Laxatives And Hemorrhoids: A Recipe For Relief Or Irritation?

Hemorrhoids are a common medical condition, affecting around half of Americans by age 50. They are characterised by swollen veins inside the rectum or around the anus, and can be caused by straining during bowel movements, spending extended periods on the toilet, pregnancy, ageing, and frequently lifting heavy objects. Laxatives are often used to treat hemorrhoids, as they can help to soften stools and reduce straining, but they may also irritate the veins and make symptoms worse.

Bulk-forming laxatives

Some common bulk-forming laxatives include psyllium (Metamucil), polycarbophil (FiberCon), and methylcellulose (Citrucel). They are generally safe for healthy people, but side effects or drug interactions may occur, including difficulty swallowing, feeling like there's a lump in your throat, difficulty breathing, mild stomach pain, bloating, or gas. People with kidney disease or diabetes are at risk of electrolyte imbalances when taking laxatives, so they should consult their doctor before use.

It is recommended to take bulk-forming laxatives with at least 8 ounces of water or fruit juice to prevent bowel obstruction. They usually take 12 hours to three days to work.

Stimulant laxatives

If you are experiencing constipation, it is recommended to first try lifestyle changes such as increasing your intake of fiber-rich foods and drinking plenty of liquids. If these measures do not help, stimulant laxatives can be considered as a next step. However, they should only be used as a last resort and under the guidance of a medical professional.

It is important to note that laxatives can be habit-forming and may create a dependency. Frequent consumption of laxatives may cause the veins in the rectum and anus to bruise and swell, making them vulnerable to infection and inflammation. Therefore, it is crucial to use laxatives with caution and only as directed by your healthcare provider.

Stool softeners

When taking a stool softener, it is important to stay hydrated by drinking eight to 12 glasses of water per day. This will help to soften the stool in conjunction with the stool softener. It is best to avoid caffeinated drinks, as these can cause dehydration.

Dosage will depend on factors such as age and form, but an adult should take 200 mg of docusate orally per day, with a maximum dose of 500 mg. Stool softeners are intended for short-term relief only and should not be used habitually, as this can lead to side effects such as diarrhoea and nutrient loss.

It is always best to consult a doctor before taking a stool softener or any other medication. They may advise a different treatment plan or suggest lifestyle changes such as increasing fibre intake and doing more exercise, both of which can help with hemorrhoids.

Laxatives and pregnancy

Constipation is a common issue during pregnancy, affecting up to 38% of pregnant women. This is due to hormonal changes that slow down the normal movement of the digestive system, as well as reduced physical activity and increased vitamin supplementation. Laxatives are often recommended for the treatment of constipation during pregnancy, but it is important to consult a doctor before taking any new medications, especially during the first trimester.

Bulk-forming laxatives, which add fibre to the digestive process and help the intestines absorb water, are considered the first-choice treatment option for constipation during pregnancy. They are not well absorbed by the body and are generally safe to take throughout pregnancy. Examples include calcium polycarbophil (FiberCon) and psyllium (Metamucil). However, these medications can take 48 to 72 hours to take effect, and side effects such as gas, bloating, and cramping may limit their use.

Stool softeners, such as docusate (Colace), are also recommended for the treatment of constipation during pregnancy. They work by moisturising the stool, making it easier to pass. Docusate has been shown to be safe during pregnancy and breastfeeding, but it is recommended only for short-term, occasional use.

Osmotic laxatives, such as polyethylene glycol (Miralax) and magnesium hydroxide (Milk of Magnesia), are considered second-choice treatment options. They keep water in the intestines, but they can cause side effects such as bloating, gas, and nausea, and may lead to electrolyte imbalances.

Stimulant laxatives, such as bisacodyl (Dulcolax) and senna (Senokot, Ex-Lax), should be used with caution during pregnancy due to a lack of evidence on their effects. They can also cause side effects such as low potassium and sodium levels.

In summary, bulk-forming laxatives and stool softeners are considered safe and effective treatments for constipation during pregnancy. Osmotic laxatives and stimulant laxatives may be used in certain situations but should be approached with caution. Adequate fibre intake through diet can also help with constipation during pregnancy.

Laxatives and hemorrhoid surgery

Hemorrhoids are a common medical condition, affecting around 4.4% of the general population and 36.4% of those in general practice. They are characterised by painful and itchy inflammation of the small veins around the anus and rectum. Laxatives are often recommended for the treatment of hemorrhoids, particularly those containing fibre, due to their safety and low cost. They work by helping to achieve a more regular bowel movement, thus preventing hemorrhoids from worsening.

However, laxatives can also be habit-forming, and may create a dependency which can end up worsening constipation. Frequent consumption may also cause the veins of the rectum and anus to bruise and swell, making them vulnerable to infection and inflammation. Therefore, laxatives should only be used as a last resort, after attempting to make lifestyle changes such as increasing fibre intake and drinking plenty of liquids.

If you are taking laxatives and your hemorrhoids seem to be getting worse, it is important to consult a doctor. Surgery may be recommended for those who do not improve with initial treatments or who have a more significant degree of prolapse. A hemorrhoidectomy, for example, involves tying off the vein inside the hemorrhoid to prevent bleeding and then cutting out the swollen area. Following a hemorrhoidectomy, wheat fibre added to the diet can produce a satisfactory bowel habit, with a lower incidence of fecal leakage and reduced pain after defecation than a standard laxative regime.

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