Marc Holland
Constipation is a common condition that can usually be treated with laxatives, which are available over the counter (OTC) or by prescription. Laxatives work by increasing the water content in the stool, making it softer and easier to pass. They come in pills, capsules, liquids, suppositories, and enemas. While laxatives can be effective, they should be used sparingly and only as short-term relief. This is because they can cause side effects such as abdominal pain, bloating, gas, and diarrhoea, and, in rare cases, more serious health issues such as dehydration, kidney injury, and even death. Before taking any laxative, it is important to read the directions on the label and consult a doctor or pharmacist.
| Characteristics | Values |
|---|---|
| Types | Bulk-forming, osmotic, emollient (stool softeners), lubricant, stimulant |
| Active Ingredients | Psyllium, methylcellulose, calcium polycarbophil, wheat dextrin, magnesium hydroxide, glycerin, sodium phosphates, lactulose, lactitol, polyethylene glycol, bisacodyl, docusate sodium, mineral oil, senna, castor oil |
| How They Work | Increase water content and bulk of stool, stimulate intestinal muscles, lubricate intestines, stimulate intestinal lining |
| How to Take | Tablets, capsules, suppositories, liquids, gels, powder mixed with water |
| When to Take | First thing in the morning, last thing at night |
| Duration of Action | Enemas and suppositories: minutes to an hour; lubricants and stimulants: several hours; bulk-forming and osmotic laxatives: up to three days |
| Side Effects | Bloating, diarrhea, stomach cramps, abdominal pain, dehydration, urine discoloration, increased constipation, increased thirst, electrolyte imbalances, mineral imbalances, severe dehydration, laxative dependency, internal organ damage |
| Precautions | Not recommended for children without medical advice; not recommended for long-term use; may interact with other medications; may affect absorption of vitamins and minerals |
What You'll Learn
Bulk-forming laxatives
Common over-the-counter bulk-forming laxative brands include:
- FiberCon (polycarbophil)
- Citrucel (methylcellulose)
- Metamucil (psyllium)
- Benefiber (wheat dextrin)
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Osmotic laxatives
The term "osmotic" refers to the movement of fluid through a membrane to equalise concentration on both sides. Osmotic laxatives use substances such as salts, sugars, and other organic compounds to encourage water movement into the colon. This process helps to soften the stool and stimulate bowel movements. Osmotic laxatives include polyethylene glycol (PEG), an organic compound derived from petroleum and available in over-the-counter products like Miralax and GlycoLax.
Lactulose, a type of sugar that the intestine does not absorb, is another osmotic laxative. It sits in the intestines and ferments, producing fatty acids that draw water into the colon. Prescription-only lactulose products include Cephulac, Duphalac, and Kristalose. Sorbitol, another non-absorbable sugar with a similar action to lactulose, is available over the counter and by prescription.
Magnesium-based osmotic laxatives include magnesium citrate (an OTC product with brand names like Citrate of Magnesia) and magnesium hydroxide, a milder form sold as Milk of Magnesia. Milk of Magnesia is also used as an antacid and can be purchased without a prescription.
If you experience chronic constipation, it is advisable to consult a healthcare provider to identify the underlying cause. In some cases, dietary and lifestyle changes, such as increasing fibre and fluid intake and exercising more, may be sufficient to improve the condition.
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Stimulant laxatives
Some common brand names of stimulant laxatives include:
- Senexon (sennosides)
- Fletcher's Castoria (sennosides)
- Senokot (sennosides)
- Black Draught (sennosides)
- Feen-A-Mint (bisacodyl)
- Correctol (bisacodyl)
- Dulcolax (bisacodyl)
- Carter's Little Pills (bisacodyl)
Side effects of stimulant laxatives include:
- Abdominal cramping
- Diarrhea
- Urine turning a brownish-red colour (when using senna)
People with the following conditions should not use stimulant laxatives:
- Previous allergic reaction to any stimulant laxatives
- Intestinal blockage
- Undiagnosed rectal bleeding
- Signs of appendicitis (severe stomach pain, nausea, vomiting)
It is important to consult a doctor or pharmacist before using any laxatives, especially if you are pregnant, breastfeeding, or giving laxatives to a child.
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Lubricant laxatives
The dosage of mineral oil laxatives is based on age, medical condition, and response to treatment. It is important to carefully measure the dose using a special device or spoon, as taking too much can lead to leakage from the rectum, causing discomfort and soiling of clothes. This type of laxative may take up to eight hours to cause a bowel movement, and it should not be taken right before lying down.
While mineral oil laxatives are generally safe for adults, they are not recommended for older adults, children under six, or individuals who are bedridden. Pregnant women should also use them with caution and only when necessary, as there may be possible risks to the unborn baby. It is always advisable to consult a doctor or pharmacist before taking any laxative, especially when considering long-term use or if you have any medical concerns or allergies.
In summary, lubricant laxatives are a safe and effective short-term solution for constipation when used as directed. However, they should not replace a healthy diet, adequate fluid intake, and regular exercise, which are the first lines of defence against constipation.
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Stool softeners
In addition to stool softeners, there are other types of laxatives available, including:
- Osmotic laxatives: These draw water into the intestines and are typically used for long-term constipation relief.
- Bulk-forming laxatives: Often derived from plants, these laxatives form a watery gel in the intestines, adding body and lubrication to the stool. They are safe for long-term use but may take longer to work.
- Stimulant laxatives: These are fast-acting laxatives that stimulate the intestines to have a bowel movement. However, they are not safe for regular use as they can lead to dependency.
- Saline laxatives: These magnesium-based laxatives pull water into the intestines and are useful for short-term relief.
- Lubricant laxatives: These oily laxatives coat the intestines to help move the stool through quicker. They are not suitable for regular use as they can interfere with vitamin absorption.
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Frequently asked questions
Some safe over-the-counter laxatives include Miralax, Ex-Lax, and Dulcolax.
If you are experiencing constipation, which can include symptoms such as painful bowel movements, a feeling of incomplete evacuation, and fewer than three bowel movements per week, you may want to consider taking a laxative. However, it is important to first try increasing your fibre and fluid intake, as well as regular exercise, before resorting to laxatives.
There are several types of laxatives, including bulk-forming laxatives, osmotic laxatives, emollient laxatives (stool softeners), lubricant laxatives, and stimulant laxatives.
The choice of laxative depends on the individual. It is recommended to start with a bulk-forming laxative and adjust from there. If your stool remains hard, you can try an osmotic laxative, and if it is soft but still difficult to pass, you can take a stimulant laxative in addition to a bulk-forming laxative.
Laxatives can cause side effects such as dehydration, increased constipation, and increased thirst. They can also lead to more serious problems such as kidney injury, electrolyte imbalances, and dependency if overused or abused. Therefore, it is important to use laxatives sparingly and consult a doctor if constipation persists.
