Bulk Forming Laxatives and Their Use

Bulk-forming laxatives, like methylcellulose, psyllium, and calcium polycarbophil, are recommended for constipation because they work by adding bulk to the stool, making it easier to pass. They're absorbed minimally by the body and are considered safe for long-term use.

Bulk-forming laxatives are like natural sponges, absorbing water and swelling in the intestines.

Bulk-forming laxatives are usually taken with a full glass of water (8 ounces) to ensure they work properly and avoid potential side effects like constipation or blockage.

Emollients, lubricants, saline laxatives, hyperosmotic laxatives, and stimulants are other types of laxatives that work in different ways to relieve constipation.

It is essential to consult a healthcare practitioner when considering long-term use of laxatives, especially if you experience chronic constipation or have any underlying medical conditions.

A condition characterized by infrequent bowel movements, typically defined as less than 3 bowel movements per week in adults, and difficulty passing hard, dry stools.

Factors outside of the body that can contribute to constipation, such as a low-fiber diet, lack of fluids, and sedentary lifestyle.

Conditions within the body that can cause constipation. Examples include thyroid disorders, diabetes, irritable bowel syndrome (IBS), and neurological disorders.

A type of constipation caused by physical abnormalities within the digestive tract, such as injury, inflammation, or structural problems.

A medication that can lead to constipation, such as antacids, analgesics, and anticholinergics.

The American Dietetic Association recommends a daily intake of 14 grams of fiber per 1000 calories.

A gradual increase in fiber intake over a period of 1-2 weeks is recommended to avoid digestive discomfort.

Symptoms that may indicate a more serious underlying condition and require medical attention, not self-care. These symptoms include severe abdominal pain, unexplained flatulence, fever, and blood in the stool.

Non-pharmacological measures to treat constipation, including increasing fruit, vegetables, and whole grains in the diet, and adopting a more active lifestyle.

The goal of constipation treatment is to relieve symptoms, restore normal bowel function, prevent future occurrences, and ensure safe and effective laxative use.

Bulk-forming laxatives work by absorbing water in the gut, creating a larger, softer stool that is easier to pass. They are often used for short-term relief of constipation and can be helpful in promoting regular bowel movements.

Bulk-forming laxatives are generally safe, but some common side effects include abdominal cramping and flatulence, particularly if not enough fluids are consumed. Choking is also a concern if the laxative is taken without sufficient water.

Bulk-forming laxatives can hinder the absorption of certain medications, such as warfarin, digoxin, and salicylates. It's important to separate the intake of these medications and bulk-forming laxatives by at least two hours.

Bulk-forming laxatives are not suitable for individuals who are on fluid-restricted diets, such as those with renal failure or congestive heart failure. They may also cause esophageal or intestinal obstruction, especially in children under 6 and those on opioids.

Calcium polycarbophil, a specific type of bulk-forming laxative, should be limited to 150 mg in individuals who are susceptible to hypercalcemia (high calcium levels) such as those with renal disease.

A type of laxative that works by drawing water into the rectum, softening the stool and promoting a bowel movement. They work by creating an osmotic gradient, where the concentration of water in the rectum is lower than inside the body, leading to water moving into the rectum to balance it.

Examples of hyperosmotic laxatives include glycerin and polyethylene glycol (PEG) 3350.

A type of hyperosmotic laxative that is available over the counter (OTC) and is often used for occasional constipation.

A laxative that works by softening the stool and making it easier to pass. They work by reducing the surface tension of the stool, allowing more water to penetrate the stool and soften it.

Examples of emollient laxatives include docusate sodium and docusate calcium.

A type of laxative that works by lubricating the intestines to prevent absorption of water by the stool. This makes the stool easier to pass.

An example of a lubricant laxative is mineral oil.

Mineral oil and docusate should not be co-administered as they can interact with each other, reducing the effectiveness of both medications.

A type of laxative that works by drawing water into the intestines, increasing pressure and promoting bowel movement. Examples include magnesium citrate, magnesium hydroxide, and sodium phosphate.

These laxatives are generally safe for occasional constipation relief, but not recommended for long-term use.

These laxatives can cause side effects such as abdominal cramping, nausea, vomiting and dehydration. They can also lead to electrolyte imbalances, especially if used improperly.

Saline laxatives can lead to an increase in magnesium levels in the blood, especially in people with kidney problems, newborns, and older adults. Be cautious with magnesium-containing laxatives in these groups.

Sodium phosphate laxatives can cause high phosphate levels, low calcium levels, and high sodium levels in the blood. Exercise caution in patients with kidney problems, heart conditions, restricted sodium/fluid diets, or those taking medications that affect electrolytes.

Saline laxatives should be avoided in patients with certain conditions such as megacolon, gastrointestinal obstruction, imperforate anus, or colostomy. These conditions can be worsened by the increased pressure and fluid in the intestines.

Take saline laxatives on an empty stomach with a full 8 oz. glass of water to enhance effectiveness and minimize side effects.

Saline laxatives work by increasing fluid in the intestines, which causes pressure and stimulates bowel movements.

Magnesium citrate and magnesium hydroxide can interact with various medications, reducing their absorption or effectiveness. This includes fluoroquinolones, tetracycline antibiotics, captopril, cefdinir, bisphosphonates, gabapentin, iron salts, phenytoin, nitrofurantoin, phenothiazines, rosuvastatin, ketoconazole, itraconazole, and levothyroxine.

Oral sodium phosphate products are used for bowel cleansing, but they have been linked to acute phosphate nephropathy. The FDA issued a boxed warning and recommends nonprescription oral sodium phosphate products not be used for bowel cleansing.

Stimulant laxatives like bisacodyl and senna work by increasing peristaltic activity in the intestines, either by local irritation of the mucosa or by acting on the intestinal smooth muscle. They also increase water and electrolyte secretion, helping to soften and move stool.

Bisacodyl and senna are used as a component of bowel preparation for endoscopic examinations, to prevent or treat opioid-induced constipation (often combined with docusate), and as a second-line option for simple occasional constipation, but they can have adverse effects.

Stimulant laxatives can cause severe cramping, electrolyte and fluid imbalances, enteric loss of protein, and hypermobility. Long-term use can lead to laxative abuse.

Laxative overuse can occur due to misconceptions about bowel movements, fear of constipation, or underlying conditions like anorexia nervosa. Symptoms include diarrhea, vomiting, fluid and electrolyte imbalance, and dehydration.

Opioid-induced constipation is commonly treated with stimulant laxatives, often combined with docusate. PEG-3350 can be used for prevention or treatment, and saline laxatives can be used periodically for acute evacuation. Bulk-forming laxatives are generally not suitable.

When choosing a laxative, consider your specific needs, lifestyle, and potential side effects. Bulk-forming laxatives and PEG-3350 are often good first choices for simple constipation.

For children under 2, consult a healthcare provider before using any laxatives. For children ages 2-6, docusate sodium or magnesium hydroxide are often recommended first. For children ages 6-12, methylcellulose, calcium polycarbophil, psyllium powder, magnesium hydroxide, or docusate sodium are preferred.

For older adults, dietary and behavior modification should be the first steps, followed by education about normal bowel habits. Bulk-forming laxatives are often a good first choice, but be aware of fluid restrictions and other medical conditions. PEG-3350 is also a good option, as is docusate for hemorrhoids. Avoid mineral oil and use saline laxatives with caution.

Always include lifestyle considerations like diet, hydration, and exercise when discussing laxatives. Don't take laxatives for more than a week without a healthcare provider's supervision, except for fiber or functional fiber supplements. Be alert for co-morbid conditions and potential drug interactions. Remember that the onset of action varies depending on the laxative.

Bisacodyl, a stimulant laxative, should be taken one hour before antacids or milk to avoid interfering with its enteric coating. It's important to avoid H2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs). Do not crush or break enteric-coated bisacodyl.

Senna, a stimulant laxative, can color urine pink, red, violet, or brown. This is a normal side effect and nothing to worry about.

Bulk-forming laxatives like methylcellulose, psyllium, and calcium polycarbophil are generally considered safe for long-term use. They add bulk to stool, making it easier to pass.

Mineral oil, a lubricant laxative, should be avoided if possible due to potential risks of aspiration, malnutrition, and prolonged absorption.