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Laxatives: Proceed With Caution

Yelena Denisko, PharmD Candidate 2011
Shenandoah University and Consumer Health Information Corporation

 

Laxatives are the most common form of self-treatment, yet many people do not know about the dangers of incorrect laxative use.

 

Each year, Americans spend more than $700 million on laxatives. A recent study showed that the United States has the highest rate of laxative use compared to several other countries. Still, many people do not know how to use laxatives correctly. One study showed that as many as 40% of people use laxatives incorrectly.  At least 15% of diarrhea cases are due to incorrect laxative use. 

 

Overuse and abuse of laxatives

Taking more laxatives than recommended can lead to overuse and abuse. Many people may not realize they are taking too much. This can happen when a person does not have a good sense of what their normal bowel function is.

 

Abuse of laxatives is often done to lose weight. Approximately 4% of people abuse laxatives at some point, and as many as 7% of high school students abuse laxatives for weight loss. Laxative abuse creates a false sense of weight loss. Laxatives do not prevent weight gain and absorption of calories. They only remove water and electrolytes.

 

Overuse and abuse could lead to dependence. This happens when the body gets used to being on laxatives. The gut and bowel relax and become unable to move or hold the contents. The body can no longer produce a bowel movement without the help of laxatives. 

 

Potential problems

Laxative abuse can be dangerous. Diarrhea, nausea, and vomiting are potential side effects. Diarrhea causes too much water loss. This could lower the blood pressure, increase the heart rate, cause dizziness and fainting. Laxatives can also change levels of important minerals in your body. This can lead to kidney stones, heart and muscle problems.

 

Not all laxatives are created equal

Each type of laxative works differently to empty the bowel. 

  • Laxatives that quickly produce a bowel movement, such as senna (Senokot) or bisacodyl (Dulcolax), are the most abused and dangerous. They stimulate the nerves in the colon.  This causes the muscles of the intestines to contract and push down the contents of the bowel. Over time, the laxatives keep the colon empty. The colon cannot send a signal so that a normal bowel movement can occur.  The muscles of the bowel become weakened because they are not being used.  The body gradually gets used to needing laxatives to produce a bowel movement.
  • Bulk laxatives, such as psyllium (Metamucil) and methylcellulose (Citrucel), are safe treatment options. They make the stool more bulky by absorbing water.  For example, psyllium (Metamucil) is safe because it is a natural form of fiber. 
  • The best treatment for constipation is food high in fiber or laxatives that create a more bulky and softer stool.

 

What to do if you feel constipated

Before using any laxatives, try these lifestyle changes: 

  • Drink at least eight 8-ounce glasses of water every day.
  • Eat more foods high in fiber (fresh vegetables, fruits, whole grains).
  • Exercise every day.
  • Go to the bathroom when you feel the urge.
  • See your doctor if you have been constipated for three or more days.

 

Choosing to self-treat

Commonly used treatment options:

  • The first treatment option would be psyllium (Metamucil). It can be used regularly for maintenance of bowel function.
  • Another option is a stool softener, such as docusate (Colace). It will help prevent constipation.
  • Stimulant laxatives, such as senna (Senokot) and bisacodyl (Dulcolax), should not be used for more than 1 week.

 

Precautions

Be careful before taking laxatives:

  • Laxatives can affect how other medications work.  They can block or increase absorption of some medicines.  For example, bulk laxatives can decrease levels of aspirin and warfarin.  Certain medications should not be taken with laxatives at all.  For example, bisacodyl (Dulcolax) interacts with Zantac and Prilosec.
  • Some laxatives, such as mineral oil, are not suitable for children and the elderly. The oil droplets can be inhaled into the lungs and lead to a lung infection. Pregnant women should not take stimulant laxatives, such as senna. They can cause early labor.
  • Get advice from a doctor or pharmacist before starting a new treatment.

 

Laxatives can help treat constipation when they are used correctly. If lifestyle changes do not help, then use a laxative that is safe. A pharmacist can guide you in picking out the right laxative. Pharmacists know the differences among all the products.  This can save you from dangerous side effects and interactions.

 

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