Chronic Laxative Dependence: What To Do?

Constipation is a common issue that affects almost 20% of people every year. It occurs when you pass fewer than three bowel movements per week or have bowel movements that are hard and difficult to pass. This can lead to excessive straining and rectal bleeding. If you're experiencing constipation, there are several quick treatments you can try to induce a bowel movement, such as increasing your fibre intake, drinking more water, or taking laxatives. However, it's important to consult a doctor if your constipation is chronic or accompanied by other symptoms such as abdominal pain, vomiting, or blood in your stool.

Laxative stimulants force a bowel movement by squeezing the intestines

Laxatives are medicines that help people have a bowel movement if they are constipated. Constipation is characterised by infrequent bowel movements (less than three per week) and hard or dry stools. It can be caused by dietary and lifestyle factors, such as not eating enough fibre, not drinking enough water, or ignoring the urge to go to the toilet. It can also be caused by certain medications, neurological conditions, or problems with the nerves and muscles in the digestive system.

Laxatives work by making stools softer and easier to pass, or by stimulating the muscles in the colon to contract and move stools along. Laxative stimulants, such as senna and bisacodyl, trigger rhythmic contractions in the bowels that push stools along. They do this by squeezing the intestines to force a bowel movement. These types of laxatives are usually fast-acting and can be effective in treating severe constipation. However, they should not be overused, as this can lead to dependency and can cause the bowel to stop functioning normally.

Laxative stimulants are typically available over the counter and can be purchased in pharmacies, grocery stores, and online. They are usually taken orally in the form of liquids, powders, chewables, tablets, or suppositories. It is important to follow the instructions on the label and not to exceed the recommended dosage. Taking stimulant laxatives for longer than directed can lead to a loss of muscle tone in the colon, which can worsen constipation.

While laxatives can be effective in treating constipation, they should not be the first line of treatment. It is recommended to first try dietary and lifestyle changes, such as increasing fibre intake, drinking more fluids, and exercising regularly. If these measures do not improve constipation, then laxatives can be considered. However, it is important to consult a healthcare provider before taking laxatives, especially if constipation is chronic or persistent.

Osmotic laxatives work by drawing water into the colon

Constipation is a common issue, with around 2.5 million people in the U.S. visiting their doctor each year for this reason. It occurs when bowel movements are infrequent or hard to pass, with stools typically hard and dry. It can be caused by various factors, such as dietary choices, lifestyle habits, age, gender, and health status.

Laxatives are a type of medication used to treat constipation. They are often recommended when lifestyle changes, such as increasing fibre intake, drinking more fluids, and exercising, have not been effective. There are several types of laxatives available, including bulk-forming, osmotic, poo-softener, and stimulant laxatives.

Osmotic laxatives, in particular, work by drawing water into the colon. This increase in water content softens the stool, making it easier to pass. The term "osmotic" refers to the movement of fluid through a membrane to equalise the concentration on both sides. In the context of constipation, osmotic laxatives alter the balance by introducing substances that encourage water movement into the colon. This process helps to soften the stool and promote bowel movements.

Some common osmotic laxatives include polyethylene glycol (PEG), lactulose, sorbitol, magnesium citrate, and magnesium hydroxide (Milk of Magnesia). These laxatives are available in various forms, such as oral solutions, powders, and tablets, and can be purchased over the counter or by prescription. However, it is important to follow the dosing instructions carefully and only use laxatives when needed, as overuse can lead to dehydration and other complications.

Lubricant laxatives add a slick coat to the intestines' walls

Lubricant Laxatives: How They Work and When to Use Them

Lubricant laxatives, such as mineral oil, work by adding a slick coat to the intestinal walls and stool mass. This coating prevents the colon from absorbing water from the stool, allowing it to retain moisture and stay soft. As a result, the stool passes through the colon more easily. Lubricant laxatives are primarily used to treat fecal impaction, which occurs when a large, hard mass of stools gets stuck in the colon or rectum.

While lubricant laxatives are highly effective in the short term, they are best used sparingly and for a specific purpose. Over a prolonged period, mineral oil can absorb fat-soluble vitamins from the intestine and decrease the absorption of certain prescription drugs. Therefore, it is important not to take mineral oil at the same time as other medications or supplements.

Lubricant laxatives can also cause side effects such as anal seepage, pruritus ani (an intense itch around the anus), perianal discomfort, and intestinal malabsorption.

If you are experiencing occasional constipation, it is recommended to first try lifestyle changes such as increasing your fibre intake, drinking more fluids, and exercising. If these changes do not help, you may then consider taking a laxative. However, it is important to consult with your healthcare provider before taking laxatives, especially if you are pregnant or taking other medications.

Overuse of laxatives can lead to decreased bowel function

Laxatives are a common remedy for constipation, but they should be used with caution. Overuse of laxatives can lead to decreased bowel function and even dependency on these medications to have a bowel movement. It is important to understand how laxatives work and how to use them safely to prevent negative side effects.

Laxatives contain chemicals that increase stool motility, bulk, and frequency, providing relief from temporary constipation. However, when misused or overused, they can cause problems, including chronic constipation. The overuse of laxatives can lead to a loss of muscle and nerve response in the intestines, resulting in a decreased ability to have a bowel movement without the aid of these medications.

To prevent the overuse of laxatives, it is recommended to first try increasing your fiber intake and making sure you are staying hydrated. Fiber is available naturally in fruits, vegetables, and whole grains, and it can also be found in over-the-counter supplements. It is important to drink enough water when taking fiber supplements to minimize the possibility of flatulence and obstruction.

If you are still experiencing constipation after making dietary changes, it is best to consult your doctor. They can help determine the underlying cause of your constipation and recommend the best course of treatment, which may include the use of laxatives. It is important to follow your doctor's instructions and read the labels on laxatives carefully to ensure safe use.

In summary, the overuse of laxatives can lead to decreased bowel function and dependency. To avoid this, it is important to use laxatives sparingly and only under the guidance of a healthcare professional. Making dietary and lifestyle changes, such as increasing fiber intake and staying hydrated, can also help treat and prevent constipation.

Laxatives can be used alongside bowel retraining to help establish a regular bowel movement pattern

Bowel retraining is a behavioural program designed to help people with bowel disorders establish or re-establish control over their bowel movements. It involves teaching new skills and strategies to develop a routine and predictable schedule for evacuation, which can prevent constipation and decrease unpredictable elimination.

• Keep a diary of bowel movements for two weeks to identify any patterns or specific situations that may be influencing bowel habits.
• Establish regular and consistent meal times to encourage more orderly digestion.
• Consume plenty of fluids and, if tolerated, increase dietary fibre to promote the formation of soft, well-formed stools.
• Pick a regular time for daily bowel movements, ideally 20-40 minutes after a meal when the gastrocolic reflex is stimulated.
• Prior to the chosen bathroom time, try to stimulate the gastrocolic reflex by consuming a hot beverage or caffeine (if tolerated).
• Use relaxation techniques while sitting on the toilet to keep the body calm and relaxed.
• Focus on using the abdominal muscles rather than straining the rectum to pass the stool.

It is important to remember that progress may be slow, and bowel retraining is not designed to cure constipation but rather to create optimal conditions for the body to establish a more regular rhythm.

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