Laxatives: What If They Don't Work?

If laxatives don't work, it may be a sign of a more serious condition, such as fecal impaction. Fecal impaction is a severe condition where a large, hard mass of stool becomes stuck in the colon or rectum. This can cause grave illness or even death if left untreated. If laxatives are ineffective, a doctor may suggest physically removing the impacted stool through a non-surgical treatment, such as an enema. This involves inserting fluid into the rectum to soften the stool and make it easier to pass. If this is also unsuccessful, surgery may be required to break up and remove the stool manually.

See your doctor

If laxatives don't work, it is important to see your doctor. They may suggest a non-surgical treatment to physically remove the impacted faeces. This involves the doctor inserting a gloved finger into the anal passage to break up the impacted faeces. This procedure is known as manual evacuation. An enema (liquid) will then be used to clear the remainder of the impacted stools and help clear the bowels. An enema is a special fluid that is inserted into the rectum to soften the stool.

If these measures are ineffective, your doctor may suggest surgery. If you have been taking laxatives for a long time and are unable to have a bowel movement without them, your doctor can advise you on how to slowly stop using them.

If you are experiencing constipation, your doctor may prescribe medication to treat it. They may also suggest that you train yourself to have a bowel movement at the same time each day. They may also recommend that you increase your fluid intake, eat more fibre, and engage in regular physical activity.

If you think your constipation is being caused by certain medications or supplements, your doctor may change the dose or suggest an alternative.

Try a different laxative

If you've tried laxatives to no avail, it may be time to try a different type of laxative. Laxatives are medicines that help you have a bowel movement if you're constipated. They work by softening hard stools or stimulating your bowels to get moving. There are several types of laxatives available, including:

Bulk-forming laxatives

These laxatives add soluble fibre to your stool, making it bigger and softer. The increase in size stimulates your colon to contract and push the stool out. Bulk-forming laxatives are generally considered the gentlest type and are the best option to try first. They include psyllium (Metamucil), polycarbophil (FiberCon), and methylcellulose (Citrucel).

Osmotic laxatives

Osmotic laxatives pull water from other parts of your body and send it to your colon, softening your stool so it's easier to pass. They include polyethylene glycol (MiraLAX or a generic version) and magnesium-based laxatives like milk of magnesia or magnesium citrate.

Stool softener laxatives

Also called emollient laxatives, these increase the water and fat your stool absorbs, softening it. An example is docusate (Colace).

Lubricant laxatives

Lubricant laxatives coat your colon, making it slick. This prevents your colon from absorbing water from your stool, so it stays soft and can pass more easily through the colon. An example is mineral oil. However, doctors generally do not recommend mineral oil or castor oil due to their potential side effects.

Stimulant laxatives

Stimulant laxatives activate the nerves that control the muscles in your colon, forcing your colon into motion and moving your stool along. Examples include bisacodyl (Dulcolax) and senna (Fletcher's Laxative). However, these laxatives should be a last resort as they can cause side effects such as cramping and diarrhoea, and taking them too often can lead to dependency.

If you've tried different types of laxatives and they still don't work, it's important to consult your doctor. They can advise you on other treatment options or prescribe a different kind of medication.

Use an enema

If you're experiencing constipation and laxatives aren't working, you might consider using an enema. An enema involves inserting liquid or gas into the rectum to empty the bowels, allow for an examination, or administer medication.

Step 1: Prepare the necessary supplies

Firstly, gather all the necessary supplies, including an enema kit (which typically includes a bag or bottle attached to a tube or nozzle), petroleum jelly or lubricant, and towels. You will also need to ensure you have access to a toilet for at least an hour after using the enema.

Step 2: Choose a comfortable position

Choose a quiet and comfortable place to lie down, preferably in the bathroom. Remove your lower body clothing and wash your hands with soap and water. Lay a towel on the floor and lie on your left side, with your right knee bent and a rolled towel underneath for support. If you are left-handed, you may prefer to lie on your right side.

Step 3: Prepare the enema

Remove the cap from the nozzle of the enema. If using a bag, fill it with the prescribed amount of solution. If using a bottle, you may need to shake it to mix the medication.

Step 4: Insert the enema

Gently insert the tip of the nozzle into your anus and continue until it reaches about 3-4 inches into the rectum. This may be uncomfortable, but it should not be painful. If you experience pain, stop the procedure and seek medical advice.

Step 5: Release the liquid

Slowly squeeze the liquid from the container until it is empty, then gently remove the nozzle from your rectum. Stay in the same position for a few minutes to allow the enema to take effect. This can take anywhere from 2 minutes to 1 hour, depending on the type of enema.

Step 6: Empty your bowels

Go to the toilet as soon as you feel the urge, which should occur within 10 minutes of using the enema. It is important to stay close to a toilet for at least 30-60 minutes after using the enema, as you may need to go several more times.

It is important to follow the instructions provided with your enema kit carefully and only use enemas for medical reasons under the recommendation of a healthcare professional. Using enemas too frequently or incorrectly can lead to serious health complications.

Surgery may be required

If you've tried laxatives and lifestyle changes without success, it may be time to consider surgery as a last resort. This is usually only recommended if your constipation is caused by a blockage or if your colon muscles aren't functioning correctly.

In some cases, surgery may be recommended to remove the colon if the colon muscles aren't working correctly. This is typically a last resort if other treatments, including laxatives, haven't been successful.

It's important to discuss the benefits and risks of surgery with your doctor before making any decisions. Surgery can be a major procedure and may come with its own set of complications. Your doctor will be able to advise you on the best course of treatment for your specific situation.

Before considering surgery, it's recommended to try a range of other treatments for constipation. This includes increasing your fluid intake, exercising, and making dietary changes, such as increasing your fibre intake. There are also various types of laxatives available, including bulk-forming laxatives, stool softeners, and stimulant laxatives. It's important to consult your doctor if you're constantly needing to take laxatives, as they can recommend other medications or treatments that may be more effective.

Change your diet

If you're experiencing constipation, it's important to consult a doctor, especially if you're constantly needing to take laxatives. They can advise on the best course of action and recommend other medications if necessary.

That being said, constipation is often caused by a diet lacking in fiber or by dehydration. Therefore, making changes to your diet can be a good first step to relieve constipation.

• Increase your fiber intake: Eating a fiber-rich diet is crucial for relieving constipation. Aim for about 28 grams of fiber per day. High-fiber foods include whole grains, fruits, and vegetables.
• Drink plenty of fluids: It is important to stay hydrated by drinking enough water or other fluids. An easy way to calculate how much water you should drink per day is to divide your body weight (in pounds) by two. For example, if you weigh 180 pounds, aim for about 90 ounces of water, or about 11 cups, per day.
• Take probiotics: Probiotics can help improve your digestive health and may relieve constipation.
• Exercise regularly: Getting regular exercise can help improve your overall health and may also help with constipation. The Physical Activity Guidelines for Americans recommend adults get at least 150 minutes of moderate-intensity cardio (like walking) or 75 minutes of vigorous-intensity exercise (like running) every week.

If you've tried these dietary and lifestyle changes and you're still experiencing constipation, you may want to consult your doctor about trying a laxative. However, it's important to use laxatives only as a short-term solution and to follow the instructions carefully to avoid side effects and potential health complications.

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