- Medically reviewed by: Horia Marculescu, MD
- Photo credits: Licenses / Author
- Last updated: 27.07.2021
Laxatives are substances that help the evacuation of the intestinal matter by stimulating the intestinal motility. They are used as very effective constipation medicine both in severe and light constipation and also in chronic constipation, due to the slow intestinal transit.
There are a few types of laxatives depending on the action mechanism and the overall effect over our intestines:
Volume laxatives (which expand the fecal matter)
These include foods based on wheat bran or products similar to Citrucel, Metamucil or Perdiem, that contain methocel or psyllium (an insoluble fiber that has the property to fix a large quantity of water).
Defecation reflexes are being stimulated by the increased fecal bowl. This type of constipation medicine is indicated in the long-term treatment of constipation because it increases the number of ejections and has no side effects.
Emollient laxatives (stool softeners)
Such as Sodium Decusate that stimulates sodium and water secretion towards the intestines, producing lubrication and soaking of the bowl.
This type of laxatives don`t pose risks, but, they are less effective if there isn`t enough daily fluids consumption.
Osmotic laxatives (intestinal water diffusion)
Products such as sodium phosphate, non-absorbable Magnesium or non-absorbable disaccharides (Sorbitol, Lactulose) have a rapid effect, keep liquids in the intestinal lumen, pushing in the fluid flow from the blood vessels and the nearby tissues, creating aqueous fecal matter.
It is recommended that the daily intake of fluids should be increased when using this type of constipation medicine.
People who suffer renal affections, high blood pressure or are undergoing a non-salted regime should avoid using this type of laxatives.
Stimulant laxatives (peristalsis stimulants)
Are contact laxatives that induce the accentuation of peristalsis by stimulating the nerve endings in the mucous membrane of the colon.
Are laxative types such as polyphenolic / diaphenylmethane compounds (Bisacodyl) or anthranoid derivate (Senna).
Are very efficient constipation medicine used for short-term treatments, especially for episodic constipation (that occur occasionally) and are not recommended for routine use.
Abusive use of stimulant laxatives reduces the tonus of the large intestine muscles and causes addiction, requiring the permanent administration to maintain the peristalsis process (not only during periods of constipation).
How to use laxatives?
The typical dosage of laxatives is 1-2 tablets a day, preferably in the evening, before going to sleep, in order to obtain a semi-liquid ejection during next morning. The recommended duration of laxative administration is a maximum of 7 days in order to avoid addictive or habitual phenomena. The administration of this type of medicine can resume a one-week break.
Precautions when using laxatives
These types of constipation medicine will be used with large amounts of water or other liquids. Please do not abuse the use of laxatives in any way. For long-term treatment of constipation, the use of laxatives that increase the volume of feces (tars or Metamucil) is recommended. The long-term use of stimulating laxatives interferes with the absorption of vitamin D and Calcium, therefore producing osteopenia (bones mass reduction) and also dehydration.
- Modifying a few wrong habits in our diet and lifestyle are required when using laxatives, such as:
- Increase fluid consumption;
- Increase consumption of dietary fiber from fruits and vegetables (eaten gradually);
- Eliminating sedentary habits (practicing sports and planning long walks as often as possible);
Pancreatic enzymes stimulants
Pancreatic enzymes such as lipase, amylase or protease that form pancreatin, are usually found in digestive stimulating tablets. These tablets are very effective constipation medicine because they have an immediate effect on the entire digestion process.
Pancreatic enzymes are useful for people whose pancreas cannot produce sufficient enzymes anymore, for the digestion of the food eaten.
Tablets with pancreatic enzymes help the decomposition process of the nutrients in order to have a proper absorption. Lipase decomposes fats, amylase decomposes carbohydrates (sugary foods, flour, starch, fructose, and glucose) and protease determines the decomposition of the proteins, ensuring proper digestion and the optimal absorption of nutrients.
Digestive stimulating tablets are used when suffering from digestive disorders, due to the lack of sufficient pancreatic enzyme secretion of various causes (example: insufficient exocrine pancreatitis).
How to use pancreatic enzyme stimulants?
Usually, pancreatic enzyme stimulants are found in the form of small tablets. For adults that suffer from episodic or severe constipation, the standard dosage this type of medicine for constipation is 1-2 tablets, taken 3 times a day during meals.
The tablets have to be swallowed in their original size with a small quantity of water, enough to find their way towards the intestines. On the other hand, depending on the type of constipation you are suffering from, you need to discuss with your doctor or pharmacist the daily dosage and eventually, the overall progress.
Hepatic bile secretion stimulants
The primary role of the bile is to indirectly intervene in the digestion and the absorption process of fats, by emulsifying them and activating the pancreatic lipase (a pancreas secreted enzyme – with strong lipolytic action). During the absorption of fats, a few fat-soluble vitamins are absorbed: A, D, E and K.
Also, in the same process, cholesterol and iron are also absorbed. The bile favorizes intestinal peristalsis (which can have a laxative effect) and neutralizes the acidity of the gastric juice when it reaches the intestine.
The bile is continuously secreted by the liver but is only eliminated during the digestive process stages.
There are many causes that influence its slow secretion. Combined with stimulants, it makes it a very good constipation medicine both for long-term treatment and short immediate relief.
It is a liquid which color and composition differ depending on the place it is found – in the liver or in the gallbladder. Usually, the hepatic bile is golden yellow and has a clear texture. The PH is alkaline, between 8 - 8.5. The vesicular bile is brown-green, has a troubled texture and its PH is 7 – 7.5. In the vesicular bile, water is absorbed and the bile can concentrate between 8 – 10 times.
The bile is composed out of bile salts, bile pigments, cholesterol, lecithin, mucin and fatty acids. There are also found: Sodium chlorides (NA), Potassium chlorides (K) and Calcium chlorides (Ca). In fact, the bile can`t be considered a digestive juice because it does not contain any digestive enzymes.
Bile salts – act similar to detergent, that is, they lower the superficial tension of the big particles (of fat) and favorizes their fraction for the emulsification process. Another role that bile salts have, is to transport the fatty acids from the interior of the lumen towards the intestinal wall, where they will be absorbed.
Bile pigments – bilirubin and biliverdin (produced by destruction of the red blood cells) are excreted through the bile. After being eliminated, they end up in the intestine and are transformed into urobilinogen (which give the color of the urine) and stercobilinogen (which gives the color of the feces matter)
Cholesterol – is found in free form in the bile. It comes from both food and hepatic synthesis. After it reaches the intestine, the cholesterol is re-absorbed or eliminated through the feces.
How to use bile secretion stimulants?
This type of constipation medicine is usually found in the form of tablets the need to be swallowed with a small quantity of water. For adults, the standard dosage is 1-3 tablets taken 2-3 times a day. For children over 7 years old, the standard dosage is 1 tablet, taken 2-3 times a day.
The typical duration of a treatment with stimulants under the form of tablets is 2-3 weeks.
ABOUT THE AUTHOR
My name is Sebastian D., and I am the senior editor of constipationguide.com. With the help of my mentor, Dr. Horia Marculescu, I decided to create a practical guide to constipation relief.. read more