Laxatives: Friend Or Foe In Treating Sbo?

Laxatives are often used to treat constipation, but do they have a place in treating small bowel obstruction (SBO)? SBO is usually managed conservatively with intravenous hydration and nasogastric-tube decompression, but this approach is associated with longer hospital stays and an increased risk of delayed surgery. A study has shown that adding oral laxative therapy to standard conservative treatment can reduce the need for surgery and shorten hospital stays. However, laxatives are not without risks and can cause side effects such as abdominal cramping and diarrhoea, and in some cases, they may even lead to bowel obstruction. Therefore, while laxatives may have a role in treating SBO, further research is needed to establish their effectiveness and safety in this context.

Laxatives can be used to treat SBO without surgery

SBO, or small bowel obstruction, is usually managed conservatively, with patients receiving intravenous hydration and nothing by mouth. This approach is associated with longer hospital stays and an increased risk of delayed surgery.

However, a randomized controlled trial conducted in Taipei, Taiwan, found that adding oral therapy with a laxative, a digestant, and a defoaming agent to the standard nonsurgical treatment of partial adhesive small-bowel obstruction resulted in a significant reduction in the need for surgery and shorter hospital stays.

In the trial, 128 patients admitted with adhesive partial small-bowel obstruction between February 2000 and July 2001 were randomly assigned to either the control group or the intervention group. The control group received standard conservative treatment, while the intervention group received the same treatment plus oral therapy with magnesium oxide (a laxative), Lactobacillus acidophilus (a digestant), and simethicone (a defoaming agent).

The results showed that patients in the intervention group were more likely to have successful treatment without surgery (91% vs. 76%) and had shorter hospital stays (1.0 vs. 4.2 days) compared to the control group. There were no significant differences in complication and recurrence rates between the two groups.

The oral therapy may have been effective because it included magnesium oxide, which stimulates bowel movement and causes the bowels to empty. The use of a defoaming agent may have also helped by reducing gaseous symptoms. Furthermore, L. acidophilus may have aided in the digestion of food debris in the bowel lumen.

While this study suggests that laxatives can be used to treat SBO without surgery, it is important to note that it had some limitations. The study was not double-blinded, which may have left room for potential investigator bias. Additionally, the cases of partial adhesive small-bowel obstruction were not definitively proven with contrast radiography, so some of the cases successfully treated may not have been caused by adhesion. The study was also conducted at a single institution, so the generalizability of the findings to other institutions is unknown.

Laxatives may cause side effects like abdominal pain and electrolyte imbalances

Laxatives are available over the counter and are used to stimulate or facilitate bowel movements. However, they may cause side effects like abdominal pain and electrolyte imbalances.

Types of Laxatives

There are five primary types of over-the-counter (OTC) laxatives: osmotics, bulk formers, oral and rectal stool softeners, and stimulants.

Osmotics are taken orally and help make the passage of stool easier by drawing water into the colon. Bulk formers, also taken orally, prompt normal intestinal muscle contraction by absorbing water to form a soft, bulky stool. Oral and rectal stool softeners make hard stools softer and easier to pass with less strain. Stimulants, taken orally, encourage bowel movements by triggering rhythmic contractions of the intestinal muscles. Rectal suppositories, taken rectally, soften stool and trigger rhythmic contractions of the intestinal muscles.

Side Effects of Laxatives

The common side effects of the above laxatives are as follows:

• Osmotics: abdominal cramping, nausea, vomiting, and diarrhoea.
• Bulk formers: increased constipation (if not taken with enough water).
• Oral stool softeners: abdominal cramping and diarrhoea.
• Rectal suppositories: abdominal cramping and diarrhoea.

Risks Associated with Laxative Use

Laxatives are not without risks. They can interact with other medications, including certain heart medications, antibiotics, and bone medications. Frequent or long-term laxative use can worsen constipation by decreasing the colon's ability to contract, except in the case of bulk-forming laxatives, which are safe for daily use. Laxative use can also lead to dehydration and electrolyte imbalance if it results in diarrhoea.

Severe Laxative Side Effects

If you experience severe cramps or pain, weakness or unusual tiredness, skin rash or itching, or difficulty swallowing (feeling of a lump in the throat) when using laxatives, contact your doctor immediately.

Laxative abuse is common in psychiatric conditions like anorexia and bulimia

Laxative abuse is a common occurrence in patients with psychiatric conditions such as anorexia nervosa and bulimia nervosa. In these patients, laxatives are misused as a means to lose weight and to cope with the psychological distress associated with their eating disorders. This abuse often goes unnoticed by healthcare providers, leading to a cycle of chronic laxative use.

The underlying motivation for laxative abuse in patients with anorexia nervosa and bulimia nervosa is often rooted in their desire to lose weight and their fear of weight gain. Initially, patients may believe that laxatives can help purge their bodies of calories before they are absorbed. However, as these psychiatric conditions progress, patients continue to use laxatives despite realizing that there are no long-term weight loss benefits. Laxatives become a psychological crutch, providing a sense of control and a means to cope with the emotional distress associated with their eating disorders.

Chronic laxative abuse can lead to various physical complications. The most common consequence is dehydration, which can pose a significant health risk, including dizziness, weakness, confusion, and even death in prolonged cases. Laxative abuse can also cause electrolyte imbalances, particularly sodium and potassium depletion, leading to rapid heart rate, joint pain, and in severe cases, shock, brain swelling, seizures, and coma. Additionally, long-term laxative use can result in constipation, as the bowel loses its natural function, and permanent impairment of the digestive system, including paralysis of the muscles used in digestion.

The abuse of laxatives in patients with anorexia nervosa and bulimia nervosa is often associated with underlying psychiatric conditions and a history of trauma. These patients may have experienced sexual abuse, domestic violence, or early developmental disturbances, contributing to their eating disorders and laxative abuse. The misuse of laxatives becomes a way to regulate their turbulent emotions and a means of self-soothing.

Treating laxative abuse in patients with anorexia nervosa and bulimia nervosa can be challenging. Conventional psychotherapy, psychoeducation, and cognitive-behavioral therapy have shown limited effectiveness. However, interventions based on addiction treatment models, such as the Serigaya Methamphetamine Relapse Prevention Program (SMARPP) workbook, have shown some promising results. This approach conceptualizes laxative abuse as an addiction, addressing the compulsive and impulsive behaviors associated with eating disorders.

Overall, laxative abuse in patients with anorexia nervosa and bulimia nervosa is a complex issue that requires a multidisciplinary approach. It is crucial to address both the physical and psychological aspects of the disorder, including the underlying trauma and emotional dysregulation that contribute to the misuse of laxatives.

Laxatives are generally safe but complications can be life-threatening

Laxatives are generally considered safe for occasional use. They are a convenient solution for addressing constipation or related discomfort. However, complications can arise from their misuse or overuse, and these can be life-threatening.

Laxatives are drugs that relieve constipation by loosening stools or inducing a bowel movement. They are typically intended for short-term use and come in various forms, including pills, liquids, suppositories, and enemas. Most laxatives are available over the counter, but some require a prescription, especially for those with chronic constipation or a digestive condition. While laxatives are generally safe, they should be used with caution as they can lead to several side effects and risks.

One of the risks associated with laxative use is medication interactions. Laxatives may interact with certain antibiotics, heart medications, and bone medicines. It is important to read labels carefully and consult a doctor or pharmacist if concerned. Another potential risk is the delayed diagnosis of digestive conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), appendicitis, or colon cancer. Reliance on laxatives may mask these conditions, leading to a delay in diagnosis and treatment.

Laxative overuse and abuse can have serious and life-threatening consequences. Abuse occurs when individuals take higher or more frequent doses than recommended, often in an attempt to lose weight. This can lead to dehydration, electrolyte and mineral imbalances, chronic constipation, intestinal blockage, and increased colon cancer risk. Additionally, prolonged and excessive laxative use can cause damage to internal organs, including the liver and kidneys. It can also disrupt the natural muscle tone of the colon, leading to a "lazy" or atonic colon, which may result in chronic constipation. The repeated and forceful expulsion of stool can also cause physical trauma to the colon lining, increasing the risk of bacterial infections.

It is important to note that laxatives are not effective for weight loss and can be dangerous when used for this purpose. The weight loss achieved through laxative-induced bowel movements is primarily water weight, which returns when the person rehydrates by drinking fluids. Misuse of laxatives is often associated with underlying psychiatric conditions, such as eating disorders like bulimia nervosa, anorexia nervosa, and Munchausen syndrome.

Laxatives are classified into bulk-forming, emollient, lubricant, and osmotic types

Laxatives are medicines that treat constipation by loosening stools and increasing bowel movements. They are generally classified into four types: bulk-forming, emollient (or stool softeners), lubricant, and osmotic.

Bulk-forming laxatives, also known as roughage, are substances that add bulk and water to stools so they can pass more easily through the intestines. These include dietary fiber, Metamucil, Citrucel, and FiberCon. They are considered the gentlest type of laxative and are ideal for long-term maintenance of regular bowel movements. However, they may take several days to be effective and are not suitable for acute relief. Potential side effects include diarrhea, abdominal cramps, and flatulence.

Emollient laxatives, or stool softeners, are anionic surfactants that enable additional water and fats to be incorporated into the stool, making movement through the bowels easier. Examples include Docusate (Colace, Diocto) and Gibs-Eze. Stool softeners are particularly useful for patients with structural causes of constipation, such as anal fissures or hemorrhoids. However, they should not be the only treatment for individuals with intestinal motility problems as the soft stool may accumulate and lead to intestinal obstruction. Common side effects may include diarrhea, abdominal cramping, and abdominal obstruction.

Lubricant laxatives, such as mineral oil, coat the stool with slippery lipids and decrease the colon's absorption of water, allowing the stool to slide through the colon more easily. They are typically used for temporary relief of occasional constipation and are less commonly prescribed due to their association with severe abdominal cramping and the risk of developing lipoid pneumonitis from aspiration of the oil. If used, they should be taken at least 30 minutes before bedtime to reduce the risk of aspiration.

Osmotic laxatives, also known as saline laxatives, are non-absorbable, hyperosmolar substances that draw fluid into the intestinal lumen, creating an osmotic gradient that adds pressure and stimulates bowel movement. Examples include glycerin suppositories (Hallens), sorbitol, lactulose, and polyethylene glycol (PEG, Colyte, MiraLax). They are generally well-tolerated, but potential side effects include nausea, vomiting, and diarrhea. Osmotic laxatives should be used with caution in patients with renal insufficiency and congestive heart failure due to the risk of fluid and salt overload.

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