Laxatives: Conditions For Use And Misuse

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 relieve constipation. Laxatives work by softening stools or stimulating the bowels to promote bowel movements. They come in various forms, including pills, capsules, liquids, suppositories, and enemas, and can be purchased over the counter or with a prescription. While they are effective in treating constipation, they should be used sparingly and occasionally to avoid potential side effects, such as dehydration, intestinal obstruction, and electrolyte imbalance.

Constipation relief

Constipation is a common issue that many people face, and laxatives are a popular solution. However, it's important to understand when and how to use them safely and effectively. Here's a detailed guide on using laxatives for constipation relief:

Lifestyle Changes:

Before turning to laxatives, it's recommended to try lifestyle changes, which can be highly effective in relieving constipation. These include:

• Dietary Fibre: Increasing your intake of dietary fibre, found in fruits, vegetables, and whole grains, can help add bulk and soften stools, making them easier to pass. Fibre supplements like psyllium (Metamucil®), polycarbophil (FiberCon®), and methylcellulose (Citrucel®) are also available over the counter.
• Fluids: Staying hydrated is crucial. Aim for at least eight 8-ounce cups of water or other fluids like tea and soup daily. Fluids help soften stools and improve bowel function.
• Probiotics: Taking probiotics can support digestive health and promote regular bowel movements.
• Exercise: Regular physical activity can stimulate bowel function and help relieve constipation.

Types of Laxatives:

If lifestyle changes don't provide sufficient relief, you can consider using laxatives. There are several types available, each with its own mechanism of action:

• Bulk-Forming Laxatives: These add bulk to stools by drawing water into the colon, making stools softer and larger, stimulating bowel movements. They are generally considered the gentlest type and are recommended as a first-line treatment.
• Osmotic Laxatives: Osmotic laxatives pull water from other parts of the body into the colon, softening stools and making them easier to pass. Examples include polyethylene glycol (MiraLAX®) and magnesium hydroxide (Milk of Magnesia).
• Stool Softener Laxatives: Also known as emollient laxatives, they increase the water and fat absorption in stools, making them softer. Docusate (Colace®) is commonly used.
• Lubricant Laxatives: Lubricant laxatives, such as mineral oil, coat the colon, making the passage of stools easier and preventing water absorption from them.
• Stimulant Laxatives: Stimulant laxatives activate the nerves controlling colon muscles, forcing bowel movements. They are typically used when other types of laxatives haven't provided relief. Examples include bisacodyl (Dulcolax®) and senna (Fletcher's® Laxative).

Administration and Precautions:

Laxatives come in various forms, including pills, capsules, liquids, suppositories, and enemas. It's important to follow the instructions on the label or provided by your healthcare provider to avoid side effects. Some key precautions to keep in mind:

• Timing and Dosage: Take laxatives as directed, during the recommended times of the day. Do not exceed the instructed dosage, as it can lead to an overdose.
• Duration of Use: Laxatives are generally meant for occasional or short-term use. Prolonged use can cause side effects and worsen constipation.
• Pregnancy and Children: Consult a healthcare provider before using laxatives during pregnancy or giving them to children.
• Drug Interactions: Some laxatives may interfere with the absorption of certain medications. Discuss this with your healthcare provider if you're taking prescription drugs.
• Side Effects: Common side effects include bloating, gas, and stomach cramps. Overuse can lead to dehydration, electrolyte imbalance, chronic constipation, and intestinal blockage.
• Underlying Conditions: Constipation may be a symptom of a more serious condition. If constipation persists or is frequent, consult a doctor to rule out underlying issues.

Bowel cleansing before medical procedures

Bowel cleansing, or bowel preparation, is a necessary step before performing surgery on the digestive system. The process involves cleaning the intestines of solid waste and bacteria to make the colon usable for surgery and to prevent infection.

There are several methods to perform bowel cleansing. One common method is to use a salt solution, which is given to the patient over a period of 6 hours or longer, depending on the amount of stool and the type of surgery. Patients need to drink a large amount of the solution every hour, which can be challenging, so a nasogastric tube is often inserted through the nose to deliver the solution directly to the stomach. An X-ray may be taken to ensure the tube is in the correct position.

Another method of bowel cleansing is to use a combination of osmotic agents and stimulant laxatives. Osmotic agents work by pulling water into the colon, softening the stool, and making it easier to pass. Stimulant laxatives stimulate the nerves that control the muscles in the colon, aiding in the evacuation of stool. When used in combination, these methods can effectively clear the bowel of stool and bacteria.

It is important to note that recent data suggests that mechanical bowel preparations may not be necessary, and dietary restrictions before surgery may also be unnecessary. However, in certain cases, such as when a colonoscopy will be performed immediately before the surgery, a bowel preparation may still be recommended.

Bowel cleansing is an important step in preparing for medical procedures involving the digestive system. It ensures that the colon is ready for surgery and helps to prevent potential infections.

Preventing constipation

Laxatives are a type of medicine used to treat constipation. They are typically used when lifestyle changes, such as increasing fibre intake, drinking more fluids, and exercising, have failed to provide relief. Constipation is characterised by straining during bowel movements, a feeling of obstruction or incomplete evacuation, and fewer than three bowel movements per week.

To prevent constipation, it is important to make certain lifestyle changes. Here are some detailed suggestions to help prevent constipation:

• Increase Fibre Intake: Fibre is a crucial component in preventing constipation. It is recommended to consume about 30 grams of fibre daily. Fibre supplements or bulking agents, such as wheat bran, can be added to your diet. These bulking agents not only make stools softer but also easier to pass. However, it is important to note that bran and fibre can sometimes worsen bloating.
• Drink Plenty of Water: Water plays a vital role in preventing constipation. It is recommended to drink at least eight 8-ounce cups of water daily. Fluids can also include teas, soups, and other liquids. Staying well-hydrated is essential when using laxatives, as some types of laxatives can cause dehydration.
• Exercise Regularly: Regular physical activity can help prevent constipation. Exercise stimulates the digestive system and promotes regular bowel movements.
• Include Probiotics in Your Diet: Probiotics are beneficial bacteria that support digestive health and can help relieve constipation. Include probiotic-rich foods in your diet, such as yoghurt, kefir, sauerkraut, and kimchi.
• Make Dietary Changes: In addition to increasing fibre intake, focus on consuming fresh fruits, vegetables, and whole-grain products. These foods provide essential nutrients and contribute to a healthy digestive system.
• Avoid Regular Use of Stimulant Laxatives: Stimulant laxatives should not be used daily or regularly. They may weaken the body's natural ability to defecate and can lead to laxative dependency. Additionally, they can interfere with the absorption of vitamin D and calcium.

By incorporating these suggestions into your daily routine, you can effectively prevent constipation and maintain a healthy digestive system. Remember, laxatives should be used sparingly and only when necessary, as they can have side effects and may not address the underlying cause of constipation.

Relieving post-surgery constipation

Constipation is a common side effect of surgery, often caused by a combination of factors such as anaesthesia, pain medications, dietary changes, and reduced mobility. It is important to address constipation after surgery to prevent discomfort and potential complications such as a surgical incision reopening, haemorrhoids, or anal fissures. Here are some strategies to relieve post-surgery constipation:

Medication Options

Laxatives are often used to treat constipation, and there are various types available, including:

• Stool softeners: These make stools easier to pass by drawing water into the intestines to moisten them. An example is docusate sodium (Colace).
• Fiber laxatives: These work by increasing the water content and bulk of the stool, aiding its movement through the colon. Examples include psyllium (Metamucil or Konsyl) and methylcellulose fiber (Citrucel). However, these are not recommended for those whose constipation is caused by opioid medication as they can cause abdominal pain and potential bowel obstruction.
• Stimulant laxatives: These stimulate the nerves that control the muscles in the colon, forcing it into motion. Examples include bisacodyl (Dulcolax) and senna (Fletcher's Laxative).
• Osmotic laxatives: These pull water from other body parts and send it to the colon, softening the stool. Examples include magnesium hydroxide (Milk of Magnesia).
• Lubricant laxatives: These coat the colon, making it slick and preventing water absorption from the stool, keeping it soft. An example is mineral oil.
• Suppositories and enemas: These are inserted into the rectum to soften the stool and trigger intestinal muscles to squeeze, making it easier to pass stools.

Lifestyle Changes

• Drink plenty of fluids: Dehydration can worsen constipation. Aim for at least four glasses of water per day, and avoid caffeinated drinks like coffee, tea, and soda, as they can be dehydrating.
• Increase fibre intake: Fibre helps with regular bowel movements. Aim for 22-34 grams of fibre per day through foods like bran, beans, apples, pears, prunes, squash, sweet potatoes, spinach, and collard greens. If you have a poor appetite, try a smoothie with blended fruits and vegetables.
• Gradually increase physical activity: Inactivity is a common cause of constipation. As soon as your doctor gives the go-ahead, start moving around, even if it's just a short walk. Exercise helps move food through the intestines and stimulates bowel movements.

It is important to consult with your doctor or healthcare provider before taking any medication or making significant dietary changes, especially during post-surgery recovery. They can advise you on the best course of action to relieve constipation safely and effectively.

Constipation relief during pregnancy

Constipation is a common issue during pregnancy, with around 16 to 39% of pregnant people experiencing it at some point. The condition can start as early as the second or third month of the first trimester, but it is most likely to occur during the third trimester when the foetus is heaviest and exerts the most pressure on the bowel. The increase in the pregnancy hormone progesterone can also affect digestion and slow down bowel movements during the first and second trimesters.

Constipation during pregnancy can cause discomfort and distress, but it is important to know that it will not harm the baby. To relieve constipation, there are several steps that can be taken:

• Increase Fibre Intake: Aim for 25 to 30 grams of fibre per day. Fibre-rich foods include whole wheat couscous, fruits, vegetables, whole grains, beans, peas and lentils.
• Stay Hydrated: Drink 8 to 12 cups of water per day. Water softens the waste in the bowels, making it easier to pass. If plain water is not appealing, try sparkling water, or include water-rich foods in your diet such as carrots, lettuce, melons, and strawberries.
• Exercise Regularly: Engage in 20 to 30 minutes of moderate exercise three times a week. Recommended activities include walking, swimming, yoga, pilates, and light aerobics.
• Consider Different Prenatal Vitamins: The iron in prenatal vitamins may be contributing to constipation. Consult with a healthcare provider about switching to a vitamin with less iron or increasing iron-rich foods in your diet.
• Supplements and Medication: Probiotics can help with constipation. Live cultural yogurt, live yogurt drinks, and fermented pickles are good sources of probiotics. Over-the-counter medications such as Fibercon (calcium polycarbophil) and Milk of Magnesia (magnesium hydroxide) are generally considered safe during pregnancy. However, always consult a doctor or midwife before taking any supplements or medication.

If constipation persists or is particularly severe, it is important to consult a healthcare provider for further guidance and treatment options.

Frequently asked questions