Laxatives: Uses, Types, and Constipation Causes

• Laxatives are primarily used for constipation and hard stools that are difficult to pass
• Laxatives are used for:
• Removal of toxic substances through feces
• Preparation for bowel procedures like colonoscopies
• Prevention of straining in surgery or myocardial infarction cases

Causes of Constipation

• Poor diet
• An inadequate amount of fiber to add bulk to the stool and help maintain regular BMs
• Dehydration
• Inactivity slows peristalsis
• Intake of opioids and anticholinergics
• Pelvic floor dysfunction
• Pregnancy
• Pressure in the colon and hormonal changes such as elevated progesterone slows down the GI tract
• Iron supplements
• Endocrine disorders like hypothyroidism and diabetes mellitus

Types of Laxatives

Bulk-Forming Laxatives

• Action: adds bulk, increases stool size, and helps soften stool
• Draws water into the colon and stool, causing it to swell and stimulate peristalsis
• Generic drugs include psyllium, methylcellulose, and polycarbophil
• Onset of action: 1-3 days
• Adverse effect: esophageal obstruction if not ample fluid is taken, and it is usually given for long term use

Stimulant Laxatives

• High potential for misuse
• Action: Directly stimulates the intestinal mucosa, increasing peristalsis and fluid secretion
• Generic drugs include bisacodyl and senna
• Onset of action: 6-12 hours
• May cause cramping and diarrhea

Surfactant/ Emollient Laxatives

• Action: Reduces surface tension of fluids to promote water absorption into the stool
• Generic drug: Docusate salts

Osmotic Laxatives

• Action: Helps increase water in the stool by drawing water from the colon to expand and soften the stool, making it easier to pass
• Generic drugs include glycerin (suppository), lactulose, laxative salts like magnesium citrate, and polyethylene glycol
• Sodium phosphate and polyethylene glycol are used for bowel preparations before a colonoscopy
• Excessive laxative use may lead to electrolyte imbalance

Lubricant Laxatives

• Actions: Lubricates stool and intestinal wall to reduce water absorption by the intestine to create a softer stool
• Generic drug: Mineral Oil

Glycerin Suppositories Techniques

• For children <3 years old:
• Position: Supine with knees and feet raised
• Use the 5th finger to insert suppositories, guiding against the rectal wall
• For children >3 years old:
• Position: Left side lying (Sim's position) with knees flexed
• Use index finger to insert the suppository against the rectal wall, allowing it to remain in contact with the rectal mucosa and not buried inside the stool
• Hold the buttocks together for several minutes or until the immediate urge to defecate has passed to prevent immediate expulsion
• Bowel movement should occur within 10-30 minutes
• Observe presence of the suppository

Adverse Effects of Laxatives

• Abdominal bloating and cramping caused by increased stool volume and peristalsis
• Electrolyte imbalance in prolonged use
• Nutrient malabsorption
• Dehydration
• Rectal irritation

Client Teaching for Laxatives

• Take laxatives with a full glass of water
• Avoid in cases of intestinal obstruction
• Implement non-pharmacologic measures for constipation:
• increased fiber and fluid intake
• regular exercise
• Long-term use may diminish defecatory reflexes due to laxative dependence