Effective Laxatives: Improving Quadriplegic Bowel Function And Health

Constipation is a common issue for quadriplegics, and it can lead to serious complications. Laxatives are often used to treat constipation by softening stools or stimulating the bowels. There are many different types of laxatives, including bulk-forming laxatives, osmotics, stool softeners, lubricants, and stimulants. Each type works differently, and it's important to use them safely and sparingly to avoid side effects and complications. Natural laxatives and lifestyle changes can also be effective in relieving constipation. This includes increasing fiber intake, staying hydrated, and exercising regularly.

Natural laxatives

High-Fiber Foods

Dietary fiber is essential for digestion and preventing constipation. Soluble fiber absorbs water in the gut to form a gel-like substance that helps soften stools, while insoluble fiber adds bulk to the stool, making it easier to pass. Aim for 25-40 grams of fiber per day, and be sure to increase your water intake as you up your fiber intake. Examples of high-fiber foods include:

• Whole-grain breads and cereals
• Fruits (especially berries, apples, and kiwis)
• Vegetables (especially leafy greens)
• Nuts
• Seeds (especially chia seeds and flaxseeds)
• Legumes

Magnesium-Rich Foods

Magnesium is an electrolyte that helps to soften the stool and draw water into the intestines. Include the following magnesium-rich foods in your diet:

• Dark leafy greens
• Avocados
• Nuts
• Fortified cereals
• Chia seeds
• Dark chocolate
• Fatty fish

Probiotic Foods

Probiotics are "good bacteria" that help balance the gut microbiome and improve digestive health. Probiotic foods include:

• Yogurt
• Cheese
• Broccoli
• Prunes
• Soybeans
• Chia seeds
• Figs
• Kefir
• Kombucha
• Sauerkraut
• Kimchi
• Probiotic yogurt

Drinks

Staying hydrated is crucial for preventing and treating constipation. Here are some drinks that can help:

• Water
• Prune juice
• Coffee (both caffeinated and decaffeinated)
• Coconut water

Herbs

Herbs can also have a natural laxative effect. Some herbs that may be beneficial include:

• Senna (a strong natural stimulant laxative)
• Ginger (helps speed up digestion and prevent bloating and cramping)
• Peppermint (soothing to the digestive tract)
• Aloe vera (improves gastrointestinal motility)

Other Natural Remedies

In addition to dietary changes, there are other natural ways to relieve constipation:

• Abdominal massage
• Bowel training (going to the bathroom at the same time every day)
• Regular exercise
• Castor oil (a natural, mild stimulant laxative)

Over-the-counter laxatives

Laxatives are medicines that treat constipation by softening hard stools or stimulating your bowels to get moving so you can pass them. They are available in different forms, including pills, powders, liquids or syrups, and suppositories. Laxatives are typically used to treat occasional constipation and may be taken as preventative medicine for those who suffer from chronic constipation. They are also used to empty the bowels before a colonoscopy or surgical procedure.

Over-the-counter (OTC) laxatives are available in pharmacies, grocery stores, and online without a prescription. However, it is always best to consult your doctor or pharmacist before taking any type of laxative, even OTC products. This is especially important if you plan to take laxatives for more than a day or two, as long-term use of laxatives can have serious health repercussions like dehydration, kidney injury, and even death.

Bulk-Forming Laxatives

Bulk-forming laxatives, also known as fibre laxatives, work by bulking up your stool. They are made of indigestible particles (colloid) that absorb water, causing distension of the bowel and triggering bowel movement via wave-like muscle contractions (peristalsis). Common OTC bulk-forming laxatives include:

• FiberCon (polycarbophil)
• Citrucel (methylcellulose)
• Metamucil (psyllium)
• Benefiber (wheat dextrin)

Stool Softeners

Stool softeners, also known as emollient laxatives, work by permitting water and fat to infuse your stool, thus softening it. They are considered a mild form of laxative and are often recommended for those recovering from surgery, women who have just given birth, or individuals with haemorrhoids. Common OTC stool softeners include:

• Phillips' Stool Softener Liquid Gels (docusate)
• Pedia-Lax (glycerin suppository)

Lubricant Laxatives

Lubricant laxatives coat the colon, making it slippery. The coating prevents the colon from absorbing water from the stool, so it stays soft and is easier to pass. The active ingredient in these laxatives is typically mineral oil. However, they are not recommended for regular use as they can interfere with the absorption of fat-soluble vitamins.

Stimulant Laxatives

Stimulant laxatives activate the nerves that control the muscles in your colon, forcing it into motion to move the stool along. They also increase the hydration of the stool. Common brands include:

• Dulcolax (bisacodyl)
• Senokot, Ex-Lax (senna)

Osmotic Laxatives

Osmotic laxatives, including saline laxatives, pull water from other body parts and send it to your colon, softening the stool and making it easier to pass. They are considered effective, but if overused, they may cause problems with your body's water and electrolyte balance. Examples of OTC osmotic laxatives include:

• Milk of Magnesia (magnesium hydroxide)
• Miralax (polyethylene glycol)
• Fleet Enema (saline enema)

Bulk-forming laxatives

These laxatives are usually the first line of treatment for constipation and are preferred because they gradually improve constipation symptoms. They are also less likely to cause cramping or explosive diarrhoea compared to other types of laxatives. Bulk-forming laxatives are generally safe for healthy individuals, but side effects or drug interactions may occur. These can include difficulty swallowing, a feeling of a lump in the throat, and difficulty breathing. Mild stomach pain, bloating, or gas may also be experienced.

When taking bulk-forming laxatives, it is important to consume at least 8 ounces of water or fruit juice with them to prevent bowel obstruction. Staying well-hydrated throughout the day is also recommended. Relief from constipation should be felt within 12 hours to 3 days of taking the laxative.

When to Use Bulk-Forming Laxatives

Stimulant laxatives

It is important to note that stimulant laxatives should not be used for more than a week unless specifically advised by a doctor. They can be habit-forming, and prolonged use may lead to laxative dependency and harm the bowels. They are not recommended for children under six unless instructed by a pediatrician.

Before taking stimulant laxatives, it is essential to consult a doctor, especially if you have any health conditions, are pregnant, or breastfeeding. They may also cause side effects such as stomach cramps, diarrhoea, and reddish-brown urine.

Osmotic laxatives

The term "osmotic" refers to the movement of fluid through a membrane so that the concentration is equal on both sides. Osmotic laxatives alter the balance with substances such as salts, sugars, and other organic compounds that encourage the movement of water into the colon.

Some common osmotic laxatives include:

• Polyethylene glycol (found in brands like MiraLAX and GlycoLax)
• Lactulose (found in brands like Cephulac, Duphalac, and Kristalose)
• Sorbitol (found in brands like Arlex and GeriCare)
• Magnesium citrate (found in brands like Citrate of Magnesia and Citroma)
• Magnesium hydroxide (found in the brand Milk of Magnesia)

Frequently asked questions