Laxatives: Instant Relief Or Not?

Laxatives are a type of medicine used to treat constipation. They are often used when lifestyle changes, such as increasing fibre intake, drinking more fluids, and exercising, have not helped. While they are available over the counter, laxatives are not suitable for everyone and should be used with caution.

There are several types of laxatives, including bulk-forming laxatives, osmotic laxatives, stool softeners, lubricants, and stimulants. Bulk-forming laxatives, considered the gentlest option, increase the weight of the stool, stimulating the bowel. Osmotic laxatives draw water from the body into the bowel, softening the stool. Stool softeners, also known as emollient laxatives, add moisture to the stool, making it easier to pass. Lubricant laxatives coat the colon, making it slippery for stool passage. Stimulant laxatives activate the nerves controlling the muscles in the colon, forcing it to move the stool along.

While laxatives can provide relief, they are not a cure-all solution. They can cause side effects such as bloating, gas, stomach cramps, and dehydration. Overuse can lead to complications like electrolyte imbalance, chronic constipation, and intestinal blockage. It is important to follow instructions, not exceed recommended doses, and consult a healthcare provider if constipation persists or occurs frequently.

How do laxatives work?

Laxatives are a type of medicine that can treat constipation. They are often used if lifestyle changes, such as increasing fibre intake, drinking more fluids, and exercising, have not helped. Laxatives are available over the counter in pharmacies and supermarkets, as well as on prescription from a doctor.

There are four main types of laxatives: bulk-forming, osmotic, stool softeners, and stimulants. They work by either softening the stool or stimulating the bowels, or both.

Bulk-forming laxatives increase the weight of the stool, which stimulates the bowel. They contain soluble fibre, which draws water from the body into the stool, making it bigger and softer. This stimulates the colon to contract and push out the stool. They are considered the gentlest type of laxative and are usually recommended as the first option. They include products such as psyllium (Metamucil®), polycarbophil (FiberCon®), and methylcellulose (Citrucel®).

Osmotic laxatives draw water from the body into the bowel, softening the stool and making it easier to pass. They also stimulate the muscles lining the gut to help move the stool along. Osmotic laxatives include polyethylene glycol (MiraLAX® or Gavilax®), magnesium hydroxide solution (Milk of Magnesia®), and glycerin (Colace Glycerin®).

Stool softeners, also called emollient laxatives, increase the water and fat absorbed by the stool, making it softer. An example of a stool softener is docusate (Colace®). Lubricant laxatives, such as mineral oil, coat the colon, making it slippery and preventing water absorption from the stool, keeping it soft.

Stimulant laxatives activate the nerves controlling the muscles in the colon, forcing it into motion to move the stool along. They are recommended if other over-the-counter types have not helped. Examples include bisacodyl (Dulcolax®) and senna (Fletcher's® Laxative).

Laxatives come in different forms, including pills, powders, liquids, suppositories, and enemas. They usually take a few days to work, but enemas and suppositories can work within minutes to an hour. It is important to follow the instructions and not exceed the recommended dose to avoid harmful side effects such as dehydration, bloating, and diarrhoea.

What types of laxatives are there?

There are several types of laxatives available, and they can be categorised in various ways. One way is by their mechanism of action: bulk-forming, osmotic, lubricant, stimulants, and others.

Bulk-forming Laxatives

Bulk-forming laxatives, also known as bulking agents, work by increasing the "bulk" or weight of the stool, which stimulates the bowel. They typically take 2-3 days to work and are considered the gentlest type of laxative. They are also the best option to try first unless a healthcare provider recommends otherwise. Examples include Fybogel (ispaghula husk), psyllium (Metamucil), polycarbophil (FiberCon), and methylcellulose (Citrucel).

Osmotic Laxatives

Osmotic laxatives, also known as osmotic or hyperosmolar laxatives, draw water from the body into the bowel to soften the stool and make it easier to pass. They typically take 2-3 days to work. Examples include lactulose (Duphalac, Lactugal), macrogol (Movicol, Laxido, CosmoCol, Molaxole, Molative), polyethylene glycol (Gavilax, MiraLAX), magnesium hydroxide solution (Dulcolax, Ex-Lax, Phillips' Milk of Magnesia), and glycerin (Colace Glycerin, Fleet Pedia-Lax).

Lubricant Laxatives

Lubricant laxatives, also known as mineral oil laxatives, work by coating the colon and making it slick, which prevents water absorption from the stool, keeping it soft. They are highly effective but are best used as a short-term cure for constipation. Examples include mineral oil.

Stool Softener Laxatives

Stool softener laxatives, also known as emollient laxatives, work by increasing the water and fat absorbed by the stool, softening it. An example is docusate (Colace).

Stimulant Laxatives

Stimulant laxatives, also known as colonic stimulants, work by stimulating the nerves that control the muscles in the colon, forcing it into motion and moving the stool along. They are typically used when other over-the-counter types have not helped. Examples include bisacodyl (Dulcolax), senna (Fletcher's Laxative), and prunes (dried plums).

Prescription Laxatives

Prescription laxatives are typically used for chronic constipation or constipation associated with conditions like irritable bowel syndrome (IBS) or when it is induced by opioid use. Examples include lactulose (Duphalac), linaclotide (Linzess), lubiprostone (Amitiza), prucalopride (Prudac, Motegrity), plecanatide (Trulance), and methylnaltrexone (Relistor).

How to take laxatives

Laxatives are drugs that relieve constipation by loosening stools or inducing a bowel movement. They are usually available over the counter and are meant for short-term use. However, it is important to take them correctly to avoid side effects and health complications. Here are some detailed instructions on how to take laxatives:

Consult a Healthcare Professional:

Before taking any laxative, it is important to consult your healthcare provider, especially if you are pregnant, breastfeeding, or giving laxatives to a child. Certain types of laxatives may be harmful during pregnancy or to children, so it is crucial to seek medical advice. Additionally, if you are taking any prescription medications, consult your doctor or pharmacist to ensure that the laxative will not interact negatively with your current medication.

Choose the Right Type of Laxative:

There are several types of laxatives available, including bulk-forming laxatives, osmotics, stool softeners, lubricants, and stimulants. Bulk-forming laxatives are generally considered the gentlest and are often recommended as a first-line treatment. Stool softeners increase the water and fat content in the stool, making it easier to pass. Lubricant laxatives coat the colon, making the stool slippery and promoting easier passage. Stimulant laxatives activate the nerves controlling the colon muscles and are typically used when other types have not been effective. Osmotic laxatives, such as polyethylene glycol (MiraLAX), draw water into the colon, softening the stool.

Follow the Instructions:

Laxatives come in various forms, including pills, capsules, liquids, suppositories, and enemas. It is crucial to follow the instructions on the package or those provided by your healthcare provider. Take the recommended dosage at the specified times and with any recommended food or drink. Do not exceed the suggested amount, as it can lead to an overdose. Be patient and give the laxative time to work, as some types may take a few hours or even days to provide relief.

Stay Properly Hydrated:

When taking laxatives, it is essential to drink plenty of fluids, preferably water. Laxatives can cause dehydration, especially those that pull water from your body to soften stools, such as bulk-forming laxatives and osmotics. Follow the recommendations of healthcare professionals and drink at least six to eight glasses of water or other liquids per day while using laxatives.

Be Mindful of Side Effects and Complications:

Laxatives may cause side effects such as bloating, gas, and stomach cramps. Overuse or abuse of laxatives can lead to more serious complications, including electrolyte imbalance, chronic constipation, intestinal blockage, and increased colon cancer risk. If you experience side effects or the laxative is not providing relief, consult your healthcare provider. Do not take laxatives continuously without seeking medical advice, as it can delay the diagnosis of underlying conditions and lead to dependence on the laxatives.

Make Lifestyle Changes:

While laxatives can provide temporary relief, it is important to address the underlying causes of constipation. Increase your fibre intake, consume more water, and incorporate physical activity into your routine. These lifestyle changes can help improve your digestive health and reduce the need for laxatives over time.

Side effects of laxatives

Laxatives are a category of medications used to treat constipation and other gastrointestinal issues. They are available over the counter and by prescription. While laxatives are generally safe, they can cause adverse side effects, especially if overused or misused.

Some common side effects of laxatives include:

• Bloating and gas: Some laxatives can cause bloating and increased gas, particularly bulk-forming laxatives and osmotics, which pull water from other parts of the body into the colon.
• Stomach cramps and abdominal pain: Laxatives can cause stomach cramps and abdominal pain, especially stimulant laxatives, which activate the nerves controlling the muscles in the colon.
• Dehydration: Laxatives can lead to dehydration as they pull water from the body to soften stools. Dehydration can cause symptoms such as weakness, dark urine, tremors, blurry vision, and kidney damage.
• Electrolyte imbalance: Overuse of laxatives can disrupt the balance of water and salt in the body, leading to an electrolyte imbalance.
• Chronic constipation: Prolonged use of laxatives can worsen constipation, especially if the underlying cause is not addressed.
• Intestinal obstruction: Misuse or overuse of laxatives can lead to intestinal obstruction, where stools become large and dry.
• Dependency: Overuse of laxatives can lead to dependency, with the colon losing muscle and nerve response, and requiring larger doses for a bowel movement.
• Interaction with other medications: Laxatives can interact with certain medications, including heart medications, antibiotics, and bone medications.
• Allergic reactions: In rare cases, people may have an allergic reaction to some laxatives, such as psyllium preparations.
• Diarrhea: Laxative use can lead to diarrhea, which can further contribute to dehydration and electrolyte imbalances.

It is important to follow the instructions on the medication and not exceed the recommended dosage to minimize the risk of side effects. If side effects occur, it is advisable to consult a healthcare professional.

Alternatives to laxatives

Laxatives are often used to treat constipation, but they are not always the best option. Before taking any laxatives, it is recommended to try making some lifestyle changes, such as:

• Eating high-fibre foods: Insoluble fibre, found in wheat bran, vegetables, whole grains, and the edible skin of fruits and vegetables, adds bulk to stools and helps them pass more quickly. Soluble fibre, found in oat bran, barley, nuts, seeds, beans, lentils, and some fruits and vegetables, absorbs water and softens stools. The United States Department of Agriculture (USDA) recommends 14 grams of dietary fibre for every 1,000 calories consumed.
• Taking probiotics: Probiotics are live, beneficial bacteria that occur naturally in the gut and can help prevent chronic constipation. Probiotic foods include yoghurt, kefir, sauerkraut, kimchi, miso, and tempeh.
• Drinking more fluids: Dehydration can cause constipation, so it is important to stay hydrated by drinking plenty of water. Carbonated water may be even more effective at relieving constipation than regular water.
• Exercising regularly: Exercise may help improve the symptoms of constipation.

If these lifestyle changes do not help, there are also some natural laxatives that can be effective, such as:

• Chia seeds: These are high in insoluble fibre and can be added to yoghurt, smoothies, oatmeal, or salad.
• Berries: Most berries are high in both soluble and insoluble fibre.
• Legumes: These include beans, chickpeas, lentils, peas, and peanuts, and are high in fibre. They also help increase the body's production of butyric acid, which may act as a natural laxative.
• Flaxseeds: A natural stool softener, flaxseeds contain a mix of soluble and insoluble fibre.
• Leafy greens: Spinach, kale, and collards are rich in fibre and promote healthy bacteria in the colon.
• Prunes: Prunes and prune juice are proven remedies for constipation due to their high fibre and sorbitol content.
• Fruits: The skins of apples, pears, and mangoes contain insoluble fibre. Kiwi fruit is also effective, as it is high in fibre and contains pectin, a natural laxative.
• Coffee: Coffee stimulates the muscles in the digestive system and may contain small amounts of soluble fibre. However, excessive consumption can lead to caffeine toxicity.

It is important to note that natural laxatives may not work for everyone, and it is always best to consult a doctor or healthcare provider before taking any new supplements or making significant dietary changes.

Frequently asked questions