laxative

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Key Terms: Cathartic, Constipation, Diarrhea, Electrolyte levels, Encephalopathy, Peristalsis.

Definition

A laxative is a drug that promotes bowel movements.

Purpose

Laxatives are used to prevent or treat constipation. They are also used to prepare the bowel for an examination or surgical procedure.

Description

Laxatives work in different ways, by stimulating colon movement, adding bulk to the contents of the colon, or drawing fluid or fat into the intestine. Some laxatives work by combining these functions. Most primary care physicians recommend that patients try the bulk-producing laxatives first before taking saline or stimulant laxatives.

Bisacodyl

Bisacodyl is a non-prescription stimulant laxative. It reduces short-term constipation and is also used to prepare the colon or rectum for an examination or surgical procedure. The drug works by stimulating colon movement (peristalsis); constipation is usually relieved within 15 minutes to one hour after administration of a suppository form and in 6 to 12 hours after taking the drug orally.

Calcium Polycarbophil

Calcium polycarbophil is a non-prescription bulk-forming laxative that is used to reduce both constipation and diarrhea. It draws water to the intestine, enlarging the size of the colon and thereby stimulating movement. It reduces diarrhea by taking extra water away from the stool. This drug should relieve constipation in 12 to 24 hours and have maximum effect in three days. Colitis patients should see a reduction in diarrhea within one week.

Docusate Calcium/Docusate Sodium

Docusate, a non-prescription laxative, helps a patient avoid constipation by softening the stool. It works by increasing the penetration of fluids into the stool by emulsifying feces, water and fat. Docusate prevents constipation and softens bowel movements and fecal impactions. This laxative should relieve constipation within one to three days.

Lactulose

Lactulose, a prescription laxative, reduces constipation and lowers blood ammonia levels. It works by drawing fluid into the intestine, raising the amount of water in the stool, and preventing the colon from absorbing ammonia. It is used to help people who suffer from chronic constipation.

Psyllium

Psyllium is a non-prescription bulk-forming laxative that reduces both constipation and diarrhea. It mixes with water to form a gel-like mass that can be easily passed through the colon. Constipation is relieved in 12 to 24 hours and maximum relief is achieved after several days.

Senna/Senokot

Senna/senokot is a non-prescription laxative that reduces constipation by promoting colon movement. It is used to treat bouts of constipation and to prepare the colon for an examination or surgical procedure. This laxative reduces constipation in eight to 10 hours.

New and Investigational Treatments for Constipation

Some newer options for the treatment of chronic constipation are being developed by various groups of researchers. These include such alternative therapies as biofeedback; newer drugs like tegaserod (Zelnorm) and prucalopride, which stimulate peristalsis; a nerve growth factor known as neurotrophin-3; and electrical stimulation of the colon.

Recommended Dosage

Laxatives may be taken by mouth or rectally (suppository or enema).

Bisacodyl

• Adults or children over 12 years: 5 to 15 mg taken by mouth in morning or afternoon (up to 30 mg for surgical or exam preparation).
• Adult (rectal): 10 mg.
• Children age 2 to 11 years: 10 mg rectally as single dose.
• Children over three years: 5 to 10 mg by mouth as single dose.
• Children under two years: 5 mg rectally as single dose.

Calcium Polycarbophil

• Adult: 1 g by mouth every day, up to four times a day as needed (not to exceed 6 g by mouth in a 24-hour time period).
• Children age 6 to 12 years: 500 mg by mouth twice a day as needed (not to exceed 3 g in a 24-hour time period).
• Children age 3 to 6 years: 500 mg twice a day by mouth, as needed (not to exceed 1.5 g in a 24-hour time period).

Docusate

• Adult (docusate sodium): 50 to 300 mg by mouth per day.
• Adult (docusate calcium or docusate potassium): 240 mg by mouth as needed.
• Adult (docusate sodium enema): 5 ml.
• Children over 12 years (docusate sodium enema): 2 ml.
• Children age 6 to 12 years (docusate sodium): 40 to 120 mg by mouth per day.
• Children age 3 to 6 years (docusate sodium): 20 to 60 mg by mouth per day.
• Children under 3 years (docusate sodium): 10 to 40 mg by mouth every day.

Lactulose

For Constipation:

• Adult: 15 to 60 ml by mouth every day.
• Children: 7.5 ml by mouth every day.

For Encephalopathy:

• Adult: 20 to 30 g three or four times a day until stools become soft. Retention enema: 30 to 45 ml in 100 ml of fluid.
• Infants and children: Parents should follow physician's directions for infants and children with encephalopathy.

Psyllium

• Adult: 1 to 2 teaspoons mixed in 8 ounces of water two or three times a day by mouth, followed by 8 ounces water; or one packet in 8 ounces water two or three times a day, followed by 8 ounces of water.
• Children over 6 years: 1 teaspoon mixed in 4 ounces of water at bedtime.

Senna/Senokot

• Adult (Senokot): 1 to 8 tablets taken by mouth per day or 1/2 to 4 teaspoons of granules mixed in water or juice.
• Adult (rectal suppository): 1 to 2 at bedtime.
• Adult (syrup): 1 to 4 teaspoons at bedtime.
• Adult (Black Draught): 3/4 ounce dissolved in 2.5 ounces liquid given between 2 p.m. and 4 p.m. on the day prior to a medical exam or procedure.
• Children: Parents should ask their doctor as dosage is based on weight. Black Draught is not to be used by children.
• Children age 1 month to 1 year (Senokot): 1.25 to 2.5 ml of syrup at bedtime.

Precautions

The doctor should be informed of any prior allergic drug reaction, especially prior reactions to any laxatives. Pregnancy is also a concern. Animal studies have shown laxatives to have adverse effects on pregnancy, but no human studies regarding pregnancy are currently available. These drugs are only given in pregnancy after the risks to the fetus have been taken under consideration. Nursing mothers should use caution and consult their doctors before receiving these drugs.

Bisacodyl should not be administered to patients with rectal fissures, abdominal pain, nausea, vomiting, appendicitis, abdominal surgery, ulcerated hemorrhoids, acute hepatitis, fecal impaction, or blockage in the biliary tract. Calcium polycarbophil should not be given to anyone with a gastrointestinal blockage (obstruction).

Both psyllium and docusate calcium/docusate sodium should be avoided by patients with intestinal blockage, fecal impaction, or nausea and vomiting. Lactulose should be avoided by patients who are elderly, have diabetes mellitus, eat a low galactose diet, or whose general health is poor.

Senna/senokot is inadvisable for patients with congestive heart failure, gastrointestinal bleeding, intestinal blockage, abdominal pain, nausea and vomiting, appendicitis, or prior abdominal surgery.

The American College of Toxicology states that cathartics should not be used as a means of clearing poisons from the digestive tract of a poisoning victim. Although some physicians have administered these laxatives along with activated charcoal in order to reduce the body's absorption of the poison, this treatment is no longer recommended.

Side Effects

Laxatives may have side effects. Some, such as nausea and vomiting, are more common than others. Side effects related to specific laxatives are described in this section. With repeated use, people may become dependent on laxatives. All side effects should be reported to a doctor.

Bisacodyl

Common side effects:

• nausea
• vomiting
• loss of appetite (anorexia)
• cramps

Less common side effects:

• muscle weakness
• diarrhea
• electrolyte changes
• rectal burning (when suppositories are used).

Life-threatening:

• severe muscle spasms (tetany)

Calcium Polycarbophil

Side effects may include:

• abdominal bloating (distention)
• gas
• laxative dependency

Life-threatening:

• gastrointestinal obstruction

Docusate Calcium/Docusate Sodium

Side effects include:

• bitter taste in the mouth
• irritated throat
• nausea
• cramps
• diarrhea
• loss of appetite
• rash

Lactulose

Common side effects include:

• nausea
• vomiting
• loss of appetite
• abdominal cramping
• bloating
• belching
• diarrhea

Psyllium

Common side effects include:

• nausea
• vomiting
• loss of appetite
• diarrhea

Less common side effects include:

• abdominal cramping
• blockage of the esophagus or intestine

Senna/Senokot

Common side effects include:

• nausea
• vomiting
• loss of appetite
• abdominal cramping

Less common side effects include:

• diarrhea
• gas
• urine that is pink-red or brown-black in color
• abnormal electrolyte levels

Life-threatening:

• Severe muscle spasms (tetany)

Interactions

Laxatives may interact with other drugs. Sometimes, the laxative can interfere with proper absorption of another drug. A patient must notify their doctor or pharmacist if he or she is already taking any medications so that the proper laxative can be selected or prescribed. Specific drug interactions are:

• Bisacodyl: Antacids, H2-blockers, and some herbal remedies (lily of the valley, pheasant's eye, squill).
• Calcium polycarbophil: (lowers the absorption of) tetracycline.
• Docusate calcium/docusate sodium: Unknown.
• Lactulose: Neomycin and other laxatives.
• Psyllium: Cardiac glycosides, oral anticoagulants, and salicylates.
• Senna/senokot: Disulfiram should never be taken with this drug. Also, senna/senokot lowers the absorption of other drugs taken by mouth.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Diarrhea and Constipation." Section 3, Chapter 27 in The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Karch, A. M. Lippincott's Nursing Drug Guide. Springhouse, PA: Lippincott Williams & Wilkins, 2003.

Periodicals

DiPalma, J. A. "Current Treatment Options for Chronic Constipation." Reviews in Gastroenterological Disorders 4, Supplement 2 (2004): S34–S42.

Newton, G. D., W. S. Pray, and N. G. Popovich. "New OTC Drugs and Devices 2003: A Selective Review." Journal of the American Pharmaceutical Association 44 (March-April 2004): 211–225.

"Position Paper: Cathartics." Journal of Toxicology: Clinical Toxicology 42 (March 2004): 243–253.

Schiller, L. R. "New and Emerging Treatment Options for Chronic Constipation." Reviews in Gastroenterological Disorders 4, Supplement 2 (2004): S43–S51.

Talley, N. J. "Management of Chronic Constipation." Reviews in Gastroenterological Disorders 4 (Winter 2004): 18–24.

Organizations

American Society of Health-System Pharmacists (ASHP). 7272 Wisconsin Avenue, Bethesda, MD 20814. (301) 657–3000. .

National Digestive Diseases Information Clearinghouse. 2 Information Way, Bethesda, MD 20892-3570. nddic@aerie.com. .

United States Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857-0001. (888) INFO-FDA. .

—Rhonda Cloos, R.N.; Rebecca J. Frey, Ph.D.

a substance that helps the expulsion of food residues from the body. If strongly laxative it is termed purgative or cathartic. Dietary fibre and cellulose function because they retain water and add bulk to the contents of the intestine; Epsom salts (magnesium sulphate) also retain water; castor oil and drugs such as aloes, senna, cascara, and phenolphthalein irritate the intestinal mucosa. Undigested carbohydrates such as lactulose and sugar alcohols are also laxatives.

A substance that increases the frequency of bowel movements. It may also be used to encourage the formation of a softer or bulkier stool. Common laxatives include castor oil, senna (and its derivatives), magnesium sulphate, and some bulking agents (e.g. bran and methyl cellulose). Some common laxatives, such as castor oil and senna, irritate the gut lining and can cause severe cramps. They are sometimes used by people trying to lose weight but they can result in dehydration and malabsorption of nutrients, leading to nutrient deficiencies. Most experts agree that taking such laxatives is a dangerous and ineffective way to lose weight.

Definition

Laxatives are products that promote bowel movements.

Description

Laxatives may be grouped by mechanism of action.

Saline cathartics include dibasic sodium phosphate (Phospo-Soda), magnesium citrate, magnesium hydroxide (milk of magnesia), magnesium sulfate (Epsom salts), sodium biphosphate, and others. They act by attracting and holding water in the intestinal lumen, and may produce a watery stool. Magnesium sulfate is the most potent of the laxatives in this group.

Stimulant and irritant laxatives increase the peristaltic movement of the intestine. Examples include cascara and bisadocyl (Dulcolax). Castor oil works in a similar fashion.

Bulk producing laxatives increase the volume of the stool, and will both soften the stool and stimulate intestinal motility. Psyillium (Metamucil, Konsil) and methylcellulose (Citrucel) are examples of this type. The overall effect is similar to that of eating high-fiber foods, and this class of laxative is most suitable for regular use.

Docusate (Colace) is the only representative example of the stool softener class. It holds water within the fecal mass, providing a larger, softer stool. Docusate has no effect on acute constipation, since it must be present before the fecal mass forms to have any effect, but may be useful for prevention of constipation in patients with recurrent problems, or those who are about to take a constipating drug, such as narcotic analgesics.

Mineral oil is an emollient laxative. It acts by retarding intestinal absorption of fecal water, thereby softening the stool.

The hyperosmotic laxatives are glycerin and lactulose (Chronulac, Duphalac), both of which act by holding water within the intestine. Lactulose may also increase peristaltic action of the intestine.

General Use

Laxatives are used to treat constipation—the passage of small amounts of hard, dry stools, usually fewer than three times a week. Constipation may be caused by several conditions, some of which are potentially serious, and require medical attention:

• Neurologic—caused by failure of nerves to stimulate movement of the muscles of the intestines.
• Obstructive—failure of the muscles in the intestine to open, or presence of a mass that's blocking passage of the feces through the intestine.
• Endocrine/metabolic—caused by some diseases including hypothyroidism.
• Medicinal—caused by some drugs, including narcotic analgesics, iron, and some drugs used in cancer treatment.

Chronic constipation occurs in 1–4% of children between the ages of four and 10. If constipation continues, it should be treated by a physician.

A reasonable first step is to assure that there is enough fiber in the diet. This may be done by switching to a high fiber breakfast cereal. If this doesn't lead to improvement, then medical attention is necessary.

Precautions

Short term use of laxatives is generally safe except in appendicitis, fecal impaction, or intestinal obstruction. Lactulose is composed of two sugar molecules; galactose and fructose, and should not be administered to patients who require a low galactose diet.

Chronic use of laxatives may result in fluid and electrolyte imbalances, steatorrhea, osteomalacia, diarrhea, cathartic colon, and liver disease. Excessive intake of mineral oil may cause impaired absorption of oil soluble vitamins, particularly A and D. Excessive use of magnesium salts may cause hypermanesemia.

Side Effects

Excessive use of laxatives may result in dependency on these products. This may cause a condition known as cathartic colon.

Excessive use of laxatives that contain sodium or magnesium may result in dangerously high blood levels of these elements.

Interactions

Mineral oil and docusate should not be used in combination. Docusate is an emulsifying agent which will increase the absorption of mineral oil.

Bisacodyl tablets are enteric coated, and so should not be used in combination with antacids. The antacids will cause premature rupture of the enteric coating.

Preventing Side Effects

Used properly, laxatives are very safe. Do not overuse or give in doses larger than those labeled. If constipation persists, obtain medical help.

Parental Concerns

Laxatives should not be used too frequently. Bulk laxatives such as psyllium should be the normal first choice.

Mineral oil should not be given to infants or other children while laying down. This may result in the oil going into the lungs.

Resources

Books

Beers, Mark H. and Robert Berkow, eds. The Merck Manual of Diagnosis and Therapy, 17th ed. Whitehouse Station, NJ: Merck and Company, Inc., 1999.

McAvoy, G., Miller J., Litvak K. AHFS Drug Information 2004. Amer. Soc Healthsys. Pharm, Bethesda 2004.

Siberry G.K., Iannone R. The Harriet Lane Handbook 15th ed. Mosby Publishing, Philadelphia, 2000.

Periodicals

Bell, EA, Wall, GC. "Pediatric constipation therapy using guidelines and polyethylene glycol 3350." Ann Pharmacother. 2004 Apr;38(4):686-93.

"Constipation, Laxatives and Dietary Fiber." HealthTips (April 1993): 9.

Griffin, GC, Roberts, SD, Graham, G. "How to resolve stool retention in a child. Underwear soiling is not a behavior problem." Postgrad Med 1999 Jan;105(1):159-61, 165-6, 172-3.

"Overuse Hazardous: Laxatives Rarely Needed." (Includes related article on types of laxatives.) FDA Consumer (April 1991): 33.

Patel, H, Law, A, Gouin, S. "Predictive factors for short-term symptom persistence in children after emergency department evaluation for constipation." Arch Pediatr Adolesc Med. 2000 Dec;154(12):1204-8.

Organizations

American Academy of Family Physicians 11400 Tomahawk Creek Parkway Leawood, KS 66211-2672.

Web Sites

Constipation in Infants and Children: Evaluation and Treatment. American Academy of Pediatrics. (accessed February 15, 2005).

Section on Gastroenterology and Nutrition (SOGN). American Academy of Pediatrics. (accessed February 15, 2005).

[Article by: Samuel Uretsky, PharmD]

A medicine that loosens the bowel contents and encourages evacuation. A laxative with a mild or gentle effect on the bowels is also known as an aperient; one with a strong effect is referred to as a cathartic or a purgative.

• bulk l. — hydrophilic, indigestible substances that absorb water and swell to form an emollient gel. The distention of the intestine stimulates defecation.
• contact l. — see stimulant laxative (below).
• emollient l. — the fecal softeners; act without being changed and simply aid expulsion by softening and lubricating. Called also lubricant laxative.
• lubricant l. — see emollient laxative (above).
• stimulant l. — stimulate accumulation of water and electrolytes in the colon, increasing intestinal motility. Called also contact laxative.

• PHARMACOLOGY - laxative: substance that stimulates bowel evacuation; cathartic; purgative

Laxatives (purgatives, aperients) are foods, compounds, or drugs taken to loosen the stool, most often taken to treat constipation. Certain stimulant, lubricant, and saline laxatives are used to evacuate the colon for rectal and/or bowel examinations, and may be supplemented by enemas under certain circumstances. Sufficiently high doses of laxatives may cause explosive diarrhea. Laxatives work to increase the movement of feces along the colon.^[1]

Some laxatives combine more than one active ingredient. Laxatives may be oral or in suppository form.

Contents 1 Foods 2 Bulk-producing agents 3 Stool softeners 4 Lubricants or emollient 5 Hydrating agents (osmotics) 5.1 Saline 5.2 Hyperosmotic agents 5.2.1 Effectiveness 6 Stimulant or irritant 7 Serotonin agonist 8 Uses 9 Problems with use 9.1 Laxative abuse 9.2 Laxative gut 9.3 Eating disorders 10 See also 11 References 12 External links

Foods

This unreferenced section requires citations to ensure verifiability.

Some foods can be eaten to cure constipation and act as laxatives, although the effectiveness may vary. These include:

• Almonds
• Aloe vera
• Apple juice
• Apricots
• Basil
• Beets
• Cactus fruit
• Carob
• Capsicum
• Celery
• Chicory
• Chewing Gum
• Coconut
• Coffee
• Dandelion
• Dates
• Endive
• Fenugreek
• Flaxseed
• Grapes
• Guava (with seeds for full effect)
• Jujube
• Kale
• Kiwifruit^[2]
• Liquorice
• Mango
• Mint
• Molasses
• Olive oil
• Orange
• Papaya
• Parsley
• Peach
• Pear
• Persimmon
• Pineapple
• Plum
• Prune and prune juice (due to the presence of neochlorogenic and chlorogenic acids or sorbitol)^[3]
• Rhubarb
• Senna
• Soybean
• Tamarind
• Tea
• Tomato juice
• Vanilla
• Walnut
• Watercress
• Yam

Bulk-producing agents

• Site of Action: Small and large intestine
• Onset of Action: 12–72 hours
• Examples: Bran, Gamkaraya, Sterculia[Normacol], psyllium husk (Metamucil), methylcellulose (Citrucel), polycarbophil, dietary fibre, apples, broccoli, prunes.

Also known as bulking agents or roughage, these include dietary fibre. Bulk-producing agents cause the stool to be bulkier and to retain more water, as well as forming an emollient gel, making it easier for peristaltic action to move it along. They should be taken with plenty of water. Bulk-producing agents have the gentlest of effects among laxatives and can be taken just for maintaining regular bowel movements.

Stool softeners

• Site of Action: Small and large intestine
• Onset of Action: 12–72 hours
• Examples: docusate (Colace, Diocto), Gibs-Eze

These enable additional water and fats to be incorporated in the stool, making it easier to move.

Lubricants or emollient

• Site of Action: Colon
• Onset of Action: 6–8 hours

These simply make the stool slippery, so that it slides through the intestine more easily. An example is mineral oil, which also retards colonic absorption of water, softening the stool. Mineral oil may decrease the absorption of fat-soluble vitamins and some minerals.

Hydrating agents (osmotics)

These cause the intestines to hold more water within, softening the stool. There are two principal types, saline and hyperosmotic.

Saline

• Site of Action: Small and large intestine
• Onset of Action: 0.5–6 hours
• Examples: sodium phosphate (and variants), potassium sodium tartrarate, magnesium citrate, magnesium hydroxide (Milk of magnesia or Cream of magnesia), magnesium sulfate (which is Epsom salt).

Saline laxatives attract and retain water in the intestinal lumen, increasing intraluminal pressure and thus softening the stool. They also cause the release of cholecystokinin, which stimulates the digestion of fat and protein. Saline laxatives may alter a patient's fluid and electrolyte balance.

Hyperosmotic agents

• Site of Action: Colon
• Onset of Action: 0.5–3 hours
• Examples: Glycerin suppositories, sorbitol, lactulose, and polyethylene glycol (PEG).

Lactulose works by the osmotic effect, which retains water in the colon, lowering the pH through bacterial fermentation to lactic, formic and acetic acid, and increasing colonic peristalsis. Lactulose is also indicated in Portal-systemic encephalopathy. Glycerin suppositories work mostly by hyperosmotic action, but also the sodium stearate in the preparation causes local irritation to the colon.

Solutions of polyethylene glycol and electrolytes (sodium chloride, sodium bicarbonate, potassium chloride, and sometimes sodium sulfate) are used for whole bowel irrigation, a process designed to prepare the bowel for surgery or colonoscopy and to treat certain types of poisoning. Brand names for these solutions include GoLytely, GlycoLax, CoLyte, Miralax, NuLytely, SUPREP, Fortrans and others.

Effectiveness

For adults, a randomized controlled trial found PEG [MiraLax or GlycoLax] 17 grams once per day to be superior to tegaserod at 6 mg twice per day.^[4] A randomized controlled trial found greater improvement from 2 sachets (26 grams) of PEG versus 2 sachets (20 grams) of lactulose.^[5] 17 grams/day of PEG has been effective and safe in a randomized controlled trial for six months.^[6] Another randomized controlled trial found no difference between sorbitol and lactulose.^[7]

For children, PEG was found to be more effective than lactulose.^[8]

Stimulant or irritant

Stimulant laxatives act on the intestinal mucosa or nerve plexus, altering water and electrolyte secretion. They also stimulate peristaltic action and can be dangerous under certain circumstances.^[9] They are the most severe among laxatives and should be used with care.

Common Stimulant Laxatives^[10][11]

Preparation(s)	Type	Site of Action	Onset of
Cascara (casanthranol)	Anthraquinone	colon	36–8 hours
Buckthorn	Anthraquinone	colon	36–8 hours
Senna extract (senokot)	Anthraquinone	colon	36–8 hours
Aloe vera (aloin)	Anthraquinone	colon	58–10 hours
Phenolphthalein	Triphenylmethane	colon	48 hours
Dulcolax (bisacodyl) (PO)	Triphenylmethane	colon	66–12 hours
Dulcolax (bisacodyl) (suppository)	Triphenylmethane	colon	160 minutes
Microlax	enema	rectum and colon	015–60 minutes
Castor Oil	ricinoleic acid	small intestine	22–6 hours

Serotonin agonist

Tegaserod is a motility stimulant that works through activation of 5-HT₄ receptors of the enteric nervous system in the gastrointestinal tract. However caution must be taken due to potentially harmful cardiovascular side-effects.

Zelnorm (market name for Tegaserod) was discontinued from marketing in the United States on March 30, 2007^[12] but is still available for prescription under tight controls.

Uses

• Bowel preparation
• Chronic constipation
• Chronic immobility

Problems with use

Laxative abuse

Laxative abuse is potentially serious since it can lead to intestinal paralysis,^{[citation needed]} irritable bowel syndrome (IBS),^[13] pancreatitis,^{[citation needed]} renal failure,^[14][15] and other problems, even though recovery is possible with proper treatment.

Laxative gut

Physicians warn against the chronic use of stimulant laxatives due to concern that chronic use causes the colonic tissues to get worn out over time and not be able to expel feces due to long term overstimulation. A common finding in patients who have used stimulant laxatives is a brown pigment deposited in the intestinal tissue, known as melanosis coli.

Eating disorders

Laxatives are often used by people with an eating disorder. In cases of bulimia nervosa the patient abuses laxatives to get rid of calories, to purge food in the intestines before it becomes digested and absorbed by the body. This will not work, because laxatives hasten the elimination of undigested remains of food in the large intestine and colon. The large intestine and colon do not digest food. They just collect the undigested remains and hold it and absorb water until it is defaecated. Weight loss may be felt, but this is only temporary due to the fact that the person has expelled much of the fluids from their body. The common question of whether or not chronic diarrhea associated with laxative use can promote some degree of true weight loss remains unknown. In any case, this type of laxative misuse causes water to be lost more rapidly than is healthy, potentially leading to dehydration and electrolyte imbalance. Prolonged usage of laxatives will actually cause constipation. The sensation of bloating can be significant due to excessive water retention, leading to people with eating disorders to increase the dosage of the laxatives, resulting in dependency and further complicating the constipation.^{[original research?]} Abusing stimulant-type laxatives can lead to permanent impairment of the bowels, and the constipation problem becomes irreversible. In addition, blood can develop in stools, and excessive blood loss can result in anemia. Patients recovering from laxative abuse often have several months of problematic water retention, resulting in temporary weight gain (not noticeable on the exterior), and sometimes "pitting" edema (in which pressing on the skin leaves an indentation).^{[citation needed]}

See also

• ATC code A06
• Cathartic

References

1. ^ http://www.articlesbase.com/supplements-and-vitamins-articles/what-is-a-laxative-and-do-natural-laxatives-work-404326.html
2. ^ Rush EC, Patel M, Plank LD, Fergus LR (2002). "Kiwifruit promotes laxation in the elderly.". Asia Pac J Clin Nutr 11 (2): 164–8. doi:10.1046/j.1440-6047.2002.00287.x. PMID 12074185. 
3. ^ Stacewicz-Sapuntzakis, M; Bowen, PE; Hussain, EA; Damayanti-Wood, BI; Farnsworth, NR (2001). "Chemical composition and potential health effects of prunes: a functional food?". Critical reviews in food science and nutrition 41 (4): 251–86. doi:10.1080/20014091091814. PMID 11401245. 
4. ^ Di Palma JA, Cleveland MV, McGowan J, Herrera JL (2007). "A randomized, multicenter comparison of polyethylene glycol laxative and tegaserod in treatment of patients with chronic constipation". Am. J. Gastroenterol. 102 (9): 1964–71. doi:10.1111/j.1572-0241.2007.01365.x. PMID 17573794. 
5. ^ Attar A, Lémann M, Ferguson A, Halphen M, Boutron M, Flourié B, Alix E, Salmeron M, Guillemot F, Chaussade S, Ménard A, Moreau J, Naudin G, Barthet M (1999). "Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation". Gut 44 (2): 226–30. doi:10.1136/gut.44.2.226. . PMID 9895382. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1727381. 
6. ^ Dipalma JA, Cleveland MV, McGowan J, Herrera JL (2007). "A randomized, multicenter, placebo-controlled trial of polyethylene glycol laxative for chronic treatment of chronic constipation". Am. J. Gastroenterol. 102 (7): 1436–41. doi:10.1111/j.1572-0241.2007.01199.x. PMID 17403074. 
7. ^ Lederle F, Busch D, Mattox K, West M, Aske D (1990). "Cost-effective treatment of constipation in the elderly: a randomized double-blind comparison of sorbitol and lactulose". Am J Med 89 (5): 597–601. doi:10.1016/0002-9343(90)90177-F. PMID 2122724. 
8. ^ "BestBETs: Is polyethylene glycol safe and effective for chro...". http://www.bestbets.org/cgi-bin/bets.pl?record=00901. Retrieved 2007-09-06. 
9. ^ Joo J, Ehrenpreis E, Gonzalez L, Kaye M, Breno S, Wexner S, Zaitman D, Secrest K (1998). "Alterations in colonic anatomy induced by chronic stimulant laxatives: the cathartic colon revisited". J Clin Gastroenterol 26 (4): 283–6. doi:10.1097/00004836-199806000-00014. PMID 9649012. 
10. ^ Dharmananda, Subhuti. "SAFETY ISSUES AFFECTING HERBS: How Long can Stimulant Laxatives be Used?". Institute for Traditional Medicine. http://www.itmonline.org/arts/laxatives.htm. Retrieved 2010-03-19. 
11. ^ "Stimulant Laxatives". Family Practice Notebook, LLC. 2010-02-26. http://www.fpnotebook.com/GI/Pharm/StmlntLxtv.htm. Retrieved 2010-03-19. 
12. ^ FDA Announces Discontinued Marketing of GI Drug, Zelnorm, for Safety Reasons
13. ^ "Laxative Abuse: Some Basic Facts" (PDF). National Eating Disorders Association. 2005. http://www.nationaleatingdisorders.org/nedaDir/files/documents/handouts/Laxative.pdf. Retrieved 2008-09-07. 
14. ^ Copeland P; Molina, H.; Ohye, Ch.; MacIas, R.; Alaminos, A.; Alvarez, L.; Teijeiro, J.; Muñoz, J. et al (1994). "Renal failure associated with laxative abuse". Psychother Psychosom 62 (3–4): 200–2. doi:10.1159/000098619. PMID 7531354. 
15. ^ Wright L, DuVal J (1987). "Renal injury associated with laxative abuse". South Med J 80 (10): 1304–6. doi:10.1097/00007611-198710000-00024. PMID 3660046. 

External links

Wikimedia Commons has media related to: Laxatives

• Laxative overdose – MedlinePlus.
• [1]
• Senna tea benefits, problems as a laxative.
• [2] bulk-forming agents.

v t e Pharmacology: major drug groups Gastrointestinal tract/metabolism (A) stomach acid (Antacids, H2 antagonists, Proton pump inhibitors) Antiemetics Laxatives Antidiarrhoeals/Antipropulsives Anti-obesity drugs Anti-diabetics Vitamins Dietary minerals Blood and blood forming organs (B) Antithrombotics (Antiplatelets, Anticoagulants, Thrombolytics/fibrinolytics) Antihemorrhagics (Platelets, Coagulants, Antifibrinolytics) Cardiovascular system (C) cardiac therapy/antianginals (Cardiac glycosides, Antiarrhythmics, Cardiac stimulants) Antihypertensives Diuretics Vasodilators Beta blockers Calcium channel blockers renin-angiotensin system (ACE inhibitors, Angiotensin II receptor antagonists, Renin inhibitors) Antihyperlipidemics (Statins, Fibrates, Bile acid sequestrants) Skin (D) Emollients Cicatrizants Antipruritics Antipsoriatics Medicated dressings Genitourinary system (G) Hormonal contraception Fertility agents SERMs Sex hormones Endocrine system (H) Hypothalamic-pituitary hormones Corticosteroids (Glucocorticoids, Mineralocorticoids) Sex hormones Thyroid hormones/Antithyroid agents Infections and infestations (J, P, QI) Antimicrobials: Antibacterials (Antimycobacterials) Antifungals Antivirals Antiparasitics (Antiprotozoals, Anthelmintics, Ectoparasiticides) IVIG Vaccines Malignant disease (L01-L02) Anticancer agents (Antimetabolites, Alkylating, Spindle poisons, Antineoplastic, Topoisomerase inhibitors) Immune disease (L03-L04) Immunomodulators (Immunostimulants, Immunosuppressants) Muscles, bones, and joints (M) Anabolic steroids Anti-inflammatories (NSAIDs) Antirheumatics Corticosteroids Muscle relaxants Bisphosphonates Brain and nervous system (N) Analgesics Anesthetics (General, Local) Anorectics Anti-ADHD Agents Antiaddictives Anticonvulsants Antidementia Agents Antidepressants Antimigraine Agents Antiparkinson's Agents Antipsychotics Anxiolytics Depressants Entactogens Entheogens Euphoriants Hallucinogens (Psychedelics, Dissociatives, Deliriants) Hypnotics/Sedatives Mood Stabilizers Neuroprotectives Nootropics Neurotoxins Orexigenics Serenics Stimulants Wakefulness-Promoting Agents Respiratory system (R) Decongestants Bronchodilators Cough medicines H1 antagonists Sensory organs (S) Ophthalmologicals Otologicals Other ATC (V) Antidotes Contrast media Radiopharmaceuticals Dressings

v t e Laxatives and cathartics (A06) Softeners, emollients Liquid paraffin Docusate sodium Contact laxatives Oxyphenisatine Bisacodyl Dantron Phenolphthalein Castor oil Senna glycosides Cascara Sodium picosulfate Bisoxatin Bulk producers Ispaghula Ethulose Sterculia Linseed Methylcellulose Triticum Polycarbophil calcium Osmotically acting laxatives Magnesium carbonate Magnesium hydroxide Magnesium oxide Magnesium peroxide Magnesium sulfate Lactulose Lactitol Sodium sulfate Pentaerythritol Macrogol Mannitol Sodium phosphate Sorbitol Magnesium citrate Sodium tartrate Laminarid Polyethylene glycol; Enemas Sodium laurilsulfate Sodium phosphate Bisacodyl Dantron Glycerol Oil Sorbitol Peripheral opioid antagonists Alvimopan Methylnaltrexone Prostaglandins Lubiprostone Other Linaclotide M: DIG anat(t, g, p)/phys/devp/enzy noco/cong/tumr, sysi/epon proc, drug(A2A/2B/3/4/5/6/7/14/16), blte

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Dansk (Danish)
adj. - afførende
n. - afførende middel, laksativ

Nederlands (Dutch)
laxatief, laxerend, laxeermiddel

Français (French)
adj. - laxatif
n. - laxatif

Deutsch (German)
n. - Abführmittel
adj. - abführend

Ελληνική (Greek)
n. - καθαρτικό, υπακτικό, καθάρσιο
adj. - υπακτικός, καθαρτικός

Italiano (Italian)
purgante

Português (Portuguese)
n. - laxante (m)
adj. - laxativo

Русский (Russian)
слабительное средство, слабительный

Español (Spanish)
adj. - laxante, purgante
n. - laxante, purgante

Svenska (Swedish)
n. - laxermedel
adj. - (läk.) lösande, avförande, laxer-

中文（简体）(Chinese (Simplified))
通便的, 不简洁的, 泻药, 缓泻药

中文（繁體）(Chinese (Traditional))
adj. - 通便的, 不簡潔的
n. - 瀉藥, 緩瀉藥

한국어 (Korean)
adj. - 완화제의, 대변을 나오게 하는
n. - 완화제 , 하제

日本語 (Japanese)
n. - 下剤, 通じ薬
adj. - 通じを付ける

العربيه (Arabic)
‏(الاسم) مسهل, ملين, فالت, جامح بمعنى غير مكبوح للألسنه (صفه) مسهل, ملين‏

עברית (Hebrew)
adj. - ‮גורם לשלשול‬
n. - ‮(חומר) משלשל‬

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