Ibs Laxatives: What Works?

Irritable Bowel Syndrome (IBS) is a common disorder that causes abdominal pain and a change in normal bowel habits. While laxatives can be a helpful treatment for IBS sufferers, they are typically considered a secondary treatment option. This is because long-term use of over-the-counter laxatives can lead to dependency and decrease the colon's ability to contract, which can worsen constipation.

There are two main types of laxatives: stimulant and osmotic. Stimulant laxatives, such as Dulcolax and Senokot, contain ingredients that encourage the muscles in the bowels to contract, aiding the passage of stool. However, they are not suitable for long-term use as they can cause damage to the bowel. Osmotic laxatives, such as Movicol and Normacol, work by drawing water into the bowel, loosening the contents and making it easier for stool to pass through the intestines. These laxatives can be bought over the counter or prescribed by a doctor. It is important to drink plenty of water when taking osmotic laxatives to avoid dehydration.

While laxatives can provide relief for IBS sufferers, it is recommended to first try dietary and lifestyle changes, such as increasing fibre intake and doing regular exercise. It is also important to consult with a doctor before taking laxatives to ensure they are the best treatment option for you.

Stimulant laxatives vs. osmotic laxatives

Overview

Stimulant laxatives and osmotic laxatives are two types of laxatives, which are medicines that treat constipation by softening stools or stimulating the bowels. While both types of laxatives can be effective in treating constipation, they work in different ways and have varying levels of suitability for long-term use, particularly for those with IBS.

How They Work

Stimulant laxatives contain ingredients that encourage the muscles in the bowels to contract, aiding the passage of stool through the bowel. On the other hand, osmotic laxatives work by drawing water from the body or the stool back into the bowel, softening the stool and making it easier to pass through the intestines.

Suitability for Long-Term Use

Osmotic laxatives are generally considered safe for long-term use and are often preferred over stimulant laxatives. This is because stimulant laxatives are not intended for long-term use as they can lose effectiveness over time and may even cause damage to the bowel. Additionally, stimulant laxatives may worsen abdominal pain and cramping associated with IBS.

Examples

Examples of stimulant laxatives include Dulcolax, castor oil, Senokot, and "sacred bark tea", which are mostly available over the counter. Common osmotic laxatives include polyethylene glycol (found in brands like Restoralax or Miralax), lactulose (found in brands like Generlac) and magnesium-based laxatives like milk of magnesia or magnesium citrate.

Precautions

It is important to consult a healthcare professional before taking any laxative, especially if you have IBS or other underlying health conditions. While osmotic laxatives are generally safer, overusing these medications may cause dehydration and electrolyte imbalances. Stimulant laxatives also carry risks, such as the potential for dependency and the need for higher doses over time.

The dangers of long-term laxative use

Laxatives are a type of medication used to treat constipation. However, they are sometimes misused as a weight-loss tool. While laxatives can be effective in providing short-term relief from constipation, they are not intended for long-term use and can lead to several health issues.

Firstly, long-term laxative use can lead to dependency, meaning that higher doses are required over time to produce the desired effect. This can result in an overstretched or lazy colon, which can cause colon cancer, irritable bowel syndrome, and other digestive problems. Additionally, the colon's ability to contract may be impaired, worsening constipation.

Secondly, laxative abuse can cause dehydration, as it leads to a loss of fluids and electrolytes from the body. Dehydration can have serious consequences, including tremors, weakness, blurry vision, fainting, and kidney damage. It is important to note that simply rehydrating may not be enough to counteract the effects of dehydration, as the body's nutrient balance can also be disrupted by laxative use, leading to disturbances in mineral balance.

Furthermore, laxatives can be tough on the body's organs, especially when abused or used excessively. The most important organs for survival may become impaired and unable to function properly, resulting in irreversible damage.

Laxatives can also cause unpleasant side effects, including diarrhoea, upset stomach, vomiting, stomach cramping, and increased constipation. Some types of laxatives can also cause vitamin deficiencies and interfere with the absorption of other medications.

It is important to note that laxatives are not a solution for weight loss or constipation. Instead, they can lead to a vicious cycle of abuse, with discontinuation leading to acute weight gain and reinforcing further misuse. If you or someone you know is struggling with laxative abuse, it is crucial to seek professional help as soon as possible to minimise the risk of physical consequences.

Natural alternatives to laxatives

Natural laxatives can be as effective as over-the-counter products at preventing constipation. They can be safe and inexpensive alternatives to over-the-counter products and have minimal side effects. Here are some natural alternatives to laxatives:

• Drink more water and stay hydrated. Water softens the stool and lubricates the digestive system.
• Eat more fibre, especially soluble, non-fermentable fibre. This increases the bulk and consistency of bowel movements, making them easier to pass. Good sources of fibre include whole-grain bread and cereals, fruits, vegetables, and beans.
• Drink coffee, especially caffeinated coffee. Coffee stimulates the muscles in the digestive system. However, people with IBS may find that coffee worsens their symptoms.
• Eat probiotic foods or take probiotic supplements. Probiotics are live, beneficial bacteria that naturally occur in the gut. Probiotics may help treat chronic constipation by improving the balance of gut bacteria.
• Drink peppermint tea. Peppermint has been shown to help reduce IBS symptoms, including abdominal pain, diarrhea, bloating, and constipation.
• Exercise regularly. Exercise has been shown to help ease IBS symptoms, including constipation.
• Eat chia seeds. Chia seeds are high in fibre, containing 9.6 g in just 1 ounce (28.4 g).
• Eat flaxseeds. Flaxseeds have natural laxative properties and contain a good mix of both soluble and insoluble fibre.
• Eat leafy greens, such as spinach, kale, and cabbage. Leafy greens are rich in magnesium, which helps draw water into the intestines to help pass stools.
• Eat prunes. Prunes contain sorbitol, a sugar alcohol that has a laxative effect.

Prescription laxatives

In addition to these prescription laxatives, doctors may also prescribe low doses of antidepressants to treat IBS. Antidepressants can block the brain's perception of pain in the gut. Selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac), and paroxetine (Paxil) are commonly used. Their side effects may include nausea, loss of appetite, and diarrhoea.

It is important to consult a doctor before taking any laxatives, as they can have side effects and may not be suitable for long-term use.

The best laxatives for constipation relief

While laxatives can help with constipation, they are typically considered a secondary treatment option for IBS. This is because long-term use of over-the-counter laxatives can lead to dependency and decrease your colon's ability to contract, which can worsen constipation. It's important to consult a doctor before taking laxatives, especially if you have IBS.

Stimulant laxatives

Stimulant laxatives are available over the counter and include bisacodyl (Correctol, Dulcolax), sennosides (Ex-Lax, Senokot), castor oil, and the plant cascara. These laxatives trigger muscle contractions in the bowels, moving stool through. However, they can cause side effects such as diarrhoea, upset stomach, vomiting, and stomach cramping. They are not suitable for long-term use and may cause damage to the bowel.

Osmotic laxatives

Osmotic laxatives can be bought over the counter or prescribed by a doctor. They work by drawing water into the colon to soften stool, making it easier to pass. Examples include milk of magnesia, polyethylene glycol (Miralax), magnesium citrate, sorbitol, and lactulose. Osmotic laxatives are considered fairly safe for long-term use for some people with IBS-C, but they can cause side effects such as diarrhoea, dehydration, and bloating. It is important to drink plenty of water when taking these laxatives to avoid dehydration.

Lubricant/emollient laxatives

Some people use mineral oil as a laxative, but healthcare providers advise against this as there are safer alternatives. Long-term use of mineral oil may lead to nutritional deficiencies and other problems such as leakage from the anus.

Frequently asked questions