Laxative Options: What Really Works?

Constipation is a common issue that can be uncomfortable and even painful. It occurs when you have fewer than three bowel movements in a week, and your stool is hard, dry, or painful to pass. To relieve constipation, laxatives are often used. These are substances that may help to soften stools and stimulate bowel movements.

There are several types of laxatives, including bulk-forming laxatives, which increase the size of stools; stool softeners, which pull water into the intestines to soften stools; lubricant laxatives, which coat the stool and make it slippery; osmotic laxatives, which pull water into the bowels to make bowel movements easier; and stimulant laxatives, which cause the intestines to contract and speed up stool movement.

Laxatives can be purchased over the counter in pharmacies, grocery stores, and online, and they are usually available without a prescription. However, it is important to use them correctly and not to overuse them, as this can lead to dependency and other health problems. Natural laxatives, such as dietary sources, oils, and fermented foods, can be a good alternative to over-the-counter laxatives. These include foods high in fibre, such as chia seeds, berries, legumes, and flaxseeds; probiotic and fermented foods like kefir and Greek yoghurt; oils like olive oil, castor oil, and coconut oil; and herbal laxatives such as senna, rhubarb, and psyllium.

Bulk-forming laxatives

Common bulk-forming laxatives include psyllium (Metamucil), polycarbophil (FiberCon), and methylcellulose (Citrucel). These laxatives are generally considered gentle and are the least likely to cause side effects. They are often the first line of defence before other types of laxatives are used. They are also preferred by some people because they usually bring about a more gradual improvement in constipation symptoms, and there is less risk of cramping or explosive diarrhoea.

However, it is important to note that bulk-forming laxatives should be taken with at least 8 ounces of water or fruit juice to prevent bowel obstruction. Staying well-hydrated throughout the day is also crucial. While generally safe, these laxatives may cause side effects like mild stomach pain, bloating, gas, and allergic reactions in some people. They can also impact how the body absorbs medications, so it is essential not to take any medication within two hours of consuming a bulk-forming laxative.

Stool softeners

The active ingredients in stool softeners are docusate sodium and docusate calcium. Colace is a common brand of docusate. Stool softeners are available in pill form, as tablets or capsules, or as a syrup or liquid. They can also come in the form of a rectal enema, which is injected directly into the rectum.

The best time to take a stool softener is usually at bedtime, following the directions on the packaging or as instructed by a healthcare provider. It can take between 12 to 72 hours for a stool softener to begin to work. They should not be taken for more than one week unless directed by a healthcare provider.

Side effects of stool softeners may include stomach pain, nausea, and diarrhoea. Most healthcare providers consider stool softeners safe to use, but if side effects become severe or persistent, it is important to consult a doctor.

Lubricant laxatives

Mineral oil is taken orally and should be consumed as directed by a doctor or according to the product package. It can interfere with the absorption of fat-soluble vitamins like vitamins A, D, E, and K, so it is recommended to take it on an empty stomach. It may take 6 to 8 hours for this type of laxative to cause a bowel movement. It is not recommended for older adults, children under 6, or bedridden individuals.

Osmotic laxatives

Other types of laxatives include:

• Emollient laxatives: These contain a surfactant called docusate, which increases the passage of water and fats into stools to make them softer.
• Lubricant laxatives: These are made with oily substances, like mineral oil, that make it easier for stool to slip through the intestine.
• Stimulant laxatives: These relieve constipation by causing the intestines to contract and push out stools.

Possible side effects of osmotic laxatives include dehydration, which can cause lightheadedness, headaches, and dark-coloured urine. Overuse of osmotic laxatives can also lead to the loss of electrolytes like sodium, calcium, and potassium.

Stimulant laxatives

It is important to note that stimulant laxatives should not be used for an extended period as they can lead to a loss of muscle tone in the colon, which may worsen constipation. Additionally, they may cause side effects such as bloating, gas, and stomach cramps. As with any medication, it is crucial to follow the instructions provided and not exceed the recommended dosage.

Some natural alternatives to stimulant laxatives include:

• Prunes and prune juice, which have high fiber and sorbitol content.
• Senna, a plant-derived laxative commonly found in over-the-counter products.
• Rhubarb, which contains sennoside A and has natural laxative effects.
• Magnesium citrate, an osmotic laxative that pulls water into the intestines to soften stools.

Frequently asked questions