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Laxative choice should fit the symptom
Laxative choice should fit the symptom Prevention is the key because it is typically easier to prevent constipation than it is to treat it.

Nearly everyone has had a bout with constipation during his/her lifetime. The most common cause of constipation is poor diet. However, medication side effects, pregnancy, and lack of exercise can also contribute to the problem. Constipation can leave you feeling bloated, irritable, and in pain. In some severe cases, it can cause bowel obstruction, which could lead to a medical emergency. Prevention is the key because it is typically easier to prevent constipation than it is to treat it.

Some laxatives are readily available over the counter and some are by prescription only. There are several different types. Each has its own distinct advantages and disadvantages.

Bulk-forming Laxatives
Bulk-forming laxatives are mainly fiber and fiber derivatives. These work by absorbing water into the intestinal tract. This action helps the colon to form a soft, “bulked-up” stool that stimulates the bowel to pass it in a normal manner.

These types of laxatives are available in a powder form (for example, Metamucil® or Citracel® which needs to be mixed with water or juice) or in capsule form (Fibercon®).

An advantage of the bulk-forming laxatives is that they have been shown to reduce cholesterol because the fiber “binds” cholesterol in the gut and aids in its elimination.

A disadvantage of these laxatives is that relief is not quick. It may take up to three days to see relief of constipation. Bulk-forming laxatives can also interfere with the absorption of oral medications and therefore administration must be separated by at least two hours to ensure proper absorption of the oral medication.

Lubricant Laxatives
Lubricant laxatives do exactly that; they lubricate the bowels and soften the stool. They “coat” the bowel walls and stool with a waterproof film, making it easier to pass. People who are confined to bed or those who cannot sit up should not use this type of laxative because there is risk of aspiration of oil particles into the lungs. These laxatives can also interfere with absorption of some vitamins and nutrients. An example of a lubricant laxative is mineral oil (Fleets® mineral oil).

Stool Softeners
Stool softeners soften the stool to ease its passage. These are most often used to prevent constipation rather than to treat it. Stool softeners are commonly given with narcotic pain medications and iron supplements to prevent the side effect of constipation in long-term users. Examples of stool softeners are docusate sodium (Colace®) and docusate calcium (Surfak®). In general, stool softeners are safe for treatment of constipation caused by pregnancy.

Osmotic Laxatives
Osmotic laxatives pull water into the bowels from surrounding tissues, softening the stool and stimulating elimination. There are two sub-types of osmotic laxatives: saline and lactose.

Saline laxatives
This type of laxative is typically used prior to procedures but is also used to treat occasional constipation. Saline laxatives act rapidly to evacuate the bowels. Examples of saline laxatives include magnesium citrate (Citromag®), Magnesium hydroxide (Milk of Magnesia®) and sodium phosphate (Fleet Phospho Soda®). However, saline laxatives contain large amounts of sodium, which can be a disadvantage.

Lactose laxatives
Lactose laxatives also pull water into the bowels but they do not act as rapidly as the saline laxatives, so they are often used for chronic constipation. Lactose laxatives include Lactulose® or Enulose® and polyethylene glycol (Miralax® or Glycolax®). This type of laxative is also used to help lower ammonia levels in the blood to treat certain chronic medical conditions.

Osmotic laxatives can cause a build-up of magnesium and phosphate, which can be dangerous for anyone with kidney problems.

Stimulant Laxatives
Stimulant laxatives act directly on the smooth muscle of the bowels to produce contractions and therefore stimulate evacuation. These types of laxatives are typically dosed orally at bedtime, with results expected in the morning. These are indicated ONLY for short-term relief of constipation and NOT for chronic constipation. Overuse of stimulant laxatives can result in the bowels dependence on the medication for evacuation. In other words, the bowels become lazy and won’t move without a laxative.

Stimulant laxatives are available in both an oral form and a suppository form. The oral form takes anywhere from six to twelve hours to be effective while the suppository form is much more rapid acting with results expected usually within thirty to sixty minutes. Examples of stimulant laxatives include bisacodyl (Dulcolax®) and Senna (Senokot®).

Stimulant laxatives can cause abdominal cramping and potentially, electrolyte imbalance. They should not be used for more than three consecutive days. There are many laxatives that are combinations of the above types, so always look at the active ingredients list on the label. Finally, laxatives should NEVER be used to assist weight loss because they do not prevent absorption of calories and abuse of laxatives can lead to serious, even deadly, health problems. The best prevention is dietary fiber intake and regular exercise.

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"Laxative choice should fit the symptom"
   authored by:
Tamara Dulin, R.Ph., is a registered pharmacist with Nightingale Home Health Care in Carmel, Indiana. A 1991 graduate of Butler University College of Pharmacy, she has spent the majority of her career in consulting. She is a past president of the Ind...

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