Laxatives

Laxatives are products that promote bowel movements, and are used to treat constipation (the passage of hard, dry stools). People who are constipated mayfind it difficult and even painful to have bowel movements. They may also feel bloated, sluggish, and generally uncomfortable and may have other symptomssuch as a dull headache and low back pain. However, these symptoms don't always mean that laxatives are necessary. A great deal of misunderstanding existsabout their use. A range of normal bowel habits exist, depending on the individual and the person's diet. Some people have bowel movements as often as three times a day, some only three times a week; anything within this range isconsidered normal. In addition, some people's stools are naturally firmer than others.

Occasional constipation can often be treated without laxatives. Increasing the amount of fiber in the diet, drinking plenty of water and other liquids (such as fruit and vegetable juices), exercising regularly, and setting aside time every day to have a bowel movement are the first steps. These measures will also help prevent constipation from occurring again.

If these methods don't relieve the problem, a doctor may suggest using a laxative for a limited time. A doctor should always be the one to decide when a laxative is needed and which type of laxative should be used.

Laxatives come in various forms -- liquids, tablets, suppositories, powders,granules, capsules, chewing gum, chocolate-flavored wafers, and caramels. Thebasic types include bulk-forming products, lubricants, stool softeners (alsocalled emollient laxatives), and stimulant laxatives.

Bulk-forming laxatives contain materials like cellulose and psyllium that pass through the digestive tract without being digested. In the intestines, these materials absorb liquid and swell, making the stool soft, bulky, and easierto pass. The bulky stool then stimulates the bowel to move. Laxatives in this group include such brands as FiberCon, Fiberall, and Metamucil.

Mineral oil is the mostly widely used lubricant laxative. Taken by mouth, theoil coats the stool. This keeps the stool moist and soft and makes it easierto pass. Lubricant laxatives are often used for patients who need to avoid straining, such as after abdominal surgery.

Stool softeners such as docusate (Colace, Sof-Lax) make stools softer and easier to pass by increasing their moisture content. This type of laxative doesn't really stimulate a bowel movement, but makes it possible to have bowel movements without straining. Stool softeners are best used to prevent constipation in people who need to avoid straining. However, they are not very effective at treating existing constipation.

Ingredients in stimulant laxatives (Correctol or Senokot) trigger the actionof muscles and nerves in the intestines to help move stool along. Although these laxatives are popular and effective, they should be used with care, as they are more likely than other types to cause side effects. They may also workmore quickly and powerfully than other laxatives.

Laxatives are among the most widely misused over-the-counter medicines. The overuse of laxatives can lead the body to depend on them. When used regularlyover a long time, laxatives can damage nerve cells in the colon, causing thecolon to lose its natural ability to contract. This makes constipation worse.In addition, overuse of certain laxatives can weaken the bones and cause other serious problems. Because of these possible problems, patients should notuse laxatives unless told to do so by a doctor. If a laxative is prescribed,it should be used only as directed.

Occasional, temporary constipation is usually caused by an improper diet, toolittle exercise, changes in daily routines, or the use of certain medicinessuch as pain relievers, antidepressant drugs, or diuretics (water pills). Constipation also can be caused by a number of diseases. A doctor should be consulted for any of the following symptoms:

  • Persistent constipation in aperson who has always had regular bowel movements
  • Constipation thatdoesn't get better with the proper use of laxatives
  • Rectal bleedingor blood in the stool
  • Pain when having a bowel movement
  • Loss of appetite or unexplained weight loss
  • Bloating that continues orgets worse
  • Nausea
  • Vomiting
  • Continuing abdominal pain or cramps
  • Sores or irritation in the anal area.

Patients should not combine stool softeners (such as Colace) and lubricant laxatives (such as mineral oil) at the same time; this may cause unwanted sideeffects, such as watery diarrhea.

People whose gag reflexes don't work properly (such as those who have had strokes) should not use mineral oil laxatives. They may inhale small amounts ofmineral oil, which could lead to inflammation of the lungs and possible pneumonia.

Some types of laxatives contain large amounts of sugar. People who have diabetes or who must limit their intake of sugar or other carbohydrates should read package labels carefully or check with a pharmacist before using laxatives.Bulk-forming laxatives must be taken with at least 8 oz. of water or other liquid; otherwise, it may form a mass that can block the throat, esophagus, orbowel. Anyone who develops a skin rash while taking a laxative should stop taking it immediately and call a physician.

Older people are especially likely to have constipation, and need to be careful not to overuse laxatives. Instead, older individuals should manage their constipation with proper diet and exercise. When laxatives are necessary, thebulk-forming types (such as FiberCon and Metamucil) are best for older people. Stimulants and lubricants should be avoided.

Bowel habits vary in children, as they do in adults, but in general childrenshould not be given laxatives unless a doctor has directed it.

People with certain medical conditions or who are taking certain other medicines can have problems if they take laxatives. People who are sensitive to psyllium or who have respiratory disorders may have severe reactions if they inhale dry particles of psyllium (found in some bulk-forming laxatives, such asMetamucil). The risk of this problem can be reduced by using a spoon to add the powder to liquid in a glass, rather than pouring the powder directly fromthe container. Anyone who has had unusual reactions to laxatives in the pastshould tell the doctor before taking the drugs again. Pregnant women should also be careful about taking laxatives; bulk-forming products (such as Metamucil and FiberCon) and stool softeners (such as Colace) are the only kinds recommended for pregnant women. Stimulants and lubricants should be avoided. Because some kinds of laxatives may pass into breast milk, breastfeeding mothersshould check with their doctors before using laxatives.

Before using laxatives, people with any of these medical problems should makesure their physicians are aware of their conditions:

  • Kidney disease
  • Past or present gastrointestinal surgery or disease
  • Abnormally high amount of calcium in the blood (hypercalcemia)
  • Throat problems
  • Swallowing problems
  • Partial bowel obstruction.

Taking laxatives with other drugs may affect the way the medicine works or may increase the chance of side effects. Recommended dosage depends on the typeof laxative, but patients should always take laxatives exactly as the doctordirects or as the package label directs. Patients should never take larger or more frequent doses, or take the drug for longer than directed.

Serious side effects aren't common, but may occur. Patients should check witha doctor if any of the following side effects occur:

  • Skin rash
  • Confusion
  • Unusual tiredness or weakness
  • Irregular heartbeat
  • Muscle cramps

Less common side effects, such as cramping, diarrhea, nausea, belching, throat irritation, or skin irritation around the rectal area also may occur and don't need medical attention unless they don't go away or they interfere with normal activities. Other rare side effects are possible. Anyone who has unusual symptoms after taking laxatives should get in touch with a doctor.

Some laxatives may make it more difficult for the body to absorb other medicines taken by mouth. For example, bulk-forming laxatives may interfere with the absorption of aspirin, the blood-thinning anticoagulant drug warfarin (Coumadin), digitalis drugs, and other drugs. Other types of laxatives such as Colace boost the absorption of other drugs taken by mouth. The stimulant laxative Correctol should not be taken with drugs that reduce stomach acid, such ascimetidine (Tagamet), ranitidine (Zantac), or omeprazole (Prilosec). This drug also should not be taken within one hour of drinking milk. Anyone who is taking any other medicines should check with a doctor or pharmacist before using a laxative.

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