Stimulant Laxatives for Constipation

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Stimulant laxatives are preparations used to ease constipation by inducing a bowel movement. Available over-the-counter (OTC), they appear on the surface to be an easy answer to the problem of constipation. But are they safe? Can you use them on a long-term basis? Learn the answers to those questions about stimulant laxatives so that you can make an informed decision for yourself.

Available Products

A visit to your local drugstore will show you that there are lots of different available brands of stimulant laxatives. These products come in a variety of forms, including tablets, liquids, and suppositories. The active ingredient in these products differ - here are the more common options:

  • Bisacodyl: Alophen, Carters Little Pills, Correctol, Dulcolax, Ex-lax Ultra, Feen-A-Mint, Fleet Bisacodyl
  • Sodium bicarbonate and potassium bitartrate: Ceo-Two Evacuant suppository
  • Senna: Black Draught, ExLax, Fletcher's, Senexon, SennaGen and Senokot. Also found in herbal stimulant laxatives.
  • Castor oil

After an extensive research review, the American College of Gastroenterology recommends sodium picosulfate and bisacodyl. They decline to recommend any other types due to lack of sufficient research.

    How Stimulant Laxatives Work

    The ingredients in stimulant laxatives induce a bowel movement by acting to speed up colonic muscle movement (motility).

    Stimulant laxatives differ in their action from stool softeners which work by reducing absorption of fluids in the intestines thereby increasing the amount of water in the stool. This results in a softer, easier-to-pass stool.

    How to Use Stimulant Laxatives

    When using stimulant laxatives make sure to read and follow package directions carefully.

    Determine if the product is a pill or liquid that should be taken orally or a suppository that is used rectally. Many of these products recommend that you use them at bedtime, in order to work with your body's natural biorhthyms to produce a bowel movement in the morning. As with all medications, check with your physician prior to use. Stimulant laxatives are designed to be used on a short-term basis only, meaning no longer than one week.

    Side Effects of Stimulant Laxatives

    Some people experience abdominal pain and cramps or temporary symptoms of fecal incontinence after using a stimulant laxative. There have been some reports of more serious side effects, including:

    • Allergic reactions
    • Electrolyte imbalances
    • Liver damage

    Safety Considerations

    Traditionally, there have been some concerns about the safety of stimulant laxatives. These areas of potential difficulty include a risk of tolerance, dependence and/or addiction to the medication or a fear that chronic use of stimulant laxatives could increase one's risk for colon cancer.

    However, other than the fact that some individuals with psychiatric and/or eating disorders are at risk for using stimulant laxatives in an unhealthy manner, these other concerns do not seem to be warranted.

    The Bottom Line

    Stimulant laxatives appear to be a safe short-term treatment for constipation. Just be sure to follow dosing instructions carefully. If you are uncomfortable with the idea of using a stimulant laxative due to the safety considerations discussed above, you might want to consider using a stool softener as an alternative. If your constipation is a chronic problem, it is best that you work with your doctor to develop a long term management plan.

    Sources:

    Cash, C., Chang, L., Sabesin, S. & Vitat, P. "Update on the Management of Adults With Chronic Idiopathic Constipation" The Journal of Family Practice 2007 S13-S20.

    Ford, A., et.al. "American College of Gastroenterology Monograph on the Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation" American Journal of Gastroenterology 2014 109:S2-S26.

    Muller-Lissner, S., Kamm, M., Scarpignato, C., & Wald A. "Myths and misconceptions about chronic constipation." American Journal of Gastroenterology 2005 100:232-242.

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