Black And White Laxatives: What Are They?

Constipation is a common issue among the elderly, and laxatives are often used to treat it. A study on laxative use among community-dwelling elderly persons found that 10.2% of participants used at least one laxative, with stimulants and bulking agents being the most common types. Laxative use was more prevalent among women, those with more physician visits, those unable to walk long distances, and those using multiple over-the-counter non-laxative medications. Another study examining constipation in elderly patients found a 29% prevalence rate in both black and white populations, with laxative use being notably higher in the black elderly population (76.6% vs 43% in the white population). While laxatives can be effective, caution is advised as some natural laxatives, such as Cascara sagrada, can cause liver issues if consumed in high doses.

Laxatives are used to treat constipation, a common problem in elderly people

Laxatives are available in various forms, including prescription and over-the-counter options. Stimulants and bulking agents are the most commonly used laxatives. However, laxative use should be approached with caution in the elderly, as it may be associated with certain risks. For example, stimulant laxatives can cause abdominal cramping and may not be suitable for elderly individuals with mobility issues. Therefore, it is essential to carefully select and monitor the use of laxatives in older adults.

The management of constipation in elderly individuals should follow a stepwise approach, starting with non-pharmacological interventions. Increasing fluid and dietary fiber intake, improving physical activity, and establishing a regular toilet routine are often recommended as first-line treatments. If these measures are ineffective, laxatives can be introduced, starting with bulk-forming agents and then progressing to osmotic or stimulant laxatives if needed. It is important to individualize the treatment plan, considering the patient's specific needs and preferences.

Additionally, it is crucial to address any reversible causes of constipation, such as optimizing the management of comorbidities and discontinuing or substituting medications that may contribute to constipation. A thorough medication review is essential to balance the benefits of a drug against its potential to cause constipation. This comprehensive approach ensures that constipation in elderly individuals is managed effectively while minimizing the risks associated with laxative use.

Laxative use is common among community-dwelling elderly persons

A study by Christine M. Ruby et al. found that 10.2% of their 4136 participants used at least one laxative. The most common types were stimulants and bulking agents. Only 11.6% of laxative users reported using two or more laxatives concurrently.

Another study, conducted in a nursing home in Taiwan, found that 83.6% of their 110 participants used laxatives regularly. The most frequently used laxatives were glycerol, senna glycoside, and magnesium oxide.

Laxative use among the elderly is related to specific factors concerning sociodemographics, health status, and access to health care. For example, Ruby et al.'s study found that laxative use was more common among women, those who had visited a physician more than four times in the previous year, those unable to walk half a mile, and those using four or more over-the-counter non-laxative medications.

The high prevalence of laxative use among the elderly is concerning due to the potential for adverse effects and overuse. Side effects such as abdominal discomfort, electrolyte imbalances, allergic reactions, and hepatotoxicity have been reported. Additionally, the high prevalence of laxative use may indicate sub-optimal management of constipation in the community-dwelling elderly. Further research is needed to fully understand this issue and its impact on bowel function and quality of life.

Laxative use is related to specific factors concerning sociodemographics, health status, and access to healthcare

Laxatives are often used to treat constipation, a common problem among the elderly. A study by Christine M. Ruby et al. examined the use of laxatives among community-dwelling elderly persons. The study found that laxative use was more prevalent among women, those who had made more than four physician visits in the previous year, those unable to walk half a mile, and those using four or more over-the-counter non-laxative medications. These factors relate to sociodemographics, health status, and access to healthcare.

The study by Ruby et al. was a cross-sectional survey of 4136 participants at baseline from 1986 to 1987. The participants were from the Duke University Established Populations for Epidemiologic Studies of the Elderly. The survey collected data on demographic characteristics, health status, health service use, and the use of prescription and over-the-counter drugs.

The results showed that 10.2% of participants used at least one laxative, with stimulants and bulking agents being the most common types. Multivariate logistic regression analyses revealed that certain factors were associated with a higher likelihood of laxative use. These factors included being female (adjusted OR of 1.78), having more than four physician visits in the past year (adjusted OR of 1.72), being unable to walk half a mile (adjusted OR of 1.44), and using four or more over-the-counter non-laxative medications (adjusted OR of 2.09).

The study concluded that laxative use among the community-dwelling elderly is related to specific factors concerning sociodemographics, health status, and access to healthcare. Further studies are needed to understand the impact of laxative use on bowel function and quality of life in the elderly population.

Laxative use and abuse are very common in the black elderly population

Laxatives are often used to treat constipation, a common problem in the elderly. A study published in the American Journal of Geriatric Pharmacotherapy examined the use of laxatives among community-dwelling elderly persons, including both black and white participants. The study found that laxative use was common, with 10.2% of participants using at least one laxative. While stimulants and bulking agents were the most commonly used types of laxatives, the study also looked at a range of other laxatives, including hyperosmotic, lubricant, stool softener, and saline agents.

Among black and white elderly populations, constipation was found to affect 29% of participants in a South African study. Interestingly, laxative use and abuse were more prevalent in the black elderly population, with 76.6% of black participants using laxatives compared to 43% of white participants. This indicates a higher reliance on laxatives among the black elderly, which may be a cause for concern.

The American study also found that laxative use was associated with specific factors such as gender, health status, and access to healthcare. Women were more likely to use laxatives, as were those who had made multiple physician visits in the previous year, had difficulty walking, or were using multiple over-the-counter non-laxative medications. These findings highlight the complexity of laxative use in the elderly and the need to consider individual circumstances when addressing constipation.

While laxatives can provide relief from constipation, their use and abuse in the elderly, particularly in the black population, warrant further investigation. Understanding the impact of laxatives on bowel function and quality of life in this demographic is essential. Additionally, exploring the reasons behind the higher prevalence of laxative use and abuse in the black elderly population can help guide interventions and educational initiatives to ensure safe and effective management of constipation.

Cascara sagrada is a plant used as a laxative but high doses can lead to liver issues

Cascara sagrada, also known as cascara, bitter bark, cascara buckthorn, cascararinde, and chittem bark, is a small tree or shrub native to North America. The bark of the cascara tree, which can grow to be around 32 feet tall, is used medicinally and is available in solid and liquid forms.

Cascara sagrada has a long history of use as a natural laxative for constipation relief. It is considered a botanical stimulant laxative and works by causing increased peristalsis (muscle contractions) in the intestines, which helps to move stool through the bowels to produce a bowel movement. The active laxative components in cascara are anthraquinone derivatives and their glucosides, referred to as cascarosides. They appear to act locally as an irritant to the colon, promoting peristalsis and stool evacuation.

While cascara is generally safe and well-tolerated, it can cause adverse effects when used in high doses for longer than recommended periods. Long-term use or abuse can lead to what is known as a "cathartic" colon, characterised by diarrhea, cramps, weight loss, and darkened pigmentation of the colonic mucosa. The most serious adverse effect, however, is liver injury. Cascara sagrada contains chemicals called anthraquinones, which have been linked to cases of clinically apparent liver injury when used in high doses for extended periods. This liver injury has been attributed to the direct toxicity of anthraquinone derivatives, although the clinical characteristics of published cases suggest an idiosyncratic rather than direct hepatotoxic etiology.

Liver injury due to cascara use is rare, and most cases have been self-limited and rapidly reversible upon discontinuation of the laxative. However, severe cases with acute liver failure, ascites, and portal hypertension have been reported. It is recommended that cascara sagrada be taken for constipation in the smallest possible dose and for no longer than one week.

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