Treatments for constipation part 3
Stimulant laxatives
These stimulate the nerves in the large bowel (the colon and rectum, sometimes also called the large intestine). This then causes the muscle in the wall of the large bowel to squeeze harder than usual. This pushes the faeces along and out. Stimulant laxatives include senna, bisacodyl, and dantron. Their effect is within 8-12 hours. Therefore, a bedtime dose is recommended so you are likely to feel the urge to go to the toilet sometime the following morning. Stimulant laxative suppositories act more quickly (within 20-60 minutes). Possible side-effects from stimulant laxatives include abdominal cramps, and a 'weakened' bowel ('lazy bowel') with long-term use.
Osmotic laxatives
Osmotic laxatives
These work by retaining fluid in the large bowel by osmosis (so less fluid is absorbed into the bloodstream from the large bowel). A commonly used one is called lactulose. However, this can take up to two days to have any effect so it is not suitable for the rapid relief of constipation. Possible side-effects of lactulose include abdominal pain and bloating. Some people find the taste of lactulose unpleasant. Another osmotic laxative is called polyethylene glycol (trade name Movicol). This usually has a rapid action.
Faecal softeners
These work by 'wetting' and softening the faeces. The most commonly used is docusate sodium (which also has a weak stimulant action too). Bulk-forming laxatives also have some faecal-softening properties. Liquid paraffin used to be commonly used as a faecal softener. However, it is now not recommended as it may cause side-effects such as seeping from the anus and irritating the skin, and it can interfere with the absorption of some vitamins from the gut.
Which laxative should I use and for how long?
The one recommended by your doctor or pharmacist will depend on factors such as your own preference, possible unwanted effects, other conditions that you may have, and cost. However, as a general rule:
-Treatment with a bulk-forming laxative is usually tried first.
-If faeces remain hard despite using a bulk-forming laxative, then an osmotic laxative tends to be tried, or used in addition to a bulk-forming laxative.
-If faeces are soft but you still find them difficult to pass then a stimulant laxative may be added in.
-You should use a laxative only for a short time, when necessary, to get over a bout of constipation. Once the constipation eases, you should normally stop the laxative. Some people get into the habit of taking a laxative each day to 'to keep the bowels regular' or to 'prevent constipation'. This is not advised, especially for laxatives which are not 'bulk-forming'. If you feel that you need a laxative regularly, then see a doctor for advice on which is best to use in your circumstances. (Some people with persistent and severe constipation do require regular laxatives. But it is best if this is done under the advice and supervision of a doctor.)
A natural laxative recipe
The Beverley-Travis Natural Laxative Mixture (recipe below) was studied in a research trial that involved older people in a care home. A treatment group was compared to a non-treatment group. The conclusion of the study stated that "The Beverley-Travis natural laxative mixture, given at a dosage of 2 tablespoons twice daily, is easy to use, cost-effective, and more effective than daily prescribed laxatives at producing normal bowel movements." So, it may be worth a try.
Recipe ingredients - one cup each of: raisins; pitted prunes; figs; dates; currants; prune concentrate.
Directions - combine contents together in grinder or blender to a thickened consistency. Store in refrigerator between uses.
Dose - two tablespoons twice a day. Increase or decrease dose according to consistency and frequency of bowel movements.
Other treatments
Constipation is usually helped by the above treatments. Sometimes, an enema is needed in severe cases. Other treatments may be advised by a specialist for people with severe constipation who have not been helped by the treatments listed above.
© EMIS and PIP 2008 Updated: January 2010 PRODIGY Validated
Average rating:
