Best Laxatives For Elderly: Safe And Gentle Relief

Constipation is a common problem among the elderly, with about a third of adults over 60 experiencing it. It can be caused by various factors, such as medication use, chronic illnesses, diet, and reduced physical activity. The best laxatives for elderly people to take will depend on the cause of their constipation and their individual needs. Polyethylene glycol (Miralax) is often recommended as it is well-tolerated and effective. Other options include osmotic laxatives such as lactulose and magnesium-based agents, stimulant laxatives like senna and bisacodyl, and bulk-forming fiber supplements like psyllium (Metamucil). It is important to note that not all laxatives are suitable for long-term use, and some may interact with medications or cause side effects. Therefore, it is always best to consult a healthcare professional before starting any new treatment.

Osmotic laxatives: polyethylene glycol (brand name Miralax) is well-tolerated by most older adults and can be used daily

Polyethylene glycol (brand name MiraLax) is a popular osmotic laxative used to treat constipation in elderly people. It is available over the counter and is well-tolerated by most older adults. It can be taken daily for up to a week and typically produces a bowel movement within 1-3 days. It is important to follow the dosage instructions on the label and not exceed the recommended amount. Polyethylene glycol works by increasing the amount of water in the intestinal tract, softening the stool, and making it easier to pass. It is generally safe, but it is always a good idea to consult a doctor or pharmacist before taking any new medication, especially if you have existing health conditions or are taking other medications.

• Dosage: The typical dose for adults is 17 grams (one packet or capful) mixed with 4 to 8 ounces of liquid once a day.
• Administration: MiraLax comes in powder form and should be mixed with a beverage such as water, juice, or tea. It is important to stir the mixture well and drink it right away.
• Side effects: Common side effects may include bloating, gas, and upset stomach. More serious side effects, such as severe or bloody diarrhea, blood in stools, or severe and worsening stomach pain, require immediate medical attention.
• Precautions: People with certain conditions, such as bowel obstruction, intestinal blockage, or eating disorders, should not use this medication without consulting a doctor. It is also important to inform your doctor if you are pregnant, planning to become pregnant, or breastfeeding.

Stimulant laxatives: senna (brand name Senakot) can be used as a rescue agent to prompt a bowel movement

Constipation is a common problem in elderly people, with studies reporting that between 24% and 30% of older people experience constipation. Laxative use is common, with daily laxative use reported in 10% of community-dwelling older adults and 50% of nursing home residents.

Stimulant laxatives, such as senna (brand name Senokot), can be used as a rescue agent to prompt a bowel movement. They work by stimulating the colon to squeeze and move things along more quickly. They can be used as a "rescue agent" (e.g. to prompt a bowel movement if there has been none for two days) or daily, if needed.

Senna is the fruit (pod) or leaf of the plant Senna alexandrina. It is approved in the US as a laxative for short-term treatment of constipation and is an FDA-approved over-the-counter (OTC) medicine. It should be taken at bedtime and tends to work within 6-12 hours. It might cause stomach upset and diarrhoea. Senna should not be used for more than 1 week without the supervision of a healthcare provider. It is likely safe for most adults when used for up to 1 week but is possibly unsafe when used for longer than 1 week or in doses above 34.4 mg sennosides twice daily. Long-term use can cause the bowels to stop functioning normally and might cause dependence on laxatives. It can also cause liver damage and other harmful effects.

Senna is most often used by adults in doses of 17.2 mg sennosides by mouth, once or twice daily. Recommended doses in children vary by age.

Bulking agents: psyllium (brand name Metamucil) must be taken with lots of water to avoid becoming impacted by the extra fibre

Bulking agents such as psyllium (brand name Metamucil) are a type of laxative that works by making the stool bigger. This is achieved by increasing the bulk of the stool, which in turn increases pressure, helping the muscles in the intestine to move the stool. The stool is also easier to pass because the pressure has been increased.

It is important to note that bulking agents must be taken with lots of water. This is because the psyllium husk in Metamucil readily absorbs water, so it is important to take the supplement with fluids. This can be done by dissolving the psyllium husk in water or juice, or blending it into a smoothie. If you drink fluids separately, you can also consume psyllium husk by adding it to food, for example, by incorporating it into a muffin recipe.

It is also important to be aware that Metamucil should not be taken for longer than one week unless advised by a doctor. Additionally, Metamucil may affect how medicines work, so it is recommended to take Metamucil at least two hours before or after taking any other medicines.

Metamucil is available in powder, capsule, and thin forms. The powder form is the most well-known and can be dissolved in water or juice, or added to food. The capsules and thins are more suitable for those with busy, on-the-go lifestyles.

Prescription medications: linaclotide (brand name Linzess) treats chronic idiopathic constipation and irritable bowel syndrome

Linaclotide, brand name Linzess, is a prescription medication used to treat chronic idiopathic constipation and irritable bowel syndrome with constipation (IBS-C) in adults. Idiopathic means that the cause of the constipation is unknown. It is not known if Linzess is safe and effective in children with functional constipation under the age of six or in children with IBS-C under the age of 18.

Linzess is a 14-amino acid peptide of the guanylin peptide family and acts as a selective agonist at the guanylate cyclase-C (GC-C) receptor on the luminal surface of intestinal enterocytes. The activation of GC-C by guanylin peptides, including linaclotide, results in increased levels of cyclic guanosine monophosphate (cGMP), a second messenger that plays a critical role in the regulation and secretion of intestinal fluid. Elevation of intracellular cGMP triggers the activation of cGMP protein kinase and subsequent phosphorylation of downstream targets, including the cystic fibrosis transmembrane conductance regulator (CFTR) ion channel. The activation of the CFTR channel results in increased secretion of chloride and bicarbonate ions into the intestinal lumen, culminating in increased intestinal fluid secretion and accelerated gastrointestinal transit.

In clinical trials of linaclotide, dose-dependent improvements in stool frequency were noted. Improved stool consistency was also observed, as measured by the Bristol Stool Form Scale (BSFS). Alleviation of abdominal pain and discomfort was demonstrated in rodent models and confirmed in clinical trials.

Linzess is available as 145-mcg and 290-mcg capsules. The approved dose of Linzess is one 290-mcg capsule once daily in adults with IBS-C and one 145-mcg capsule once daily in adults with chronic idiopathic constipation. It should be taken in the morning, 30 minutes before breakfast. Although Linzess has not been studied in patients with renal or hepatic impairment, these conditions are unlikely to affect the metabolism or clearance of the parent drug or metabolite because of the low systemic availability following oral administration. No dosage adjustments are needed.

Enema administration: older adults should avoid saline enemas; use warm water enemas or mineral oil enemas instead

Enema administration is a technique used to stimulate stool evacuation, usually to relieve constipation. It is a last resort for constipation treatment, and should only be used if diet and exercise are not enough to keep you regular. Laxatives may also be used before an enema administration to encourage waste flow.

There are several types of enemas, but for older adults, saline enemas should be avoided. Instead, use warm water enemas or mineral oil enemas. Warm water enemas may be needed to treat fecal impaction or prepare for a procedure. They are generally safer than soapy enemas, which can damage the lining of the colon.

Mineral oil enemas are considered a safer choice for older adults than phosphate enemas. They can be purchased over the counter and are recommended by healthcare providers. However, mineral oil enemas may cause oily leakage from the rectum and general rectal irritation.

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