Colitis And Laxatives: What's The Best Relief?

Ulcerative colitis is an inflammatory bowel disease that causes inflammation along the lining of the large intestine and rectum. While diarrhoea is a common symptom, constipation can also occur. Constipation is defined as having fewer than three bowel movements per week, with dry, hard stools that are difficult to pass. For those with ulcerative colitis, constipation may be caused by inflammation and swelling in the rectum, or by mechanical obstructions such as strictures (narrowed sections of the intestine).

There are several remedies for ulcerative colitis constipation, including lifestyle changes, prescription medications, and over-the-counter laxatives. This article will explore the different types of laxatives available and discuss which may be most suitable for those with ulcerative colitis.

Osmotic laxatives

If you have chronic constipation, it is important to see your healthcare provider to identify the underlying cause. In some cases, the condition can be improved with diet, exercise, and increased fluid intake. In other cases, treatments that extend beyond the use of laxatives may be required.

Stool softeners

You can take stool softeners orally or rectally. They come in the form of tablets, capsules, syrup, or liquid. Some stool softeners also come in the form of a rectal enema, which you inject directly into your rectum. The best time to take a stool softener is usually at bedtime, following the directions on the packaging or your healthcare provider's instructions.

Side effects of stool softeners may include stomach pain, nausea, and diarrhoea. Unlike other laxatives, they are not associated with bloating and cramping but can cause an electrolyte imbalance if used long-term.

Stimulant laxatives

Side Effects and Precautions

Examples of Stimulant Laxatives

Some common stimulant laxatives include:

• Bisacodyl (Correctol, Dulcolax, Feen-a-Mint)
• Sennosides (Ex-Lax, Senokot)
• Sodium picosulphate (Dulcolax Pico liquid, Picolax)
• Glycerol (glycerine) suppositories

Bulk-forming laxatives

Common Bulk-Forming Laxatives

Common bulk-forming laxatives include:

• Psyllium (Metamucil)
• Polycarbophil (FiberCon)
• Methylcellulose (Citrucel)
• Fybogel (ispaghula husk)

Benefits of Bulk-Forming Laxatives

They may be particularly beneficial:

• During pregnancy or after giving birth
• During preparation for surgery
• For treating constipation in bedridden people, or that caused by medication
• For preventing strain after surgery
• For restoring normal bowel function after a period of poor diet or physical inactivity
• For helping to reduce cholesterol
• For treating diarrhoea
• For improving medical conditions made worse by straining

Side Effects and Precautions

• Difficulty swallowing
• Feeling like there's a lump in your throat
• Difficulty breathing
• Mild stomach pain, bloating, or gas
• Allergic reaction to psyllium (seek immediate medical attention)

It is important to take bulk-forming laxatives with at least 8 ounces of water or fruit juice to prevent bowel obstruction, and to stay well-hydrated throughout the day. They usually take 12 hours to 3 days to provide relief.

You should avoid bulk-forming laxatives and consult your doctor if you have symptoms of appendicitis or inflamed bowel, if you miss a bowel movement for more than two days and have abdominal pain, or if you experience a sudden change in bowel habits lasting two weeks or more.

People with kidney disease or diabetes are at risk of electrolyte imbalances when taking laxatives, so it is important to consult a doctor before use if you have either of these conditions.

Laxatives may also impact how your body absorbs medications, so it is recommended to leave at least two hours between taking a laxative and any other medication.

Dietary changes

Increase Fluid Intake

• Drinking plenty of water can help soften stools and make them easier to pass. It is recommended to consume about 2 litres of water per day.
• Other fluids such as teas, soups, and other liquids can also contribute to daily fluid intake.
• Caffeinated and alcoholic beverages should be limited as they can have a diuretic effect, increasing the risk of dehydration and constipation.

Adjust Fibre Intake

• Consuming a high-fibre diet is generally recommended, with adults advised to aim for 22-34 grams of dietary fibre per day.
• However, during a colitis flare-up, a low-fibre diet may be recommended to reduce abdominal bloating and discomfort.
• Soluble fibre, which dissolves in water, is often suggested over insoluble fibre, as it creates less residue and is gentler on the digestive system.
• It is important to introduce or increase fibre gradually to minimise side effects such as abdominal cramping, bloating, or gas.
• Fibre can interfere with the absorption of some medications, so it is advisable to take any prescribed medications at least one hour before or two hours after consuming fibre.

Choose the Right Types of Fibre

• Fibre is found in fruits, vegetables, and whole grains.
• When increasing fibre intake, it is important to be mindful of the type of fibre. Insoluble fibre adds bulk to the stool, which may be difficult to pass, especially if there are strictures or obstructions in the intestine.
• Soluble fibre, on the other hand, dissolves in water and is recommended for people with inflammatory bowel diseases as it creates less residue.

Try a Low-FODMAP Diet

A low-FODMAP diet may help reduce constipation in some people with ulcerative colitis. FODMAPs are a group of carbohydrates found in certain foods that can be difficult to digest and may contribute to digestive symptoms.

Avoid Dairy

Dairy products are known to cause constipation in some individuals, so reducing or eliminating dairy from the diet may help improve bowel movements.

Stay Away from Constipation-Inducing Medications

• Certain medications can contribute to constipation. Antidepressants, antidiarrhoeals, some supplements, and painkillers are known to cause or worsen constipation.
• It is important to review your current medications with your doctor or pharmacist to identify any that may be contributing to constipation.

Frequently asked questions