Navigation

Laxatives for Constipation

Laxatives and constipation definitions and facts

Fruits and vegetables can act as natural laxatives.
Fruits and vegetables can act as natural laxatives.
  • The definition of constipation is infrequent bowel movements that may be painful or difficult, along with hard stool.
  • Common causes of constipation include diets low in fiber, side effects of medications (such as narcotics, antidepressants, iron supplements, calcium channel blockers and other medications for high blood pressure, and certain types of antacids, prior surgeries, certain medical conditions including narrowing or blockage of the large intestine (colon), irritable bowel syndrome (IBS) or other colon disease, hormonal (endocrine) disturbances such as underactive thyroid and diabetes, and neurologic conditions.
  • A doctor should be consulted for chronic constipation, if it does not respond to home treatment, is accompanied by bleeding, abdominal pain, nausea and vomiting, weight loss, or during pregnancy.
  • Natural and home remedies for constipation include:
    • adding fiber to the diet,
    • increasing fluids, and
    • regular exercise.
  • Foods that increase fiber in the diet are helpful in treating mild cases of constipation. These foods include fruits, vegetables, whole grains, and beans.
  • Types of over-the-counter (OTC) preparations for constipation include:
    1. Bulk-forming laxatives, for example, methylcellulose (Citrucel) and psyllium hydrophilic mucilloid (Metamucil)
    2. Stool softeners such as Colace and Surfak
    3. Lubricant laxatives such as mineral oil (liquid petrolatum)
    4. Stimulant laxatives are the fastest-acting, such as include aloe, cascara (Nature's Remedy), senna compounds (Ex-Lax, Senokot), bisacodyl (Dulcolax, Correctol), and castor oil
    5. Saline laxatives or enemas such as Fleet Phospho-Soda, milk of magnesia, and magnesium citrate
    6. Osmotic-type laxatives such as GoLYTELY, GlycoLax, and MiraLax
    7. Suppositories such as docusate (Microenema), bisacodyl (Dulcolax Suppository), and sodium phosphate (Fleet Enema).
  • There is concern that over-use of laxatives, especially the stimulant laxatives, may have a harmful effect on the colon and make the constipation worse.
  • Children and infants usually can benefit from dietary modification to help relieve constipation.
  • Constipation in pregnancy can often be remedied with dietary changes and exercise.
  • Individuals should consult their physicians before using laxatives or stool softeners.
  • Laxatives are not intended as weight loss supplements, and laxative abuse can contribute to many health problems, including death.

What is constipation?

Constipation is a condition characterized by infrequent bowel movements that are painful or difficult, or stools that are hard in consistency. Infrequent bowel movements alone are not a reliable indicator of constipation because bowel frequency can vary between three times a day to once a week among normal individuals. Hard stools that are difficult to pass or infrequent stools accompanied by abdominal pain, back pain, and abdominal bloating define constipation.

What causes constipation?

There are many causes of constipation including:

Which medications cause constipation?

Examples of common medications that can cause constipation:

What natural and home remedies help cure constipation?

Mild constipation without an underlying cause (such as medications, an underactive thyroid, or colon obstruction) can often improve with lifestyle modifications that include:

  1. Increase fiber in the diet. Fiber improves bowel function by adding bulk and softening the stool. You can increase the fiber in your diet with foods or over-the-counter (OTC) fiber supplements.
  2. Increase fluid intake. Although this is widely recommended as a treatment for constipation, there are no studies showing that increasing fluids improves constipation.
  3. Regular exercise such as walking, swimming, or running. Similar to increasing fluid intake, although exercise is widely recommended for treating constipation, there are no studies demonstrating its value for constipation.

What foods naturally help cure constipation?

Many foods can act as natural laxatives. These foods are high in fiber and can help get things moving, for example:

  • Seeds, for example, flax, chia, and pumpkin
  • Raisins, figs, and prunes
  • Vegetables, for example, sweet potatoes, greens (spinach, kale), and pumpkin
  • Fruits (include the skin)
  • Whole grain breads and cereals
  • Whole beans (such as kidney beans and pinto beans)
  • Oat bran
  • Corn
  • Barley

What types of over-the-counter (OTC) laxatives help cure constipation?

Laxatives are medicines that increase the frequency and ease of passing stool. Many types of laxatives are available over-the-counter (OTC) for the relief of mild, occasional constipation. If constipation becomes moderate to severe or does not respond to OTC products, consult a doctor.

Most OTC laxatives are safe, effective, and well tolerated. There are distinct types of laxatives that function differently and have varying degrees of effectiveness and potential side effects. Talk to your doctor about the best laxative for your needs.

What natural laxatives are safe for infants, toddlers, and children?

If an infant is younger than four months old and seems constipated, contact the child's pediatrician. For older children, home remedies including dietary modifications may help relieve constipation. If a child has been constipated for a short time, changing the diet may be the only treatment needed. It is common for infants to become constipated when they transition to solid foods, and often adding fiber to the diet can ease constipation.

The following natural treatments may be used for infants older than four months of age, or for children with constipation:

  • Dark corn syrup (Karo syrup) contains complex sugar proteins that keep water in the bowel movement. One teaspoon per four ounces of formula or expressed breast milk until the infant has a bowel movement.
  • Prune or apple juice works best to treat constipation in children. Four ounces/day for children 4 months to 1 year of age.
  • High-fiber foods. If your infant is eating solid foods, barley cereal may be used. Other high-fiber fruits and vegetables (or purés), including apricots, sweet potatoes, pears, prunes, peaches, plums, beans, peas, broccoli, or spinach can be fed to the child.
  • Your doctor may recommend increased fiber in the child's diet, through supplementation.
  • In infants with acute or recurrent constipation, glycerin suppositories or rectal stimulation with a lubricated rectal thermometer may be used to move hard stools. These methods should not be used often because they may cause irritation or tolerance. Infants older than 6 months with recurring constipation despite dietary changes may be treated with osmotic laxatives, such as polyethylene glycol (PEG) without electrolytes (polyethylene glycol 3350,, for example, Miralax), lactulose, or sorbitol. Do not use stimulant laxatives (for example, senna, bisacodyl), mineral oil, and enemas in infants because they may have unwanted side effects.

Parents or caregivers should contact the physician immediately if the child has severe abdominal pain, swollen or bloated abdomen, rectal pain, or bleeding. If there are any concerns about the child's bowel habits or questions about diet, parents or caregivers should talk to their child's pediatrician.

Are laxatives safe to take during pregnancy or while breastfeeding?

Hormones from pregnancy, as well as prenatal vitamins and iron supplements may cause constipation. Pressure from the uterus pushes on the bowels and can cause constipation.

Dietary and behavioral modifications can ease constipation during pregnancy and are considered safe. It's best to try these natural remedies first to treat constipation during pregnancy.

  • Eat a diet rich in fiber with whole grains, fruits, and vegetables.
  • Supplement fiber in the diet with over-the-counter products such as Metamucil, which is considered safe
  • Stay hydrated -- drink at least 6-8 glasses of water per day
  • Drink 1-2 glasses of prune juice per day
  • Exercise regularly -- if permitted by your obstetrician

Pregnant women should talk with their doctor before using over-the-counter laxatives or stool softeners during pregnancy. Laxatives can cause fluid loss and diarrhea, so it is important not to overuse them during pregnancy. Avoid cod liver oil as a treatment for constipation if you are pregnant because it may prevent the absorption of needed vitamins and minerals.

Pros and precautions for using stimulant laxatives

Stimulant laxatives are fast-acting laxatives that induce bowel movements by increasing the contraction of muscles in the intestines, and are effective when used on a short-term basis. Examples of stimulant laxatives include:

Bisacodyl: Bisacodyl (Dulcolax, Correctol) is available over-the-counter in oral pill form and as a suppository or enema. The oral form takes 6 to 10 hours to work. Bisacodyl is commonly used in cleansing the colon for colonoscopies, barium enemas, and intestinal surgeries. While effective for occasional constipation, bisacodyl should not be taken for more than a week, and a doctor should supervise repeated use.

Senna, cascara sagrada, and casanthranol: Other stimulant laxatives include senna (Ex-Lax, Senokot), cascara sagrada (Nature's Remedy), and casanthranol. These laxatives are converted by the bacteria in the colon into active compounds, which then stimulate the contraction of colon muscles. After taking these products orally, bowel movements occur quickly, after only 8 to 24 hours. Prolonged, chronic use of these laxatives can cause the lining of the colon to become darker than normal (melanosis coli) due to the accumulation of a pigment (melanin).

Castor oil: Castor oil (an ingredient of Purge Concentrate) is a liquid stimulant laxative that works in the small intestine. It causes the accumulation of fluid in the small intestine and promotes evacuation of the bowels. Castor oil should not be taken with food, although juice or other flavored liquids can help hide its unpleasant taste. This laxative works rather quickly, usually within 2 to 6 hours. Castor oil is usually used to cleanse the colon for surgery, barium enema, or colonoscopy. The absorption of nutrients and minerals by the small intestine can be impaired by the frequent use of castor oil. This medicine is not recommended for the repeated treatment for constipation.

Precautions for stimulant laxatives

  • The intensity of the action of stimulant laxatives is dose related. A large dose of any stimulant laxative can produce serious adverse effects.
  • Side effects include severe cramps, excess fluid loss and dehydration, blood electrolyte disturbances such as low levels of blood potassium (hypokalemia), and malnutrition with chronic use.
  • There is concern that chronic, long-term use of stimulant laxatives can lead to loss of colon function (cathartic colon). After years to decades of frequent use of stimulant laxatives, the nerves of the colon slowly disappear, the colon muscles wither, and the colon becomes dilated. Consequently, constipation may become increasingly worse and unresponsive to laxatives. It is not clear, however, which comes first; a progressive decrease in colon function that leads to the use of stimulant laxatives, or the use of laxatives that leads to a decrease in colon function. Nevertheless, long term use of stimulant laxatives usually is reserved for use after other treatments have failed.

Pros and precautions for using stool softeners (emollient laxatives)

Stool softeners, called emollient laxatives, prevent hardening of the feces by adding moisture to the stool. The active ingredient in most stool softeners is a medicine called docusate. Agents containing docusate do not by themselves stimulate or increase the number of bowel movements. They are used more to prevent constipation than to treat it.

Stool softeners are commonly recommended for individuals who should avoid straining while defecating, including those:

Softening the stool in these affected individuals can help reduce pain during defecation.

Stool softeners available OTC include:

  • Colace
  • Surfak
  • Pharmacy or store-branded products containing docusate

Some preparations (for example, Peri-Colace) combine a stool softener with a stimulant laxative to activate bowel movements.

What are the pros for using stool softeners?

Stool softeners are generally safe and well tolerated.

What are the precautions for using stool softeners?

They should not be combined with mineral oil, a lubricant laxative, because stool softeners may increase the absorption and toxicity of mineral oil. Mineral oil droplets absorbed into the body can deposit and cause inflammation in the lymph glands, liver, and spleen.

Pros and precautions for using bulk-forming laxatives

Bulk-forming laxatives are the most commonly recommended initial treatments for constipation as they tend to be the most gentle. Bulk-forming laxatives may work as quickly as 12 hours or take as long as three days to be effective. Some bulk-forming laxatives are derived from natural sources such as agar, psyllium, kelp (alginates), and plant gum. Others are synthetic cellulose compounds such as methylcellulose and carboxymethylcellulose. Natural and synthetic bulk-forming laxatives act similarly. They dissolve or swell in the intestines, lubricate and soften the stool, and make the passage of stool easier and more frequent.

Examples of bulk-forming laxatives include:

For patients

About clinic

Online Store

MIN — Minimally Invasive Neurosurgery Clinic