Laxative
Encyclopedia
Laxatives are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool
, most often taken to treat constipation
. Certain stimulant, lubricant, and saline laxatives are used to evacuate the colon
for rectal
and/or bowel examinations, and may be supplemented by enema
s under certain circumstances. Sufficiently high doses of laxatives cause diarrhea
.
Laxatives work to increase the movement of fecal matter along the colon
.
Some laxatives combine more than one active ingredient to produce a combination of the effects. Laxatives may be oral or in suppository
form.
Also known as bulking agents or roughage, these include dietary fibre. Bulk-producing agents cause the stool to be bulkier and to retain more water, as well as forming an emollient gel, making it easier for peristaltic action
to move it along. They should be taken with plenty of water. Bulk-producing agents have the gentlest of effects among laxatives and can be taken just for maintaining regular bowel movements.
These enable additional water and fats to be incorporated in the stool, making it easier to move.
These simply make the stool slippery, so that it slides through the intestine more easily. An example is mineral oil
, which also retards colonic absorption of water, softening the stool. Mineral oil may decrease the absorption of fat-soluble vitamins and some minerals.
Saline laxatives attract and retain water in the intestinal lumen, increasing intraluminal pressure and thus softening the stool. They also cause the release of cholecystokinin
, which stimulates the digestion of fat and protein. Saline laxatives may alter a patient's fluid and electrolyte balance.
Lactulose works by the osmotic effect, which retains water in the colon, lowering the pH
through bacterial fermentation to lactic, formic and acetic acid, and increasing colonic peristalsis
. Lactulose is also indicated in Portal-systemic encephalopathy
. Glycerin suppositories work mostly by hyperosmotic action, but also the sodium stearate in the preparation causes local irritation to the colon.
Solutions of polyethylene glycol and electrolytes (sodium chloride
, sodium bicarbonate
, potassium chloride
, and sometimes sodium sulfate
) are used for whole bowel irrigation
, a process designed to prepare the bowel for surgery or colonoscopy
and to treat certain types of poison
ing. Brand names for these solutions include GoLytely, GlycoLax, CoLyte, Miralax, NuLytely, and others.
found PEG
[MiraLax or GlycoLax] 17 grams once per day to be superior to tegaserod
at 6 mg twice per day. A randomized controlled trial
found greater improvement from 2 sachets (26 grams) of PEG
versus 2 sachets (20 grams) of lactulose
. 17 grams/day of PEG
has been effective and safe in a randomized controlled trial
for six months. Another randomized controlled trial
found no difference between sorbitol
and lactulose
.
For children, PEG
was found to be more effective than lactulose
.
, altering water and electrolyte
secretion. They also stimulate peristaltic action
and can be dangerous under certain circumstances. They are the most severe among laxatives and should be used with care.
is a motility stimulant that works through activation of 5-HT4
receptors of the enteric nervous system
in the gastrointestinal tract
. However caution must be taken due to potentially harmful cardiovascular side-effects.
Zelnorm (market name for Tegaserod
) was discontinued from marketing in the United States on March 30, 2007 but is still available for prescription under tight controls.
(IBS), pancreatitis
, renal failure
, and other problems, even though recovery is possible with proper treatment.
.
the patient abuses laxatives to get rid of calories, to purge food in the intestines before it becomes digested and absorbed by the body. This will not work, because laxatives hasten the elimination of undigested remains of food in the large intestine and colon. The large intestine and colon do not digest food. They just collect the undigested remains and hold it and absorb water until it is defaecated. Weight loss may be felt, but this is only temporary due to the fact that the person has expelled much of the fluids from their body. The common question of whether or not chronic diarrhea
associated with laxative use can promote some degree of true weight loss remains unknown. In any case, this type of laxative misuse causes water to be lost more rapidly than is healthy, potentially leading to dehydration
and electrolyte imbalance. Prolonged usage of laxatives will actually cause constipation
. The sensation of bloating can be significant due to excessive water retention
, leading to people with eating disorders to increase the dosage of the laxatives, resulting in dependency and further complicating the constipation. Abusing stimulant-type laxatives can lead to permanent impairment of the bowels, and the constipation problem becomes irreversible. In addition, blood can develop in stools, and excessive blood loss can result in anemia
. Patients recovering from laxative abuse often have several months of problematic water retention, resulting in temporary weight gain
(not noticeable on the exterior), and sometimes "pitting" edema
(in which pressing on the skin leaves an indentation).
Feces
Feces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus or cloaca during defecation.-Etymology:...
, most often taken to treat constipation
Constipation
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...
. Certain stimulant, lubricant, and saline laxatives are used to evacuate the colon
Colon (anatomy)
The colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...
for rectal
Rectum
The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
and/or bowel examinations, and may be supplemented by enema
Enema
An enema is the procedure of introducing liquids into the rectum and colon via the anus. The increasing volume of the liquid causes rapid expansion of the lower intestinal tract, often resulting in very uncomfortable bloating, cramping, powerful peristalsis, a feeling of extreme urgency and...
s under certain circumstances. Sufficiently high doses of laxatives cause diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
.
Laxatives work to increase the movement of fecal matter along the colon
Colon (anatomy)
The colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...
.
Some laxatives combine more than one active ingredient to produce a combination of the effects. Laxatives may be oral or in suppository
Suppository
A suppository is a drug delivery system that is inserted into the rectum , vagina or urethra , where it dissolves.They are used to deliver both systemically-acting and locally-acting medications....
form.
Foods
Some foods can be eaten to cure constipation and act as laxatives, although the effectiveness may vary. These include:- AlmondAlmondThe almond , is a species of tree native to the Middle East and South Asia. Almond is also the name of the edible and widely cultivated seed of this tree...
s - Aloe veraAloe veraAloe vera, pronounced , also known as the true aloe or medicinal aloe, is a species of succulent plant in the genus Aloe that is believed to have originated in the Sudan. Aloe vera grows in arid climates and is widely distributed in Africa, India, Nepal and other arid areas.The species is...
- Apple juiceApple juiceApple juice is a fruit juice manufactured by the maceration and pressing of apples. The resulting expelled juice may be further treated by enzymatic and centrifugal clarification to remove the starch and pectin, which holds fine particulate in suspension, and then pasteurized for packaging in...
- ApricotApricotThe apricot, Prunus armeniaca, is a species of Prunus, classified with the plum in the subgenus Prunus. The native range is somewhat uncertain due to its extensive prehistoric cultivation.- Description :...
s - BasilBasilBasil, or Sweet Basil, is a common name for the culinary herb Ocimum basilicum , of the family Lamiaceae , sometimes known as Saint Joseph's Wort in some English-speaking countries....
- BeetBeetThe beet is a plant in the Chenopodiaceae family which is now included in Amaranthaceae family. It is best known in its numerous cultivated varieties, the most well known of which is the purple root vegetable known as the beetroot or garden beet...
s - BananaBananaBanana is the common name for herbaceous plants of the genus Musa and for the fruit they produce. Bananas come in a variety of sizes and colors when ripe, including yellow, purple, and red....
- Cactus fruit
- Carob
- CapsicumCapsicumCapsicum is a genus of flowering plants in the nightshade family, Solanaceae. Its species are native to the Americas where they have been cultivated for thousands of years, but they are now also cultivated worldwide, used as spices, vegetables, and medicines - and have become are a key element in...
- CeleryCeleryApium graveolens is a plant species in the family Apiaceae commonly known as celery or celeriac , depending on whether the petioles or roots are eaten: celery refers to the former and celeriac to the latter. Apium graveolens grows to 1 m tall...
- ChicoryChicoryCommon chicory, Cichorium intybus, is a somewhat woody, perennial herbaceous plant usually with bright blue flowers, rarely white or pink. Various varieties are cultivated for salad leaves, chicons , or for roots , which are baked, ground, and used as a coffee substitute and additive. It is also...
- CoconutCoconutThe coconut palm, Cocos nucifera, is a member of the family Arecaceae . It is the only accepted species in the genus Cocos. The term coconut can refer to the entire coconut palm, the seed, or the fruit, which is not a botanical nut. The spelling cocoanut is an old-fashioned form of the word...
- CoffeeCoffeeCoffee is a brewed beverage with a dark,init brooo acidic flavor prepared from the roasted seeds of the coffee plant, colloquially called coffee beans. The beans are found in coffee cherries, which grow on trees cultivated in over 70 countries, primarily in equatorial Latin America, Southeast Asia,...
- Dandelion
- Dates
- EndiveEndiveEndive , Cichorium endivia, is a leaf vegetable belonging to the daisy family. Endive can be cooked or used raw in salads.-Background:Endive is also a common name for some types of chicory...
- FenugreekFenugreekFenugreek is a plant in the family Fabaceae. Fenugreek is used both as a herb and as a spice . The leaves and sprouts are also eaten as vegetables...
- Flaxseed
- GrapeGrapeA grape is a non-climacteric fruit, specifically a berry, that grows on the perennial and deciduous woody vines of the genus Vitis. Grapes can be eaten raw or they can be used for making jam, juice, jelly, vinegar, wine, grape seed extracts, raisins, molasses and grape seed oil. Grapes are also...
s - GuavaGuavaGuavas are plants in the myrtle family genus Psidium , which contains about 100 species of tropical shrubs and small trees. They are native to Mexico, Central America, and northern South America...
(with seeds for full effect) - JujubeJujubeZiziphus zizyphus , commonly called jujube , red date, Chinese date, Korean date, or Indian date is a species of Ziziphus in the buckthorn family Rhamnaceae, used primarily as a fruiting shade tree.-Distribution:Its precise natural distribution is uncertain due to extensive cultivation,...
- KaleKaleKale is very high in beta carotene, vitamin K, vitamin C, lutein, zeaxanthin, and reasonably rich in calcium. Kale, as with broccoli and other brassicas, contains sulforaphane , a chemical with potent anti-cancer properties. Boiling decreases the level of sulforaphane; however, steaming,...
- KiwifruitKiwifruitThe kiwifruit, often shortened to kiwi in many parts of the world, is the edible berry of a cultivar group of the woody vine Actinidia deliciosa and hybrids between this and other species in the genus Actinidia....
- Liquorice
- MangoMangoThe mango is a fleshy stone fruit belonging to the genus Mangifera, consisting of numerous tropical fruiting trees in the flowering plant family Anacardiaceae. The mango is native to India from where it spread all over the world. It is also the most cultivated fruit of the tropical world. While...
- MintMenthaMentha is a genus of flowering plants in the family Lamiaceae . The species are not clearly distinct and estimates of the number of species varies from 13 to 18. Hybridization between some of the species occurs naturally...
- MolassesMolassesMolasses is a viscous by-product of the processing of sugar cane, grapes or sugar beets into sugar. The word molasses comes from the Portuguese word melaço, which ultimately comes from mel, the Latin word for "honey". The quality of molasses depends on the maturity of the sugar cane or sugar beet,...
- Olive oilOlive oilOlive oil is an oil obtained from the olive , a traditional tree crop of the Mediterranean Basin. It is commonly used in cooking, cosmetics, pharmaceuticals, and soaps and as a fuel for traditional oil lamps...
- Orange juiceOrange (fruit)An orange—specifically, the sweet orange—is the citrus Citrus × sinensis and its fruit. It is the most commonly grown tree fruit in the world....
- PapayaPapayaThe papaya , papaw, or pawpaw is the fruit of the plant Carica papaya, the sole species in the genus Carica of the plant family Caricaceae...
- ParsleyParsleyParsley is a species of Petroselinum in the family Apiaceae, native to the central Mediterranean region , naturalized elsewhere in Europe, and widely cultivated as an herb, a spice and a vegetable.- Description :Garden parsley is a bright green hairless biennial herbaceous plant in temperate...
- PeachPeachThe peach tree is a deciduous tree growing to tall and 6 in. in diameter, belonging to the subfamily Prunoideae of the family Rosaceae. It bears an edible juicy fruit called a peach...
- PearPearThe pear is any of several tree species of genus Pyrus and also the name of the pomaceous fruit of these trees. Several species of pear are valued by humans for their edible fruit, but the fruit of other species is small, hard, and astringent....
- PersimmonPersimmonA persimmon is the edible fruit of a number of species of trees in the genus Diospyros in the ebony wood family . The word Diospyros means "the fire of Zeus" in ancient Greek. As a tree, it is a perennial plant...
- PineapplePineapplePineapple is the common name for a tropical plant and its edible fruit, which is actually a multiple fruit consisting of coalesced berries. It was given the name pineapple due to its resemblance to a pine cone. The pineapple is by far the most economically important plant in the Bromeliaceae...
- PlumPlumA plum or gage is a stone fruit tree in the genus Prunus, subgenus Prunus. The subgenus is distinguished from other subgenera in the shoots having a terminal bud and solitary side buds , the flowers in groups of one to five together on short stems, and the fruit having a groove running down one...
- PrunePruneA prune is any of various plum cultivars, mostly Prunus domestica or European Plum, sold as fresh or dried fruit. The dried fruit is also referred to as a dried plum...
and prune juice - RhubarbRhubarbRhubarb is a group of plants that belong to the genus Rheum in the family Polygonaceae. They are herbaceous perennial plants growing from short, thick rhizomes. They have large leaves that are somewhat triangular-shaped with long fleshy petioles...
- Senna (genus)Senna (genus)Senna , the sennas, is a large genus of flowering plants in the family Fabaceae, subfamily Caesalpinioideae. This diverse genus is native throughout the tropics, with a small number of species reaching into temperate regions. The number of species is usually estimated to be about 260, but some...
- SoybeanSoybeanThe soybean or soya bean is a species of legume native to East Asia, widely grown for its edible bean which has numerous uses...
- TamarindTamarindTamarind is a tree in the family Fabaceae. The genus Tamarindus is monotypic .-Origin:...
- TeaTeaTea is an aromatic beverage prepared by adding cured leaves of the Camellia sinensis plant to hot water. The term also refers to the plant itself. After water, tea is the most widely consumed beverage in the world...
- Tomato juiceTomato juiceTomato juice is a juice made from tomatoes. It is usually used as a beverage, either plain or in cocktails such as a Bloody Mary or Michelada.-History:...
- VanillaVanillaVanilla is a flavoring derived from orchids of the genus Vanilla, primarily from the Mexican species, Flat-leaved Vanilla . The word vanilla derives from the Spanish word "", little pod...
- WalnutWalnutJuglans is a plant genus of the family Juglandaceae, the seeds of which are known as walnuts. They are deciduous trees, 10–40 meters tall , with pinnate leaves 200–900 millimetres long , with 5–25 leaflets; the shoots have chambered pith, a character shared with the wingnuts , but not the hickories...
- WatercressWatercressWatercresses are fast-growing, aquatic or semi-aquatic, perennial plants native from Europe to central Asia, and one of the oldest known leaf vegetables consumed by human beings...
- YamYam (vegetable)Yam is the common name for some species in the genus Dioscorea . These are perennial herbaceous vines cultivated for the consumption of their starchy tubers in Africa, Asia, Latin America and Oceania...
Bulk-producing agents
- Site of Action: Small and large intestine
- Onset of Action: 12–72 hours
- Examples: Bran, Gamkaraya, Sterculia[Normacol], psylliumPsylliumPsyllium , or Ispaghula , is the common name used for several members of the plant genus Plantago whose seeds are used commercially for the production of mucilage.-History:...
husk (MetamucilMetamucilMetamucil is a bulk-producing laxative and fiber supplement. The Metamucil brand has existed since 1934, and was owned by G.D. Searle & Company until 1985 when Procter & Gamble acquired the brand. The active ingredient is psyllium seed husks. It may also reduce cholesterol when taken daily....
), methylcellulose (Citrucel), polycarbophilPolycarbophilPolycarbophil calcium is a drug used as a stool stabilizer. Chemically, it is a synthetic polymer the calcium salt of polyacrylic acid cross-linked with divinyl glycol.-Clinical uses:...
, dietary fibre, apples, broccoli, prunes.
Also known as bulking agents or roughage, these include dietary fibre. Bulk-producing agents cause the stool to be bulkier and to retain more water, as well as forming an emollient gel, making it easier for peristaltic action
Peristalsis
Peristalsis is a radially symmetrical contraction and relaxation of muscles which propagates in a wave down the muscular tube, in an anterograde fashion. In humans, peristalsis is found in the contraction of smooth muscles to propel contents through the digestive tract. Earthworms use a similar...
to move it along. They should be taken with plenty of water. Bulk-producing agents have the gentlest of effects among laxatives and can be taken just for maintaining regular bowel movements.
Stool softeners
- Site of Action: Small and large intestine
- Onset of Action: 12–72 hours
- Examples: docusate (Colace, Diocto)
These enable additional water and fats to be incorporated in the stool, making it easier to move.
Lubricants or emollient
- Site of Action: Colon
- Onset of Action: 6–8 hours
These simply make the stool slippery, so that it slides through the intestine more easily. An example is mineral oil
Mineral oil
A mineral oil is any of various colorless, odorless, light mixtures of alkanes in the C15 to C40 range from a non-vegetable source, particularly a distillate of petroleum....
, which also retards colonic absorption of water, softening the stool. Mineral oil may decrease the absorption of fat-soluble vitamins and some minerals.
Hydrating agents (osmotics)
These cause the intestines to hold more water within, softening the stool. There are two principal types, saline and hyperosmotic.Saline
- Site of Action: Small and large intestine
- Onset of Action: 0.5–6 hours
- Examples: sodium phosphate (and variants), potassium sodium tartrarate, magnesium citrateMagnesium citrateMagnesium citrate, a magnesium salt of citric acid, is a chemical agent used medicinally as a saline laxative and to completely empty the bowel prior to a major surgery or colonoscopy. It is available without a prescription, both as a generic brand or under the brand name Citromag or Citroma. It is...
, magnesium hydroxideMagnesium hydroxideMagnesium hydroxide is an inorganic compound with the chemical formula Mg2. As a suspension in water, it is often called milk of magnesia because of its milk-like appearance. The solid mineral form of magnesium hydroxide is known as brucite....
(Milk of magnesia or Cream of magnesia), magnesium sulfateMagnesium sulfateMagnesium sulfate is a chemical compound containing magnesium, sulfur and oxygen, with the formula MgSO4. It is often encountered as the heptahydrate epsomite , commonly called Epsom salt, from the town of Epsom in Surrey, England, where the salt was distilled from the springs that arise where the...
(which is Epsom salt).
Saline laxatives attract and retain water in the intestinal lumen, increasing intraluminal pressure and thus softening the stool. They also cause the release of cholecystokinin
Cholecystokinin
Cholecystokinin is a peptide hormone of the gastrointestinal system responsible for stimulating the digestion of fat and protein...
, which stimulates the digestion of fat and protein. Saline laxatives may alter a patient's fluid and electrolyte balance.
Hyperosmotic agents
- Site of Action: Colon
- Onset of Action: 0.5–3 hours
- Examples: Glycerin suppositoriesSuppositoryA suppository is a drug delivery system that is inserted into the rectum , vagina or urethra , where it dissolves.They are used to deliver both systemically-acting and locally-acting medications....
, sorbitolSorbitolSorbitol, also known as glucitol, Sorbogem® and Sorbo®, is a sugar alcohol that the human body metabolizes slowly. It can be obtained by reduction of glucose, changing the aldehyde group to a hydroxyl group. Sorbitol is found in apples, pears, peaches, and prunes...
, lactuloseLactuloseLactulose is a synthetic, non-digestible sugar used in the treatment of chronic constipation and hepatic encephalopathy, a complication of liver disease. It is a disaccharide formed from one molecule each of the simple sugars fructose and galactose...
, and polyethylene glycolPolyethylene glycolPolyethylene glycol is a polyether compound with many applications from industrial manufacturing to medicine. It has also been known as polyethylene oxide or polyoxyethylene , depending on its molecular weight, and under the tradename Carbowax.-Available forms:PEG, PEO, or POE refers to an...
(PEG).
Lactulose works by the osmotic effect, which retains water in the colon, lowering the pH
PH
In chemistry, pH is a measure of the acidity or basicity of an aqueous solution. Pure water is said to be neutral, with a pH close to 7.0 at . Solutions with a pH less than 7 are said to be acidic and solutions with a pH greater than 7 are basic or alkaline...
through bacterial fermentation to lactic, formic and acetic acid, and increasing colonic peristalsis
Peristalsis
Peristalsis is a radially symmetrical contraction and relaxation of muscles which propagates in a wave down the muscular tube, in an anterograde fashion. In humans, peristalsis is found in the contraction of smooth muscles to propel contents through the digestive tract. Earthworms use a similar...
. Lactulose is also indicated in Portal-systemic encephalopathy
Hepatic encephalopathy
Hepatic encephalopathy is the occurrence of confusion, altered level of consciousness and coma as a result of liver failure. In the advanced stages it is called hepatic coma or coma hepaticum...
. Glycerin suppositories work mostly by hyperosmotic action, but also the sodium stearate in the preparation causes local irritation to the colon.
Solutions of polyethylene glycol and electrolytes (sodium chloride
Sodium chloride
Sodium chloride, also known as salt, common salt, table salt or halite, is an inorganic compound with the formula NaCl. Sodium chloride is the salt most responsible for the salinity of the ocean and of the extracellular fluid of many multicellular organisms...
, sodium bicarbonate
Sodium bicarbonate
Sodium bicarbonate or sodium hydrogen carbonate is the chemical compound with the formula Na HCO3. Sodium bicarbonate is a white solid that is crystalline but often appears as a fine powder. It has a slightly salty, alkaline taste resembling that of washing soda . The natural mineral form is...
, potassium chloride
Potassium chloride
The chemical compound potassium chloride is a metal halide salt composed of potassium and chlorine. In its pure state, it is odorless and has a white or colorless vitreous crystal appearance, with a crystal structure that cleaves easily in three directions. Potassium chloride crystals are...
, and sometimes sodium sulfate
Sodium sulfate
Sodium sulfate is the sodium salt of sulfuric acid. When anhydrous, it is a white crystalline solid of formula Na2SO4 known as the mineral thenardite; the decahydrate Na2SO4·10H2O has been known as Glauber's salt or, historically, sal mirabilis since the 17th century. Another solid is the...
) are used for whole bowel irrigation
Whole bowel irrigation
Whole bowel irrigation is a medical process involving the rapid administration of large volumes of an osmotically balanced polyethylene glycol solution , either orally or via a nasogastric tube, to flush out the entire gastrointestinal tract.-History:Whole bowel irrigation was originally developed...
, a process designed to prepare the bowel for surgery or colonoscopy
Colonoscopy
Colonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It may provide a visual diagnosis and grants the opportunity for biopsy or removal of suspected...
and to treat certain types of poison
Poison
In the context of biology, poisons are substances that can cause disturbances to organisms, usually by chemical reaction or other activity on the molecular scale, when a sufficient quantity is absorbed by an organism....
ing. Brand names for these solutions include GoLytely, GlycoLax, CoLyte, Miralax, NuLytely, and others.
Effectiveness
For adults, a randomized controlled trialRandomized controlled trial
A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...
found PEG
Polyethylene glycol
Polyethylene glycol is a polyether compound with many applications from industrial manufacturing to medicine. It has also been known as polyethylene oxide or polyoxyethylene , depending on its molecular weight, and under the tradename Carbowax.-Available forms:PEG, PEO, or POE refers to an...
[MiraLax or GlycoLax] 17 grams once per day to be superior to tegaserod
Tegaserod
Tegaserod is a 5-HT4 agonist manufactured by Novartis and sold under the name Zelnorm for the management of irritable bowel syndrome and constipation. Approved by the FDA in 2002, it was subsequently removed from the market in 2007 due to FDA concerns about possible adverse cardiovascular effects...
at 6 mg twice per day. A randomized controlled trial
Randomized controlled trial
A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...
found greater improvement from 2 sachets (26 grams) of PEG
Polyethylene glycol
Polyethylene glycol is a polyether compound with many applications from industrial manufacturing to medicine. It has also been known as polyethylene oxide or polyoxyethylene , depending on its molecular weight, and under the tradename Carbowax.-Available forms:PEG, PEO, or POE refers to an...
versus 2 sachets (20 grams) of lactulose
Lactulose
Lactulose is a synthetic, non-digestible sugar used in the treatment of chronic constipation and hepatic encephalopathy, a complication of liver disease. It is a disaccharide formed from one molecule each of the simple sugars fructose and galactose...
. 17 grams/day of PEG
Polyethylene glycol
Polyethylene glycol is a polyether compound with many applications from industrial manufacturing to medicine. It has also been known as polyethylene oxide or polyoxyethylene , depending on its molecular weight, and under the tradename Carbowax.-Available forms:PEG, PEO, or POE refers to an...
has been effective and safe in a randomized controlled trial
Randomized controlled trial
A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...
for six months. Another randomized controlled trial
Randomized controlled trial
A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...
found no difference between sorbitol
Sorbitol
Sorbitol, also known as glucitol, Sorbogem® and Sorbo®, is a sugar alcohol that the human body metabolizes slowly. It can be obtained by reduction of glucose, changing the aldehyde group to a hydroxyl group. Sorbitol is found in apples, pears, peaches, and prunes...
and lactulose
Lactulose
Lactulose is a synthetic, non-digestible sugar used in the treatment of chronic constipation and hepatic encephalopathy, a complication of liver disease. It is a disaccharide formed from one molecule each of the simple sugars fructose and galactose...
.
For children, PEG
Polyethylene glycol
Polyethylene glycol is a polyether compound with many applications from industrial manufacturing to medicine. It has also been known as polyethylene oxide or polyoxyethylene , depending on its molecular weight, and under the tradename Carbowax.-Available forms:PEG, PEO, or POE refers to an...
was found to be more effective than lactulose
Lactulose
Lactulose is a synthetic, non-digestible sugar used in the treatment of chronic constipation and hepatic encephalopathy, a complication of liver disease. It is a disaccharide formed from one molecule each of the simple sugars fructose and galactose...
.
Stimulant or irritant
Stimulant laxatives act on the intestinal mucosa or nerve plexusNerve plexus
A nerve plexus is a network of intersecting nerves. Except for the ventral rami of Th2-Th11 nerves, they combine sets of ventral rami of spinal nerves that serve the same area of the body into one large grouped nerve...
, altering water and electrolyte
Electrolyte
In chemistry, an electrolyte is any substance containing free ions that make the substance electrically conductive. The most typical electrolyte is an ionic solution, but molten electrolytes and solid electrolytes are also possible....
secretion. They also stimulate peristaltic action
Peristalsis
Peristalsis is a radially symmetrical contraction and relaxation of muscles which propagates in a wave down the muscular tube, in an anterograde fashion. In humans, peristalsis is found in the contraction of smooth muscles to propel contents through the digestive tract. Earthworms use a similar...
and can be dangerous under certain circumstances. They are the most severe among laxatives and should be used with care.
| Preparation(s) | Type | Site of Action | Onset of |
|---|---|---|---|
| Cascara Rhamnus purshiana Rhamnus purshiana Rhamnus purshiana Rhamnus purshiana (Cascara Buckthorn, Cascara, Bearberry, and in the Chinook Jargon, Chittam or Chitticum; syn... (casanthranol) |
Anthraquinone Anthraquinone Anthraquinone, also called anthracenedione or dioxoanthracene is an aromatic organic compound with formula . Several isomers are possible, each of which can be viewed as a quinone derivative... |
colon Colon (anatomy) The colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a... |
6–8 hours |
| Buckthorn Buckthorn The Buckthorns are a genus of about 100 species of shrubs or small trees from 1-10 m tall , in the buckthorn family Rhamnaceae... |
Anthraquinone | colon | 6–8 hours |
| Senna extract (senokot) | Anthraquinone | colon | 6–8 hours |
| Aloe vera Aloe vera Aloe vera, pronounced , also known as the true aloe or medicinal aloe, is a species of succulent plant in the genus Aloe that is believed to have originated in the Sudan. Aloe vera grows in arid climates and is widely distributed in Africa, India, Nepal and other arid areas.The species is... (aloin Aloin Aloin, also known as Barbaloin, is a bitter, yellow-brown colored compound noted in the exudate of at least 68 Aloe species at levels from 0.1 to 6.6% of leaf dry weight , and in another 17 species at indeterminate levels [Reynolds, 1995b]... ) |
Anthraquinone | colon | 8–10 hours |
| Phenolphthalein Phenolphthalein Phenolphthalein is a chemical compound with the formula C20H14O4 and is often written as "HIn" or "phph" in shorthand notation. Often used in titrations, it turns colorless in acidic solutions and pink in basic solutions... |
Triphenylmethane Triphenylmethane Triphenylmethane, or triphenyl methane, is the hydrocarbon with the formula 3CH. This colorless solid is soluble in nonpolar organic solvents and not in water. Triphenylmethane has the basic skeleton of many synthetic dyes called triarylmethane dyes, many of them are pH indicators, and some display... |
colon | 8 hours |
| Dulcolax (bisacodyl Bisacodyl Bisacodyl is a stimulant laxative drug that works directly on the large colon to produce a bowel movement. It is typically prescribed for relief of constipation and for the management of neurogenic bowel dysfunction as well as part of bowel preparation before medical examinations, such as for a... ) (PO) |
Triphenylmethane | colon | 6–12 hours |
| Dulcolax (bisacodyl) (suppository Suppository A suppository is a drug delivery system that is inserted into the rectum , vagina or urethra , where it dissolves.They are used to deliver both systemically-acting and locally-acting medications.... ) |
Triphenylmethane | colon | 60 minutes |
| Microlax | enema Enema An enema is the procedure of introducing liquids into the rectum and colon via the anus. The increasing volume of the liquid causes rapid expansion of the lower intestinal tract, often resulting in very uncomfortable bloating, cramping, powerful peristalsis, a feeling of extreme urgency and... |
rectum Rectum The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long... and colon |
15–60 minutes |
| Castor Oil Castor oil Castor oil is a vegetable oil obtained from the castor bean . Castor oil is a colorless to very pale yellow liquid with mild or no odor or taste. Its boiling point is and its density is 961 kg/m3... |
ricinoleic acid Ricinoleic acid Ricinoleic acid is an unsaturated omega-9 fatty acid that naturally occurs in mature Castor plant seeds or in sclerotium of ergot . About 90% of the fatty acid content in castor oil is the triglyceride formed from ricinoleic acid... |
small intestine Small intestine The small intestine is the part of the gastrointestinal tract following the stomach and followed by the large intestine, and is where much of the digestion and absorption of food takes place. In invertebrates such as worms, the terms "gastrointestinal tract" and "large intestine" are often used to... |
2–6 hours |
Serotonin agonist
TegaserodTegaserod
Tegaserod is a 5-HT4 agonist manufactured by Novartis and sold under the name Zelnorm for the management of irritable bowel syndrome and constipation. Approved by the FDA in 2002, it was subsequently removed from the market in 2007 due to FDA concerns about possible adverse cardiovascular effects...
is a motility stimulant that works through activation of 5-HT4
Serotonin
Serotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of animals including humans...
receptors of the enteric nervous system
Enteric nervous system
The enteric nervous system is a subdivision of the autonomic nervous system that directly controls the gastrointestinal system in vertebrates.It is derived from neural crest.-Function:...
in the gastrointestinal tract
Gastrointestinal tract
The human gastrointestinal tract refers to the stomach and intestine, and sometimes to all the structures from the mouth to the anus. ....
. However caution must be taken due to potentially harmful cardiovascular side-effects.
Zelnorm (market name for Tegaserod
Tegaserod
Tegaserod is a 5-HT4 agonist manufactured by Novartis and sold under the name Zelnorm for the management of irritable bowel syndrome and constipation. Approved by the FDA in 2002, it was subsequently removed from the market in 2007 due to FDA concerns about possible adverse cardiovascular effects...
) was discontinued from marketing in the United States on March 30, 2007 but is still available for prescription under tight controls.
Laxative abuse
Laxative abuse is potentially serious since it can lead to intestinal paralysis, irritable bowel syndromeIrritable bowel syndrome
Irritable bowel syndrome is a diagnosis of exclusion. It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements...
(IBS), pancreatitis
Pancreatitis
Pancreatitis is inflammation of the pancreas. It occurs when pancreatic enzymes that digest food are activated in the pancreas instead of the small intestine. It may be acute – beginning suddenly and lasting a few days, or chronic – occurring over many years...
, renal failure
Renal failure
Renal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...
, and other problems, even though recovery is possible with proper treatment.
Laxative gut
Physicians warn against the chronic use of stimulant laxatives due to concern that chronic use causes the colonic tissues to get worn out over time and not be able to expel feces due to long term overstimulation. It is unclear whether the elongated and poorly moving colon of a patient with chronic constipation was a result of or was just a cause for patients' use of stimulant laxatives. A common finding in patients who have used stimulant laxatives is a brown pigment deposited in the intestinal tissue, known as melanosis coliMelanosis coli
Melanosis coli, also pseudomelanosis coli, is a disorder of pigmentation of the wall of the colon, often identified at the time of colonoscopy. It is benign, and may have no significant correlation with disease...
.
Eating disorders
Laxatives are used by people with an eating disorder. In cases of bulimia nervosaBulimia nervosa
Bulimia nervosa is an eating disorder characterized by binge eating and purging or consuming a large amount of food in a short amount of time, followed by an attempt to rid oneself of the food consumed, usually by purging and/or by laxative, diuretics or excessive exercise. Bulimia nervosa is...
the patient abuses laxatives to get rid of calories, to purge food in the intestines before it becomes digested and absorbed by the body. This will not work, because laxatives hasten the elimination of undigested remains of food in the large intestine and colon. The large intestine and colon do not digest food. They just collect the undigested remains and hold it and absorb water until it is defaecated. Weight loss may be felt, but this is only temporary due to the fact that the person has expelled much of the fluids from their body. The common question of whether or not chronic diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
associated with laxative use can promote some degree of true weight loss remains unknown. In any case, this type of laxative misuse causes water to be lost more rapidly than is healthy, potentially leading to dehydration
Dehydration
In physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism...
and electrolyte imbalance. Prolonged usage of laxatives will actually cause constipation
Constipation
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...
. The sensation of bloating can be significant due to excessive water retention
Water retention (medicine)
The term water retention signifies an abnormal accumulation of fluid in the circulatory system or within the tissues or cavities of the body.Water is found both inside and outside the body’s cells...
, leading to people with eating disorders to increase the dosage of the laxatives, resulting in dependency and further complicating the constipation. Abusing stimulant-type laxatives can lead to permanent impairment of the bowels, and the constipation problem becomes irreversible. In addition, blood can develop in stools, and excessive blood loss can result in anemia
Anemia
Anemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...
. Patients recovering from laxative abuse often have several months of problematic water retention, resulting in temporary weight gain
Weight gain
Weight gain is an increase in body weight. This can be either an increase in muscle mass, fat deposits, or excess fluids such as water.-Description:...
(not noticeable on the exterior), and sometimes "pitting" edema
Edema
Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
(in which pressing on the skin leaves an indentation).
External links
- Laxative overdose – MedlinePlusMedlinePlusMedlinePlus is a free Web site that provides consumer health information for patients, families, and Health care providers. The site brings together information from the United States National Library of Medicine, the National Institutes of Health , other U.S. government agencies, and...
. - http://www.gummastic.gr/elma_dental_gum_info.asp
- Senna tea benefits, problems as a laxative.
- http://familydoctor.org/online/famdocen/home/common/digestive/basics/037.html bulk-forming agents.