiac disease of the adult

• In long trips, it is recommended to take gluten-free foods to be taken in the stops made every two hours.
• It is not advisable to run the risk of taking any food in cafeterias or restaurants in the road, that can enhance uncomfortable symptoms of dyspepsia during the trip, in addition to worsening the disease.
• Asymptomatic celiac patient can drive.
• The neurological symptoms of celiac individuals are disabling for driving, and the physician should inform on this.