Don't bomb the bowel with laxatives

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Published: April, 2014

If constipation becomes chronic, don't keep playing laxative roulette. See your doctor for an exam.

Occasional irregularity is a fact of life, but you can minimize it with some basic steps. "You should be sure you are eating a fiber-rich diet, drinking adequate fluids, and staying physically active," says Dr. Jacqueline Wolf, a gastroenterologist and associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center. But when you do have constipation, start with the gentlest and safest option, like a bulk-forming laxative. If laxatives don't work, ask for help. "You should see your doctor and discuss it if you are constantly needing to take laxatives," Dr. Wolf says. "People shouldn't have to take laxatives every day."

First choice: bulk-forming laxatives

Bulk-forming laxatives draw water into stool, making it softer and easier to pass. But don't expect instant gratification: these can take a half-day to several days to provide relief. They are safe to use daily. They contain various ingredients, and you may have to try more than one to find the product that helps you with minimal side effects, such as flatulence and bloating. They may be marketed as laxatives or as fiber supplements.

For stuck stools...

Stool softeners add moisture to stools to make them softer and easier to pass. Mineral oil, a lubricant, helps stools "slide on by" if the stools feel stuck low in your bowels, if you have an internal tear or "fissure," or if you have pain from hemorrhoids during bowel movements. Don't take mineral oil at the same time as stool softeners. Take 1 tablespoon at breakfast or lunch. But don't use it for more than a few days, because mineral oil interferes with absorption of some vitamins and if inhaled it can cause pneumonia. Consider wearing a protective pad in your undergarments to absorb any leakage.

Other laxative options

If the conservative route doesn't work, Dr. Wolf recommends the osmotic laxative MiraLAX or a generic version. These hold water in stool to soften it and increase bowel movements. Common side effects are gas, bloating, and nausea. Another option that works for some people is diet candies containing the sweetener sorbitol. These essentially trigger a mild case of the runs. You may experience bloating and gas along with the laxative effect, however.

Another option would be a magnesium-based laxative, such as milk of magnesia or magnesium citrate. These are members of a larger class of laxatives called saline osmotics, which draw water into the bowels and trigger bowel movements. The active ingredients include magnesium, sulfate, citrate, and phosphate. But don't take more than the recommended amounts of these laxatives, or use them long-term, because they can throw off your chemistry. Combined with an underperforming kidney or heart failure, saline osmotic laxatives can be dangerous.

Common laxatives and brands

Active ingredient

Common brands

Bulk forming

bran

cereals and other foods

calcium polycarbophil

FiberCon

dextrin

Benefiber

methylcellulose

Citrucel

psyllium

Metamucil

Stool softeners

docusate

Colace, Correctol, Peri-Colac e, Surfak

Lubricants

mineral oil

Various branded and generic products

Osmotics

magnesium

magnesium citrate, milk of magnesia

polyethylene glycol

MiraLAX or generic versions

sodium phosphate

Fleet Phospho-Soda

sorbitol or lactulose

ingredients in various products

Stimulants

Bisacodyl

Correctol, Dulcolax, Ex-Lax Ultra

Casanthranol

Dialose Plus, Peri-Colace

Cascara

Naturalax

castor oil

various brand and generic products

Senna

Ex-Lax, Fletcher's Castoria, Senokot

Stimulant laxatives

Stimulant laxatives such as bisacodyl and cascara trigger contractions in the bowels that push the stool along. "When bowel movements are slow, some people really do need stimulant laxatives," Dr. Wolf says. The first choice she recommends is a senna-based stimulant laxative. But if you take stimulant laxatives too often, you could become dependent on them to have a bowel movement at all—possibly because the bowel is not functioning normally.

When to talk to a doctor

If you find yourself trying one laxative after another for long periods, see your doctor for an evaluation. Additional testing can lead to better therapy and rule out any possible serious malfunctions. "And if it is just constipation, your doctor can offer other medications to you that may be more helpful than over-the-counter laxatives," Dr. Wolf says.

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